Category Archives: nurses

👏🏻Clap for the NHS👏🏻 is to gestures what Jeff Koons is to art

Every Thursday at 8pm, Britishers are required to come to their windows and hail 🙏🏻the NHS bureaucracy🙏🏻. Applause must be long, loud, and accompanied, Dalrymple notes,

with ululations.

He dislikes such actions,

which seem to me empty and shallow. They are supposed to be gestures of gratitude and encouragement, but all that I have seen suggests that doctors and nurses are more irritated than pleased by them. Often they have to work in poor conditions, with essential equipment lacking despite the vast expenditure on the health service.

He points out that thus to genuflect is cheap.

It costs nothing, financially or in any other way.

The Danube of Thought: cheer him to the rafters

There is also

something unpleasant about it. When lots of people make a gesture collectively, there is often the implication that if you refrain from making it—and even worse if you actively refuse to make it—you are in some sense an enemy, in this case, of the people. Whatever your inner conviction, it is safest to join in. By doing so you avoid drawing attention to yourself and you are assumed to think and feel like everyone else, which is always safest.

It reminds Dalrymple, in its tendency to get longer and louder and almost more hysterical,

of the applause after a speech by Nicolae Ceaușescu or any other communist despot, in which everyone in the audience had to show himself to be as enthusiastic as the most enthusiastic applauder, and to continue applauding as long as someone else was applauding, for to be the first to stop might be taken as a sign of disloyalty and dissent from the official line.

His objection is also æsthetic:

I find it to be emotionally kitsch.

The sort of ‘art’ excreted by Jeff Koons: Play-Doh (five versions, 1994-2014)

Surely no human existence can be as empty of meaning as this

screen-shot-2016-09-10-at-13-28-10From time to time Dalrymple receives invitations to attend conferences on something called medical leadership. The invitations ask,

Do you want to be a leader?

The answer, in Dalrymple’s case, is

No.

The latest conference on medical leadership, Dalrymple reports,

has 80 speakers and lasts three days. The organisers seem to believe that the longer the conference and the larger the number of speakers on so patently dull a subject, the more impressive it is, no doubt in the way that a big box of chocolates impresses a greedy person more than a small one. All things considered, I’d rather stay at home and read the collected works of Kim Il-sung.

screen-shot-2016-09-10-at-13-25-28Dalrymple looks at the biographical details of a couple of the speakers, taken from the list at random.

Mr R.

is founding Director of Harthill Consulting. His extensive practitioner background includes working with senior leaders from organisations such as Fujitsu, Danone, Shell, Hewlett Packard, Volvo, Eli Lilly and Microsoft. Co-author of HBR’s award-winning article ‘Seven Transformations of Leadership’ (April 2005) it has since consistently been named as one of HBR’s ‘Top 10 Must Reads’ on Leadership. He recently co-authored and contributed to the large-scale 2015 PwC study on leader transformation and retention. His expertise is exploring leadership as a process of evolving ‘wisdom’ — enabling individuals to integrate discernment, courage, power and compassion.

screen-shot-2016-09-10-at-13-31-37Ms A.-M.

is a Chartered Occupational Psychologist and Chief Executive of Real World Group (a University of Leeds spin-out company). She is also Adjunct Associate Professor at the Centre for Sustainable Business and Enterprise, University of Southern Queensland. She has been working with Real World Group for the past 15 years, supporting leadership development with both individuals and groups up to Board level globally. She has a particular passion for a focus on positive psychology and diversity & inclusion in leadership. She has helped establish Real World Group’s approach to Engaging Leadership, based on uniquely proven research involving tens of thousands of people across the world, and has authored or co-authored most of Real World Group’s diagnostic instruments. The research she has been involved with has established the common sense but often missing behaviours that distinguish leaders from managers, and effective leadership among teams and organisations. They are factors that drive productivity in a sustainable way, even when resources are diminishing. As a result of her research and experience in working with organisations, she has been invited to speak at international and national conferences, and consults on behalf of Real World Group with organisations from the UK, North America, South East Asia and the wider Asia Pacific region. She has worked extensively in Higher Education, including at leading Universities and with the Leadership Foundation for Higher Education. She has authored and co-authored a number of articles in practitioner and peer-reviewed journals, as well as book chapters in academic books by leading publishers on leaders’ career development. She is Co-Chair of the Steering Group of the government sponsored Engage For Success movement (www.engageforsuccess.org) and the editorial committee of the International Congress on Leadership, Management and Governance. She has an MSc in Occupational Psychology from the University of London, Birkbeck College and an MSc in Positive Organization Development and Change from Case Western Reserve University, Ohio.

