Healing the binds that tie us. Part two: Examples

Following on from part one Dr Rant thought he’d have some fun with readers by describing various double binds that he has encountered in his long and illustrious medical career. He's sure readers will recognise the game and supply others from their experiences and fields of work.

Here they are:-

“You will be a self-motivated student……but we will say in just what direction your motivation should go.”

“We value your opinion very much indeed, especially after we have told just what it should be.”

“You must make care of the patient your first concern…..but not if we cannot afford to pay for it!”

“This is a high trust system……..we trust our bombproof audit trail to tell us exactly what you’ve all been up to.”

“We believe that GPs carry out excellent work….but we’re putting the money into NHS direct, walk in centres etc.”

“You must reduce the levels of cardiac risk found in your patients…but you mustn’t exceed the drugs budget with all those expensive extra statins you lot seem so keen on prescribing.”

“Whenever we praise GPs ……..there will always be a sting in the tail”
(Timeo Danaos, et dona ferentes!)

“We want to reduce the burden of GP paperwork. To help us document the success of this scheme please fill in this comprehensive form every month to update us on the progress of our initiative.”

“We will teach you great consultation skills…..and then launch you into a world of extras, hassles and interruptions where the only good GP is a quick one.”

“Explore the patient’s ideas, concern and expectations fully…….within eight minutes."

“We care about your problems deeply……there have I shown enough empathy now?”

“You must be reassuring……whilst explaining that running risks akin to those of a kamikaze fighter pilot is not really entirely healthy!”

“You must not admit too many patients to hospital…….but if you ever once get the decision wrong we’ll direct all the medico-legal flack straight at you.”

“You must be reassuring….without being paternalistic. But if your father was a reassuring figure in your life you can borrow just a teeny-weeny bit of his paternalism.”

“You must counsel the patient in an unbiased way about the risks of a procedure…with full statistical detail to help him make up his mind…..to reach the right decision.”

“You must not over investigate…….but equally you must not miss a diagnosis!”

“You must always strike a balance…..but we will free to disturb it for you at any time.”

“It’s good to base practice on evidence…..which is why we are so careful never to gather any.”

“It’s good to base practise on evidence…..especially as we’ve chosen what will count as evidence already!”

“You must always achieve maximum beneficence…..but you must not override a patient’s autonomy even if the patient’s autonomy is not consistent with the public good. That’s ethics for you.”

“We want you to succeed……and (or but) we’re right behind you!”
(Shades of Ronald Reagan’s joke, “I’m from the government… and I’m here to help”)

“You must achieve your targets……including staying within your budget!”

“Exercise your skill and discretion freely …..to stay within the guidelines.”

“Confidentiality is an important value…..but we want information to flow easily around the system.”

“We’ll teach you that time is of the essence in acute medicine…..and then introduce you to patients waiting on trolleys for hours.”

“We want greater accuracy on death certification…..….but we won’t spend too much on coroner’s post-mortems.”

“Meeting people’s needs will be just what they want.”

“Be empowered……...let us show you how to run your consulting room better with our micromanagement techniques.”

“Central direction clearly encourages local flexibility”

“Be spontaneous…go on…..do it….. now!”

“Innovate…..but don’t make mistakes.”

“Think long term…..but improve today’s productivity.”

“Reduce costs and improve morale.”

“Downsize…and improve teamwork.”

“Empower staffs, but be sure they follow corporate rules.”

“Central credit and local blame” (but we’ll give the Chief Exec who falls on sword a hefty pay off.)