Wednesday, 17 November 2010

A patient patient

It could be YOU
It probably will be, eventually

A couple of evenings ago I had an email 'conversation' with a long-established and well-respected correspondent who had dropped me a line to recommend an article published on line, a research review on family-centred therapy.  In response, I expressed my long-standing concern about professionals' extolling 'collaboration' with parents and other client groups and the (to me) spine-chilling concept of 'partnership'.

My objection is that ownership of the given problems does not lie with the professionals in the first place, so it is not for them to dispense a share of this, whether through collaboration or partnership. The use of such words implies that they have indeed appropriated ownership, though they like to deploy the smoke-screen that they regard it 'good practice' to share in some way, in collaboration or in partnership.

In what other walk of life would you have something taken off you, then to applaud being granted some supposed say in its future use?

I do not regard any branch of bureau-professionalism to be particularly guilty in this respect, having seen the crocodile smiles well exercised and flourishing away at close hand over the last thirty-odd years, in child-care, education and health. Nor from what I hear is this circumstance unique to the United Kingdom.


That was two evenings ago. Yesterday I went to my local hospital for an out-patient appointment. Nothing serious, worse things happen at sea – nothing immediately so anyway, though I did not know that till the end of my appointment.

Nice hospital. Modern buildings, well maintained. Cheery and welcoming atmosphere. Staff universally courteous, smiling and helpful, though they come from the ends of the Earth to tend our increasingly ageing population. A couple of longish waits between stages in the process but it was warm and cosy there and I was free to do what I always do in such circumstances, nod off. So no problem there – and, given the numbers being processes over the course of the day in this large and busy out-patients' department, no grounds for complaint either.

Amazing technology. Brilliant computer graphics and all sorts of other gizmos. Cracking good pharmaceuticals. All state-of-the art stuff, readily and plentifully to hand. No fears that my specific problem was not being investigated from from the heights of present-day knowledge.

Nice people, and intelligent too. With extensive (and expensive) systems of training behind them. This all shows. You cannot say all this for large swathes of the public services (including less esteemed parts of the health service) but here I was under a branch of surgery, high-status and justifiably respected, top of the tree.

So everything was all right, then...? Well, no, not really.

At one level, everything went swimmingly. My problem had the attention and the genuine interest of a senior specialist nurse, a registrar and a consultant, plus a trainee something-or-other, I know not what as she was not introduced. In fact none of them was introduced to me, either by themselves or by each other. Nor was I introduced to them. I worked out who they were from their name tabs, from what was written on the door, and from what I know about how the system works. I myself presumably needed no introduction, as within only a couple of visits my case has already accrued a fat paper file and I am in the computer too (odd duplication, that).

Anyway, it did not seem important to their processes and their work to know who I am.

And very interesting their work was, to watch and listen to. They had a difficult intellectual judgement to make, whether there is something wrong with me or not, a pathological process requiring intervention of some kind or whether I am just getting old. The computer certainly had it down as the former and the lower-order staff appeared governed by this

This work was intensive as well as intellectual. Their working day was already drawing to a close, they were running late and there was a corridor of patients still waiting to be finished . The exceedingly pretty young registrar (she looked about seventeen, and dreadfully bright) was not really on my case. She had rushed in to ask the easy-going consultant something about the case that she was dealing with down the corridor, but she lingered then came back because there really was a difficult and interesting technical judgement being made here. I did not mind, not only because she was so lovely but because I recognised that she has her training needs too, and meeting these extended and raised the level of the technical conversation about my problem.

Very interesting it was too, just to sit there where I had been left on my own in a funny chair in a corner of the room. I rather enjoyed it. And when all had been made clear, and the ladies all understood the basis for the judgement being made, the consultant could turn his attention to signing a bunch of end-of-day papers that someone had brought in for his attention part-way through this. Then he suddenly remembered one small detail not yet dealt with. Me.

He looked up and they all followed his glance. 'Did you understand all that?' he asked me in a pleasant manner, the first words that he had addressed to me.

'It means that it is within the range of normal variation?' I asked back.


'So I don't need any treatment?'

'Of course not'. Then he added 'We'll review in six months,' and went back to his papers.

My further presence seemed redundant so, like they used to write in the News of the World, your reporter made his excuses and left them to get on with their work.

Their work. Not mine. I had no ownership of it.


What do I make of any of this? Not a lot. I am reminded of my powerful suspicions about the workings of established institutions and about the class interests and actual motives of the professional (and semi-professional) classes that work for them. I find  this orientation explanatory and reassuring. I also find that I am no longer thinking of Milton (the poet, not the mild disinfectant) and am truly grateful to the health service for assuaging this anxiety – without enquiring too closely about where and how the question was ever raised in the first place. Anyway, no great harm was done along the way, and I enjoyed a leisurely and interesting bit of participative observation, a single-case study of personal alienation within high-tech, managed health care.

Along the way I had the satisfaction of having some preconceptions confirmed, to my own satisfaction, so I can continue to look askance at any suggestion that such systems, in health or anywhere else, can regard the client, the patient, the citizen, primarily as subjects rather than... well, primarily as objects of their labour. It looks a good-enough hospital, but I did not feel that I belonged there, and certainly not that it belongs to me in the first place! I was a commodity, not a soul, so reciprocally I experienced my dealings with it as soul-less.

Does any of this matter? Perhaps not. But in a modern, economically advanced, liberal democracy, the chances are that most citizens will have all sorts of chances of experiencing this for themselves,  personally or through their families, sometime over the course of their lives. 

Of course, if there is disability in your family, you probably already have.


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