On the loss of critical faculties



I think you will find the following a bit shocking.

 Several years ago, I think it was 2002 or so, I attended a quarterly meeting of an IT subcommittee at the PCT. During the coffee break, one of the managers asked me if I was doing any sessions in the local A+E department the following week. They were recruiting local GPs to do sessions for that week, because there was an audit, a national audit, on waiting times in A+E. I said, no, I was too busy. And thought nothing more of it until a few years later.

Perhaps in 2006 or so I was feeling particularly overloaded with demands being made on us and I found myself reflecting on how mad some of the planning was. I thought back to the A+E audit. An audit is an exercise to find out how something is working. You gather data to see how you are doing. The results then help you plan some changes in order improve things so that you can improve whatever it is you are investigating; then you repeat the audit and see if things have improved.

Now the strange thing about this A+E audit was that it wasn’t going to tell the planners how things were. It was going to tell them how things would be if you hired extra doctors to do the job. Now I am assuming that this audit was meant to answer the question, ‘How are we doing?’ and not ‘How would we do if we hired extra doctors and pulled out all the stops?’

 So an audit was performed; extra money was spent; the results purported to show you how the ‘normal’ service performed, but in reality told you how things would work if you hired extra doctors and did the best you could for a week. The shocking thing is this: you think you are checking on how things are, you are given results. You presumably use these results to plan things. So the results are in reality misleading: they make you think you a doing better than you are, and you have spent extra money to get this wrong data.

This is pretty shocking. But what is also shocking is that at the time I thought little of it. I did not say, ‘This is mad.’ I didn’t even think it. Nor did my colleagues, whom I viewed as thoughtul people.

 And I have observed further anomalies over the years which have been a bit mad, and otherwise sensible, thoughtful people not challenging it but just getting their heads down, and getting on with it.

And so I posited an explanation for this: infection with LCFV (Loss of Critical Faculties Virus). What this infection does is dulls your critical faculties so you become slow-witted, accepting of whatever you are presented with, and you just get on with it.

Once you become aware of this terrible virus, things begin to make sense.

On the Kafkaesque



Kafkaesque: you may be familiar with this term. Not everyone is. I sometimes say to a patient who has brought me a particular type of problem, ‘Do you know the meaning of Kafkaesque?’ Many do not. I then explain that it is a situation where a person feels in a nightmarish situation: they are standing in a queue for hours; then are told that they are in the wrong queue, that they need to go to Section 7 and wait for further instructions; they go to Section 7 and wait; nobody comes for them. They ask for guidance and are told they should not be in Section 7, how silly of them to come to Section 7, they need to be in Section 9a; they go to Section 9a and find a sign which says: ‘Section 9a is closed for refurbishment, please go to Section 7 and await further instructions’. And so on; you get the picture. Patients are usually helped by being aware of this term and its meaning: at least someone has described this, recognised this; they are not alone.

Like the patient who has quite severe, enduring depression; he has seen psychiatrists, is on medication, but feels dreadful, hopeless. He feels physically exhausted and spends a lot of time in bed. He feels ashamed of his inability to get going. He goes to the DWP medical examination (with great effort), and is told, in a letter that arrives a week or two later, that based on the examination (one test was to see if he could fold a piece of paper and put it in an envelope) he has been deemed fit for work, and that his benefit (including his housing benefit which is paying his rent) has been stopped. This is a true story, incidentally, and occurred recently. This is Kafkaesque. The patient appealed the decision; then waited several months (benefits cut off); when he went to the Tribunal they apologised and re-instated his benefit. (In a truly Kafkaesque situation, they would have turned down the appeal….)

The writer Borges said this: ‘Kafka’s most striking talent was for inventing intolerable situations.’

Yes, intolerable situations. Our situation with having to register all patients was Kafkaesque.

The policy of registering with whatever GP you would like, anywhere in England, is Kafkaesque.

That nobody is discussing this policy is, in itself, also Kafkaesque. When I asked about this at a GP meeting a few months ago, I was told, ‘Yes, it is a crazy thing but all 3 parties are in favour of it so there’s nothing we can do.’ They are all worrying about how we are going to form Consortia, grapple with a limited budget, and so on.