The NHS rhetoric is the reality

And apparently, so do Joe and Josephine Public. So who's right and who's wrong, and where will this leave us in the up and coming world of Patient Reported Outcome Measures?

As a great devotee of both the French existentialists (Camus is better than Sartre, by the way, and don't let anybody tell you any different) and of Derrida and his torch-carrying postmodernist chums, there is no doubt in my mind that the rhetoric is the reality. So if the punter says that he couldn't get to see his GP or that the care he received at the hospital wasn't up to muster, well then frankly that's that. Equally, if he says that he could get to see his GP and that the hospital care was tip-top, does it matter that the surgery was closed or that the wrong leg was cut off? (I know it does, I know it does!)

And to generalise, dear hearts, I would postulate that this debate lies at the very heart of the (ideally) creative tension between the clinical and non-clinical view of the world. By the very nature of their profession, clinicians in general and doctors in particular are the ultimate modernists. They are driven by data and measurement and look for universal "truths" based on good science and the sharing of knowledge. There's nothing they like better than a randomised control trial and a good bit of quantitative data. The public, meanwhile - and the managers amongst them - are increasingly postmodernist, giving equal weight to qualitative measures of perception and feeling alongside the quantitative measures of outcome. And sometimes these views of the world aren't too easy to reconcile, particularly when the data sets tell you different things.

And the conclusion is... well, to keep on talking about it for a century or so. And in the meantime to recognise that it's not an "either/or", it's an "also/and" (qv every management course I went on from 1994-1996).

Alternative philosophical ramblings to the usual address.

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