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FIRST, LETS KILL THE BUREAUCRATS!

By Pete Davies
Contact the author by e-mail at christopher.johnstone@ntlworld.com

Don’t let the B******* get you down. Today I had a typical request. Lady with back pain (fair enough reason to see a GP) Not been paid last month at her work. She had handed in sick notes to her work but they had gone missing between her supervisor and the human resources department. The HR department knew that the sick notes had been handed in, and could be replaced, but refused to pay anything out on trust until the lady had got duplicate sick notes.

What a misuse of time and energy. What an example of the worthless and cowardly human behaviour of following procedure rather than meeting need.

And in this phenomenon, of which this is a minor example, lies a massive danger to us as individuals and collectively. We live in a world where no-one now knows what the right thing to do is. We have lost faith in the concept of individual agents acting sensibly, in the light of their context to make rational decisions that make sense at the time. We have stopped reading Aristotle, and indeed think he is rather too complex for “ordinary people” to understand.

Instead we suggest that ordinary people should “follow the rules” and follow it up with the weasel words “for your own safety and protection.” Now there are certain times when some procedures such as learning how to cross the road are means to achieving the aim of safety for us.

But most of the time procedures are nothing at all to do with safety or protection. They are means of control, exercising influence and power over our will to independent thought and action. They try to make our decisions dependent on a rule, rather than on who we are, what we find, and our own values and beliefs. Heaven forbid that we should ever have those.

Yet this is precisely what Heaven endows us with. We have our free will, and have the blessing or curse of having to use it. You can go to church as long as you like but there is no step by step manual to get you into heaven. Jesus ridiculed the Pharisees who stuck to the rules precisely for this reason: namely that rules cannot ever take you anywhere, they can merely stop you doing something.

We now have a culture that would have a Pharisee rejoicing. So many rules. So many procedures. And all to keep us not at risk, not in trouble, to not offend anyone, to not appear judgemental, to not make mistakes.

When did you last hear anyone say, “Go on, take a few risks today!” The rules try to force us into predictable patterns of behaviour that will avoid harm, but simultaneously stop us from doing any good either. Even where innovation is encouraged, the double bind of “innovate, but do it safely” is endemic in our sclerotic companies, and even if we have run out of NHS beds, we have made the NHS the most fertile ground ever for rules to be embedded into!

Nietchze would have had no truck with this. We need to rediscover the Will, the power within us to behave intelligently, creatively, and to adapt according to circumstances and need. We need to give people the education that will embed this way of thinking so deep inside them that we all become supermen and women and claim our freedom. Sadly teachers are some of the most constrained people of all when they are those who should be showing us how to be free! Camus rightly said “integrity needs no rules.” We need to rediscover integrity, not cover its lack with rules.

There is a moral case that rules and protocols are bad in themselves, and in their effects on us. They are a sign of failure, not success. After every scandal or tragedy such as the Victoria Climbie case someone (usually after a long, duly constituted legal inquiry has proceeded westerly along the street , having obeyed all the procedures, and successfully evoked all the false wisdom of hindsight and regret) decides that “procedures must be tightened up” and “a protocol for communications will be written.”

Do you feel reassured? No, I thought not. You can be pretty certain the same thing will happen again, and worse. The first time as tragedy, the second as farce. Think transition from Hutton toButler and you’ll get the idea. When did you last see anyone whose life was any better as a protocol had been rigorously applied?

Yet this lack of examples does not stop the endless production line from felling forest and spewing out the contents as “guidelines” and “protocols” and other such imposed imperatives on many workers.

The attempt to tie up the medical and teaching professions is now in full swing. Good health and good education are the two most empowering things that anyone can have. No wonder government is afraid of both. Endless guidance issues from government and the real message behind it all is “We do not trust you” “We do not want you to think for yourselves” and, “we fear you.”

At present opposition to guidelines and protocols is considered as heresy. Well I am happy to stand as a heretic….and you’d better get the old manual out for how to build a stake and bonfire as I am going to burn all the manuals and I want to know how to do it. For once in my life I promise I’ll follow it step by step!

External links to this article:

Dr Rant - Highly ineffective and highly defective: The State of NHS 12.11.07

Daily Telegraph - comment by Pete Davies

Neither hoolet nor the RCGP Scotland is responsible for the content of external links.

Other hoolet online articles by Peter Davies can be found at:
hoolet edition 48 - Three Theories
hoolet edition 46 - Whinging
hoolet edition 44 - Cons In The Consulting Room
hoolet edition 41 - Who are we kidding on confidentiality?
hoolet edition 40 - First, let's kill the bureaucrats
hoolet edition 38 - Waking up from the medical matrix: Reality and its representation in medicine
hoolet edition 36 - Festina lente
hoolet edition 35 - Determinants or Prerequisites?
hoolet edition 34 - Propulsion Systems in Medicine
hoolet edition 32 - Time to give MRCGP away?
hoolet edition 31 - Proper work for a doctor
hoolet edition 30 - The Intruder
hoolet edition 29 - Edging towards the truth: Does it make any sense at all?
hoolet edition 28 - Thoughts from the Dark Forest
hoolet edition 27 - The Vision Splendid

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.