Being Human: getting round the ‘them and us’ of clinical practice

English: Hôtel Dieu in Paris, about ad 1500. T...

Last week I popped into the optician’s to make an appointment for a routine eye test and I was asked if I was a patient there. Well, was I? A patient? Not before I stepped over the threshold, I thought, and I wasn’t ill. There were goods on sale, it looked like a shop and I wasn’t entirely convinced that I could be a patient in a shop. Maybe that sounds a little touchy – what’s wrong with being a patient if you’re receiving health care? Well the word, for a start. It implies passivity and dependence and not an awful lot of control, and frankly, that is pretty much how clinicians have wanted their clientele over the years. There has been a shift in recent times but there are occasions when it seems the words are just rhetoric. Listen to almost any health care clinician – although I must say that doctors are the worst offenders in my experience – talking generically about health issues. As soon as they begin to discuss the population – us – there are no people, we have all suddenly become patients.

Tom Main, way back in 1957 in his seminal collection of essays, The Ailment, highlighted the need clinicians seemed to have for separation. Staff are, by definition, healthy and patients are not, which raises the question of how patients can ever be healthy if everyone is automatically a patient just by dint of not being a doctor. That the reverse also applies so that doctors cannot be patients is most likely evidenced by a traditional denial of health problems, and the historically ridiculous working hours that were regarded as ‘character building’. A receptionist at my local surgery once called me ‘Miss’ because, she whispered, ‘we don’t like patients to know doctors get ill’. A clear indication that the culture did not, and perhaps still does not, allow for a matrix.

I am banging on about this today because two articles in the latest issue of Clinical Psychology & People with Learning Disabilities (intellectual disability) exemplify a humanisation of the relationship between health professionals and those we work with. Mark Haydon-Laurelut, a systemic psychotherapist with Sussex Partnership NHS Foundation Trust and Portsmouth university, describes a process called reflexive self awareness in which staff can begin to understand and make sense of ‘the part they are playing in the social construction of the lives of those they support.’ In other words, how does the way we think of someone or understand them, the stereotypes or historical references we have applied, affect our actions when they ‘do’ something? Mark gets people to consider the meaning of actions for all the participants – for instance throwing a cushion at someone. He asks everyone to think about the relationship that exists, whether this was an aggressive act, a joke, and attempt at communication by a person with limited language. The discussion centres around questions about meaning and what is being ‘made’ by a given action, evidence – what there is to support beliefs about intention, and ideas for actions based on conclusions. It is a process that humanises all parties by equalising their participation in a micro-relationship that can be set up in an instant, and it enquires, it does not blame. Such a contrast with current public toxicities; perhaps there is something organisations can learn from this.

The second article is by Brian Leaning, a clinical psychologist in Ealing. It’s called The Funnel: a brief narrative and it is indeed brief. But that page-and-a-bit captures a completely shared humanity. Brian describes his encounters with a woman who refuses to see psychologists, nurses, psychiatrists and, one gets the impression, anyone at all who might be wearing a badge. She and Brian have exchanges in the street that would make traditional therapists implode with the weight of their countertransference issues, and eventually they get to meet. He attached a funnel to her notes to remind everyone of the awfulness of this woman’s past experience and which, I suggest, builds a platform that shows what happens when people get lost in the terminologies of health care.

These two articles demonstrate the value of re-considering the clinical relationship; allowing it to breathe and become as consensual as legislation requires but traditional psychologies barely allow. The sooner, I think, that we all abandon the language of dependency and separation and think of health care as a collaborative effort with joint provider-recipient responsibilities, the sooner the nightmare of blame, covered-up errors, media witch hunts, and tickbox target paralysis will come to an end.

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6 thoughts on “Being Human: getting round the ‘them and us’ of clinical practice

  1. You have my head spinning now Suzanne. Hotels have guests, restaurants have diners, and doctors usually do have patients. But opticians? Suckers is the first word that comes to my my mind when I think about what they charge for a pair of Gucci frames. Cynical I know, but there are just some professions that do not inspire trust. “Killers, thieves, and lawyers,” as Tom Waits so finely said. Sorry, off topic I know, but as I said, you did get me head spinning.

    • Spin away – it’s important, I think. In my service, we abandoned ‘patients’ a long while ago and referred instead to clients. Even though that has its drawbacks, it applies generally to more equal relationships and, it has to be said that learning (intellectual) disability services have been ahead of the curve since we extricated ourselves from the mire of the old institutions.

      • I think this issue is more about a sense of equality and correctness. I teach English to mostly French speakers, and they find it interesting that in English the word handicapped is considered not only redundant, but also extremely demeaning. Disabled or challenged takes some explaining to them. So maybe this is more about the English language being more progressive and flexible of purpose. From a selfish perspective though, I’d love to change ‘readers’ to ‘rabid and frantic book buyers’, but then again, that’s just a starving author’s point of view. 🙂

        • It’s certainly about equality. Not in expertise but in the sense of removing paralysing deference in recipients and that dreadful combination of arrogance and fear of inadequacy in clinicians. We’ll all be safer if people can say they don’t know without getting sued. In the meantime, I think ‘rabid and frantic book buyers’ might have some mileage, at least in the health information leaflet department!

          • Being an Aussie, I never let any sense of arrogance or superiority last too long. When a doctor calls me Derek, I immediately call him or her by their first name. Well, except my dermatologist. I can’t pronounce his first name, so I just call him ‘Doc’. It works. 🙂

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