David Sless's Soap Box

David Sless’s Soap Box

This space—this blog— has been set up for months, and was there in an earlier form as my director’s notes, but somehow never got going. Travelling, settling into our new home in Melbourne, cooking, carpentry, and gardening (not to mention the day job) all seemed to get in the way. Then there is my old friend, procrastination, always ready to help me out. But in the end, here I am.

The problem is, where to begin? I have a long list of things that I think may interest you, my reader. But there is no way of choosing—not without a conversation—and this is not a conversation. As the title suggests, it’s a soap box. So I shall go where my gut and keyboard takes me… You are of course free to heckle.

Position, position, position! Isn’t this what real estate agents say about the three most important attributes of a desirable property? Well, in a different way—using the word position in a slightly different context—I’ve come to the view that position, position, position, are the most important attributes of communication between people. When I have conversations I speak and listen from particular positions. Others taking part in the conversation do so too. In fact, I’ve argued in one of my books that there is an inexorable logic—a logic of positions—that governs what we can and cannot do in conversation. Well, enough of theory for the moment. I must watch myself and not get carried away up my own spiral of abstraction—something I’m fond of accusing others of doing.

Here is a specific issue of position: the relationship between people and a health system. One of the repeated mantras among today’s health professional is:

“We must involve patients in the decision-making about their health.”

I came across it again, just a few days ago.

“The National Patient Safety Agency (NPSA) today previewed to the NHS a new campaign to empower patients to take a more active role in managing their health.”

Good stuff? Progress? Enlightened? No, not really. At the heart of this well-meaning mantra is a misunderstanding.

Here is how I manage my health. I spend a lot of my eating, drinking and occasional exercising with one eye on whether or not I am doing these things ‘healthily’. If I feel unwell, I go and lie down. If I am in pain, I take a pill. If my throat hurts or irritates, I have chamomile tea with honey, lemon, and scotch. If I feel anxious and worried, I go for a long walk. Only when none of these work, or I am struck by some catastrophic failure of my body, do I ask for help from the ‘health system’. I don’t know what the proportions are, but at a rough guess I manage my health for 99% of my time and ask for help from the ‘system’ 1% of the time. So how come I’m being asked to take a ‘more active role in managing my health’. Is 99% not enough?

Either somebody in the system wants to take less responsibility for the little I ask them to do, or they have a profound misunderstanding about the relationship between me and them. I suspect the former, but I’ll assume the latter. When I do visit a doctor or hospital it is because I have decided to involve them in managing my health. I usually do so only at the point when my own management has failed. I need help.

The idea that I need to be more involved is absurd. All this talk of ’empowerment’ misses the point. Having overcome my reluctance to ask anyone for help, put to one side my fear of additional pain, ignored my instinct that tells me hospitals are dangerous places, and prepared myself to deal with arrogant and uncommunicative doctors, I ask for help.

It would be refreshing and reassuring at that moment and throughout my stay if someone told me what they were going to do, why, what the risks were, and what the outcome might be; it might also be helpful for me to know what it might feel like to me and what I need to do, etc: in other words good communication between me and the people I have asked for help.

Instead of this, the representative of the health system is quoted as saying:
“Safer healthcare is everyone’s responsibility. By providing practical information about safety issues and good health behaviour, the NPSA hopes to encourage patients and the public to get more involved in their own healthcare – to ask questions, discuss concerns and share their experiences with us. Informed patients are an important part of a safer patient journey.”

In other words, I should take over 99.5% of my health management, and the system may do me less harm in the 0.5% it manages, as I travel along my ‘patient journey’.

It’s time to go to 99.9% management of my health!