screen-shot-2016-09-10-at-13-22-57In case, says Dalrymple, the above

should be insufficiently enticing to prospective attendees,

it is explained why they should attend the conference:

Be a part of the first Leaders in Healthcare conference, which will bring together both the future generation and most senior of healthcare professionals and managers. The event aims to focus on the leadership challenges all nations face in healthcare to improve the care we deliver for our patients. Learn about and be part of widespread discussions including standards, professionalism and the opportunity for a step change in quality, the leadership challenges facing healthcare on a national and international scale and how we, as a profession, will face these, and contemporary leadership theory from international experts. Attend interactive workshops and hear from inspiring speakers exploring the essentials of what you need to know to continually grow your leaderships skills, how innovation in healthcare can change the way we work, and how medical education can improve leadership, clinical performance and patient safety. Represent the voice of medical students by planning your leadership skills development at an early stage of your career. Explore sessions to understand the essentials of leadership and how to take charge of your own development, and network with peers and senior medical leaders. Develop essential skills for being an effective leader who can motivate and inspire others in the team, influence the way care is given, ensuring it is high quality, compassionate and responds to individual needs, and network with the full spectrum of healthcare leaders from all professional backgrounds. Network with a broad range of healthcare professionals, develop a shared understanding of what good leadership is and how working together can benefit service delivery and patient care, consider how we can encourage greater involvement of healthcare professionals, service users, communities and the general public in shaping healthcare services that are fit for purpose, and network in a unique multi-professional healthcare leadership event embracing all levels and sectors. Leaders in Healthcare 2016 welcomes other professionals who share our passion for excellence in leadership and management.

screen-shot-2016-09-10-at-13-38-20After reading a few lines of such prose, Dalrymple’s mind

goes fuzzy as if I were suffering from a hangover, or as if an almost physical shutter comes down in my brain, just as it does on reading a paragraph of Kim Il-sung. The prose destroys my capacity, even my will, to concentrate or fix my mind on anything. My remaining thoughts are fleeting and desultory: ‘Can anyone really have a passion for diversity and inclusion in leadership?’ or ‘What can the life of someone who does have such a passion be like?’ I try to imagine it, but nothing comes to mind. Surely no human existence could be as empty of meaning as that.

screen-shot-2016-09-10-at-13-23-09Then Dalrymple begins to wonder what Alexander the Great or Napoleon would have made of the conference on leadership.

Would they have been able to reach a shared understanding of what good leadership is? If Alexander had only been better able to integrate compassion into his discernment, courage, and power, would he have found new worlds to conquer? If Napoleon had learned about leader transformation, would he have crowned himself emperor earlier in his career than he did?

Who would pay good money for such a conference?

The taxpayer. He would not attend the conference himself, of course, but he would pay for employees to attend it who needed or desired a three-day break from their work in a public hospital or as part of their mandatory continuing professional development. He would also pay the fees of the speakers, some of them flown in from distant lands.

screen-shot-2016-09-10-at-13-40-36The attendees, Dalrymple notes, would learn about something called lean management, one definition of which is as follows:

If someone tells you that ‘lean management is this’ and not something else, if someone puts it in a box and ties a bow around it and presents it in a neat package with four walls around it, then that someone knows not of what they speak. Why? Because it is in motion and not a framed picture hanging on the wall. It is a melody, a rhythm, and not a single note.

This, says Dalrymple, is

the mysticism of apparatchiks, the romanticism of bureaucrats, the poetry of clerks. From my limited observations of management in public hospitals and other parts of the public health care system, it seeks to be not lean, in the commonly used sense of the word, but fat, indeed as fat as possible; nor are large private institutions very much different.

screen-shot-2016-09-10-at-13-43-08We have entered, writes Dalrymple,

gradually and without any central direction or decree, a golden age of langue de bois or of Newspeak. Langue de bois is the pompous, vague, and abstract words that have some kind of connotation but no real denotation used by those who have to hide their real motives and activities by a smokescreen of scientific- or benevolent-sounding verbiage. Newspeak is the language in Nineteen Eighty-Four whose object is to limit human minds to a few simple politically permissible thoughts, excluding all others, and making doublethink — the frictionless assent to incompatible propositions—part of everyday mentation.

