….that might seem like a strange and obvious statement, but the reality is that health is experienced by individuals which is why we need a health service which is patient centred, taking a holistic focus to understand the differences between people as well as their similarities (what diseases they have). However, the other side of the partnership in healing is the health care professional – doctors, nurses and other professionals. There’s a strange distortion of “Evidence Based Medicine” which seeks to reduce the whole of health care to numbers, as if people don’t matter. We see this in the way that randomised controlled trials are conducted using methods which explicitly seek to exclude the individual people effects – you never see any mention in a research paper of who the individual health care professionals were who actually interacted with the nameless and faceless patients in the trial. It’s as if we can only rely on studies which exclude the effects and contexts of human beings. This has always struck me as strange.
In any GP partnership, patients quickly suss out which doctor is good for which approach. Those who want to be given time to talk about their problems seek out the doctor who listens. Those who want antibiotics seek out the one who is best known for prescribing them without lectures…….and so on.
Doctors are not clones. They are individuals too. In good health care each of us needs to find a doctor we can connect with, one who is on our wavelength. Yes, we want a surgeon, a physician, a GP who has good up to date technical knowledge and skill. That’s a given. But we need more than that. We need a good human relationship with him or her.
So, I wholeheartedly endorse Dr Everington of the BMA today who says
Doctors feel under attack, the government wants to turn everything into something that has just a monetary value. Vocation, dedication and lifetime commitment to patients and the NHS has little value in this new world – we are just financial commodities.
There’s a process going on in the NHS known as “Agenda for Change“. It’s central tenet seems to be that every job in the NHS can be described according to the knowledge and skills required to do that job, every person can have their knowledge and skill level assessed, then anyone with the requisite level for a particular job can do that job. The actual human beings become dispensible and interchangeable. The whole process is demoralising for thousands of NHS staff. People matter. Personal, individual qualities and characteristics matter. Two different people doing the same job will interact with people differently. In health care this matters. In a factory making widgets it maybe doesn’t. But GP surgeries and hospitals are not factories and people are not widgets.
Heroes Not Zombies 
How I agree with your perspective! Calling a person a “human resource” has led to the depersonalisation of individuals in the eyes of their managers at every level, and opened the doors to this abomination called euphamistically “Agenda for Change”. It’s a management concept that should have been restricted to the areas you mention, instead of being crudely adapted by the NHS so that they could slot individuals into catagories for budgetry reasons, claim that it was done with consultation, and try to avoid further claims under the equal pay legislation. I’m a nurse in a psychiatric unit, and used to be involved in the evaluation process as a staff side, Union representative. I have first hand knowledge of the expensive farce that is taking place to manipualate job descriptions to fit predetermined bands, so that it superficially appears to be the robust, transparent, unbiased system we were promised. Jobs were argued up or down to fit budgets, to maintain existing hierarchies, and to jostle for status. As the necessary bulk of the work force, front line staff salaries had to be controlled and restricted. There’s not one of us [both qualified and unqualified] whose job description and band reflects the actual responsibility and performance required from us on a daily basis. We are appealing the outcome, using the ideals and principles of the process we were promised. As you can imagine this is classifying us as troublemakers- we don’t know our place perhaps. Now feeling quite threatened at times, and after several months have yet to have the appeal evaluated. We know it’s a budget issue, but why should the drones’ jobs not be subject to the same “principles” that have benefitted so many others.
You put the case so clearly Moira. It’s difficult to swallow in an organisation that should be about caring for individuals. There is no doubt that patient-centredness is important in health care but we need to remember who’s the other part of the therapeutic relationship – the doctors and nurses are human too.
I know it’s not comfortable to seen as a non-conforming troublemaker but when you’re acting for the best of reasons – human scale health care – then thank goodness for your troublemaking!
More power to you. I hope the appeal goes well.
The NHS needs people who care about people as individuals. Sadly, those kinds of values don’t seem to rate very highly these days, but, they’re on the way back!
[…] The NHS should be a people focussed organisation – focussed on the patients and those who deliver the health care. Targets, budgets, managerial processes, should all be measured against the impacts they will have on people. Please, can we have a health service that cares, that really cares about people? […]