Questioning the habitual and taken-for-granted
- Correspondence to Dr Deborah Kirklin, UCL Division of Medical Education, Whittington Campus, Highgate Hill, London N19 5LW, UK; email@example.com
- Accepted 28 March 2013
In the fifth of a series of papers, Alan Bleakley and Rob Marshall1 “use thinking with Homer as a medium and metaphor for questioning the habitual and the taken-for-granted in contemporary [medical] practice”. The importance of being prepared to challenge the status quo has been brought into sharp and painful relief by the on-going scandals about the care, or rather lack thereof, provided to some National Health Service (NHS) patients, most notably in The Mid-Staffordshire NHS Foundation Trust.
The status quo in Mid-Staffordshire was one of poor care, high mortality rates and widespread patient concern, compounded by managerial and clinical inaction. Appalling care had, quite literally, become habitual and taken-for-granted. As the inquiry report makes clear, there were many warning signs, but because of “an engrained culture of tolerance of poor standards, a focus on finance and targets, denial of concerns, and an isolation from practice elsewhere”, as well as professional disengagement whereby “clinicians did not pursue management with any vigour with concerns they may have had”, nothing was done to improve the situation.2
With hindsight, it seems all too obvious what should have happened, and for the majority of healthcare professionals, working within organisations that deliver high quality healthcare, these events and practices will feel far removed from their own. It would be all too easy, therefore, to dismiss failings in Mid-Staffordshire as something terrible but alien, but it would be a mistake to do so.
Instead, each and everyone of us, working in health and social care, needs to play an active role in upholding our duty of care—that is the duty to take care that our actions or inactions do not harm our patients—by subjecting what we do, and why, to a more critical gaze. Crucially, we need to be prepared for the fact that we might not always like what we see.
In a group of companion papers in this issue,3 five art historians turn their critical gaze on medical portraits and what they reveal about the relationship between patients, practitioners and artists. George Washington Lambert's 1910 painting, Chesham Street, the focus of Keren Hammerschlag's paper,3 is featured on the cover of this issue. Hammerschlag “interpret[s] Chesham Street as a patient self-portrait, which reveals the artist's dual personalities of bohemian artist and Australian boxer: two personae that did not combine seamlessly”.
For anyone who has been a patient, the idea that patients have dual, or even multiple personae, that do not combine seamlessly, will be familiar, with the term patient implying the assumption of a new role. It is a role that all too often subsumes other roles previously central to the patient's identity, and that is, perhaps, one of the reasons why some people favour the term client over patient.
Personally, I consider this an unhelpful move, one moreover that risks undermining the compassion and care provided to patients by re-designating them as mere consumers. I would argue that success in healthcare depends on ensuring that patients are recognised and acknowledged, in all their personae, so that the people providing care, and the healthcare systems they work within, are guided by the needs of these very individual human beings.
As I say, that's a personal opinion, and although one of the privileges of writing an editorial is the opportunity to say what you think, as an individual, producing a journal is very much a team effort. Over the last 5 years, I have been fortunate to share my goals for this wonderful journal with passionate and hardworking editorial and production teams, and far-sighted joint owners. As my tenure draws to a close, I would like to pay tribute to them all, and to thank them for their friendship, support and tolerance of my foibles.
When I first took up my post, I was encouraged by wiser, more experienced souls, to be true to myself and to have confidence in my vision. At the same time, I was brought down to earth by being told that it is only after an editor has left her post that the effects of her tenure—for good or for bad –begin to become evident. In other words, while the job of an editor is to be imaginative and creative, it is also to play the long game.
As this issue goes to print, from my admittedly highly subjective viewpoint, the long game looks promising. Medical Humanities is now recognised as a leading international journal, and the quality and breadth of submissions reflects this. The quality of student submissions has also risen, such that we rarely need to provide additional help during the revision process, although this remains on offer. Publishing online first allows innovations and resources, including educational case studies, book and film reviews, and open access poetry, to be shared around the world in a timely and efficient manner. And thanks to beautiful cover designs, our print version subscriptions have held up well, bucking the seemingly unstoppable trend to online only.
So as I hand over the reins to Dr Sue Ekstein, I do so in the hope that she will not be too disappointed with what she finds, but also in the knowledge that she is ideally placed, both as a medical humanities scholar and an accomplished editor, to take the journal on the next stage of its exciting journey. In wishing you well, Sue, it only remains for me to say, that if you have half as much fun as I did then you're in for quite a ride.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.