Langue de bois and Newspeak

are no longer languages into which normal thought must be translated; rather they have become the languages in which thought itself, or rather cerebral activity, takes place, at least in the upper echelons of the bureaucracy that rules us. If you ask someone who speaks either of them to translate what he has said or written into normal language, it is more than likely he will be unable to do so: His translation will be indistinguishable from the words translated.

screen-shot-2016-09-10-at-13-49-41It is therefore clear that,

where culture is concerned, the Soviet Union scored a decisive and probably irreversible victory in the Cold War.

screen-shot-2016-09-10-at-13-52-17

The gentle Sikh woman

Screen Shot 2016-05-10 at 20.32.12She waited outside without demur, reading a book of prayers

In the ward, writes Dalrymple, was a young Englishwoman

of the slut-babymother class, whose jaw was clenched in a habitual expression of world-destroying hatred. Her glittering saurian eyes swivelled mistrustingly, on the qui vive for infringements of her rights. She exuded grievance as a skunk exudes its odour.

She had been admitted to hospital because

she had been out celebrating the night before.

Enlightenment reason turned into psychopathic unreason

In England,

celebration is synonymous with aggression and public nuisance, and she had conformed to type. The police dumped her in the hospital rather than in the slammer, where she belonged.

Screen Shot 2016-05-10 at 20.34.20She

turned the attention of her lip to the admitting doctor, who took down verbatim some of what she said to him.

Her recorded remarks were littered with the word ‘fuck’, which the doctor rendered ‘f***’ in neat handwriting, showing that

in India, at least (where the doctor came from), there is still some sense of dignity, decorum and self-respect.

Putrid fruit borne of the doctrine of rights

The following morning a friend of the patient arrived in the ward before visiting time.

Both patient and friend were what is called in the prison ‘very verbal’. A nurse, acting on the biblical observation that a soft answer turns away wrath, asked them to keep their voices down, only to discover that the Bible has been superseded in modern Britain and that wrath turns away a soft answer.

Superseded: the book of Proverbs

Superseded: the Book of Proverbs

The nurse then told the visitor that she had to leave. Shortly after her departure under foul-mouthed protest,

the wife of another patient came. She was a respectable Sikh woman with a gentle manner, but it was not yet visiting time, and the nurses feared to provoke the slut-babymother by allowing her to stay, when they had told the slut-babymother’s visitor to leave. The nurses could all too well imagine the scene: Why am I not allowed a fucking visitor when that person over there is? In vain would the nurses point out the difference in the conduct of the two visitors; if anyone had a right to a visitor, everyone did, irrespective of the conduct of the visitor.

To avoid a conflict over rights,

the Sikh woman was asked to wait outside, which she did without demur, reading a book of prayers.

A good nurse is above the price of rubies

Screen Shot 2016-04-10 at 15.05.06But, says Dalrymple,

a bad nurse is… well, the mind tries not to think too much about it.

The question is,

how are good nurses to be trained? And how are bad nurses to be avoided? The government, unsurprisingly, thinks it has the answer: is there any question to which it does not have the answer? This, no doubt, accounts for the flourishing state of the country today.

The right day for your operation

Screen Shot 2016-04-09 at 12.04.19Dalrymple draws attention to a UK statistical study that examined 30-day death rates after non-emergency operations in 2008-11 (except day cases) according to the day on which the procedure was performed. There were 27,582 deaths after 4,133,345 operations, a raw rate of 6.7 per 1,000.

  • Those who underwent an operation on Friday had a death rate 44% higher than those who underwent an operation on Monday
  • Those who underwent an operation at the weekend had a death rate 82% higher

Screen Shot 2016-04-09 at 12.10.15The death rate

increased steadily as the week progressed.

Perhaps, says Dalrymple,

hospital staff, especially surgeons and nurses, grow steadily more tired or careless as the week progresses.

