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Improvement Science London



A discourse of lament and a discourse of joy

By Emily Bellshaw, on 1 April 2016

Professor Martin Marshall











Professor Martin Marshall

Lead, Improvement Science London

I recently had a chat with a health manager from New Zealand who was in London for a three month sabbatical. He told me that prior to his arrival he had read about how unhappy doctors are in the NHS, about vacant posts, mass emigration and early retirement. These stories were reinforced by introductory conversations that he had with the leaders of national professional bodies. But then he started talking to front line clinicians about their work and he was surprised to hear a completely different story, one dominated by moral purpose, full of passion and commitment.

‘You must have been directed to the small band of incurable optimists’, was my sceptical response. But he disagreed. He described how, if he started a conversation with a group of doctors about the challenges of working in the NHS, then what he got back was a graphic tale of woe, about financial cut-backs, unreasonable workload, staff sickness and disabling bureaucracy. But if he talked to the same people about their interaction with patients, their eyes lit up.

Sociologists tell us that professions classically describe themselves using a range of different discourses. The discourses of the medical profession are often critical of political and social change. A discourse of lament has become a dominant one in recent years. This negative discourse is criticised by some commentators but it is a legitimate narrative that serves an important purpose. It highlights the very real risks of trying to keep a public service running with inadequate or poorly allocated resources and undervalued staff. Professional leaders have learnt that impassioned laments grab the attention of politicians and are much loved by their more vociferous members. Tactical laments are even more effective and that is why the newspapers and professional journals are full of them.

But laments, understandable and useful as they are, have side effects. Are we reaching a point where the medical profession is contributing to its own poor morale and making the recruitment of new doctors and the retention of old ones even worse? It is easy to talk yourself into a hole and even easier to reinforce other people’s unhappiness. Misery is contagious. But so too is joy and whilst it is hardly fashionable to talk about joyful discourses in pubic, they are out there, in every consulting room and over every cup of coffee.

So perhaps it’s time to rebalance our professional discourse. As the Dalai Lama says, ‘choose to be optimistic, it feels better’.

Martin Marshall
GP and Professor of Healthcare Improvement, UCL
27th March 2016

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