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PETER DAVIES ON WHINGING

By Peter Davies
Contact the author by e-mail at Alisonlea@aol.com

I think complaining is existential to the human condition. And as doctors we offer such a convenient outlet for this impulse. Free at the point of use. Can't grumble about that...but the waiting room...the receptionist...the other patients...all offer ample scope to even the least imaginative of whingers.

And that's before we get onto the state of their internal organs. We insist that the suffering one must have a problem, as without this they cannot be a patient and so cannot come and see the doctor. We start from the “presenting complaint” and there is an open door that even the blindest of whingers will see. As doctors we set ourselves up to meet all the whingers in the world. Indeed I sometimes wonder if we create whingers by the fact of our availability.

We hold out hope to a faithless age. Come unto us all ye who are burdened and we will sort your problem, for free. Such is the unspoken promise much of the NHS holds out to the people of the UK and I think that this promise needs to be broken and reframed or the NHS is on a hiding to nothing.

Where shall we start? Firstly we need to accept that the set of symptoms is far larger than the set of diseases. The work of sociologists and doctors such as David Hannay on the symptom iceberg shows clearly that the prevalence of symptoms is huge. Most are not presented to doctors (for which relief much thanks). Even of those presented to doctors most symptoms are transitory. This is why primary care is such a vital filter in the system and explains why the deep fear of primary and secondary care is of being overwhelmed by symptomatology.

Pathology is rare, symptoms are common.

Secondly whingers assume that they have an entitlement that in some way is being thwarted. They assume that they have an entitlement to a virtually problem free life and can blame and claim if this entitlement is not met. And clearly it is someone else's responsibility to meet their entitlement. A huge industry has grown up on the back of this belief system.

Negligence lawyers do not deserve their compensation.

Thirdly whingers usually buy into the expert neurosis. For every problem there is a solution that can be bought, hired or swallowed. If only you find the right expert the problem will be sorted. And if there is not an appropriate expert, well there ought to be one. The solutions to life's problems are outside oneself.

Waiting for the experts to sort it may be your conduit to imbecility.

There is a madness in all this. We set up a service that encourages people to have complaints. We set up a service that encourages external solutions over internal resilience. We set up an expectation that life should be smooth progress with few problems.

We know that this bears no relation to the reality of life. Life is full of problems and challenges and indeed is more worthwhile because of this. Bertrand Russell said, “the secret of happiness is to face the fact that the world is horrible, horrible, horrible.” Yet we seem to have medical and legal professions that deny this truth and to connive with the public in trying anything and everything to avoid having to face this truth.

We cannot treat the fact that life is problematic, that people let themselves and each other down, with fluoxetine and lawsuits. There is no remedy for human nastiness, unkindness, sadness or silliness. They are part of life. There is a deep flaw, a failure to see things as they are in pandering to people who try and avoid confronting existential angst in whatever form they encounter it. At root there is a lie here. We think philosophy is an academic discipline, not a deep means of sorting human problems

Jimmy Boyle once observed that many people live in prisons. Some of them have bars already, and in others people build their own. We are currently serving time in a National Helplessness Service that is slowly sipping the vitality out of the economy (via taxes) and the people (via the false promise of pills for all ills) It is sapping the vitality out of political debate as the NHS is a sacred cow that demands ever more propitiatory sacrifice. Nigel Lawson commented that the NHS is “the closest thing the English have to a religion.” I am becoming a non-believer.

As a society we are reaching a limit where we will soon have to tell patients that the NHS is not, will not, and indeed cannot be the answer to all their problems. Up till now the NHS has more or less accepted whatever is presented to it but we will not be able to sustain this in future. The problem is not the iceberg of disease which is reasonably finite, but the iceberg of symptoms which is potentially infinite. These symptoms can easily be brought to the surface and may just be due to some dread disease that needs expensive investigation to check it out.

At some stage we are going to have to have to draw a limit to whinging at NHS expense. People will be welcome to whinge privately but only certain whinges will be admissible into our surgeries.

Before I close I want to acknowledge that doctors are masters at the art of whinging because we too have an ill articulated belief that things should be different and that someone else should make them different for us.

But like the best whinging this strategy will keep us waiting for our Godot to arrive. Till then we can console ourselves that things may be better tomorrow. And we can lick our wounds with our patients. Shared understanding is ever so empowering.

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.