Not everyone who needs surgery can have it done on Monday. Therefore,

so long as the information is not known by everyone, the wise patient would be well-advised to keep it to himself. A small number of patients, but not many, can ask for their operations on Monday and have their wishes respected.

Economics of sham operations

Dalrymple comes across a paper in the New England Journal of Medicine comparing physical therapy with surgery for meniscal tears in the knees of people with osteoarthritis.

There was no difference in outcome, an important finding since 465,000 people undergo operations for this situation every year in the USA alone.

Actually, says Dalrymple,

the uselessness of operation had been established before — uselessness from the patients’ point of view, that is. Two previous trials had compared real with sham operations, and with no operations at all, and found no difference in the outcome two years later. One might suppose that, in the light of these findings, the 465,000 operations still performed annually constituted something of a scandal.

Dalrymple considers the economic aspect of unnecessary operations. Granted that

unnecessary operations are more expensive than intensive physical therapy, do these operations increase or decrease gross national product? At first sight they do. As everyone knows, operations are not cheap. Without them, the GDP would fall. So would the incomes of those who perform them – orthopædic surgeons, for example, and their hangers-on such as operating room nurses. Presumably their incomes have a multiplier effect, for example on the legal profession. On the other hand, there are opportunity costs of employing money in this rather futile, indeed counterproductive, manner. But would the money in fact be better employed elsewhere? Would not something just as unproductive be done with it?

Screen Shot 2016-03-31 at 16.14.18

Confessions of a kafferboetie

Johannesburg

Johannesburg

At a hospital in the black township in which he works, Theodoor attends the black nurses’ graduation ceremony. He writes:

The graduation was an occasion of immense local pride, for a nursing qualification was highly regarded; and my presence was welcomed with a celerity and generosity which made me feel ashamed. I was the only white who turned up for the ceremony, though white doctors worked in the hospital, and I was at once accorded the place of honour though I knew that I had done nothing special to deserve it other than be white. Refusal of the place of honour would have offended, of course, and so I took it, instead of a black clergyman scheduled for it. What was so moving about this was that there was absolutely no resentment in it.

Screen Shot 2015-06-14 at 22.17.50

Herstigte Nasionale Party

Fraternisation

On another occasion, he drives the black nurse in his clinic home to her house in the black township.

I asked her to sit beside me in the car, rather than in the rear, which she found remarkable: it would have been enough by itself to give me a local reputation as a kafferboetie. (‘And if you can’t call a kaffer a kaffer,’ the mother-in-law of the man who employed me wanted plaintively to know, ‘who can you call a kaffer?’) A white sitting in the back of a car driven by a black would have been a man with his chauffeur; but a black in the back of a car driven by a white would have been as good as chattel.

Screen Shot 2015-06-14 at 22.40.52Gesture of equality

The nurse, who knows Dalrymple is British,

concluded en route that I must be a member of the British royal family to act in this fashion, for only someone of the highest social status would dare do such a thing or be sure enough of his position not to feel it endangered by such a gesture of equality.

Screen Shot 2015-06-14 at 22.11.31Screen Shot 2015-06-14 at 22.44.09

Dalrymple’s nurse-poisoner book plan spurned

Victorino Chua: jailed for a minimum of 35 years for murdering and poisoning patients at Stepping Hill Hospital, Stockport. Two victims suffered agonising deaths and a third was left brain-damaged

Victorino Chua: jailed for a minimum of 35 years for poisoning patients at Stockport’s Stepping Hill Hospital. Two patients suffered agonising deaths while a third was left brain-damaged

Dalrymple, author of So Little Done: The Testament of a Serial Killer (1995), suggests to a number of publishers that he write a book about the trial of Victorino Chua, the poisoner, but

no publisher accepted my kind offer, despite the fact that I had experience of murder trials and understood the complex pharmacological matters at issue.

The main reason given for refusal

was that the accused was a Filipino rather than a son of the soil and therefore there would be no market for such a book.

Does it mean

that the British public is interested only in native and not imported wickedness? That we expect Filipinos to behave in this fashion and therefore there is nothing surprising or interesting about Chua’s behaviour? Or is it that murder trials are interesting only if there is the prospect of the rope at the end of them?

Screen Shot 2015-05-20 at 08.55.59