{"id":32919,"date":"2014-12-05T15:03:22","date_gmt":"2014-12-05T14:03:22","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=32919"},"modified":"2014-12-05T15:03:43","modified_gmt":"2014-12-05T14:03:43","slug":"ben-gibbison-well-its-the-nhs-what-do-you-expect","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2014\/12\/05\/ben-gibbison-well-its-the-nhs-what-do-you-expect\/","title":{"rendered":"Ben Gibbison: &#8220;Well, it\u2019s the NHS . . . what do you expect?&#8221;"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/ben_gibbison.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft  wp-image-32920\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/ben_gibbison-225x300.jpg\" alt=\"ben_gibbison\" width=\"121\" height=\"161\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/ben_gibbison-225x300.jpg 225w, https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/ben_gibbison.jpg 480w\" sizes=\"auto, (max-width: 121px) 100vw, 121px\" \/><\/a>A few years ago, I was climbing in the Indian Himalaya. After driving to the road head, we walked for four days to our base camp. There, one of our group suffered with high altitude cerebral oedema. We carried her back down the valley for 12\u00a0hours until we reached the road head and found a car to take us to the nearest hospital.<\/p>\n<p>Once inside the hospital, I asked, \u201cHave you got any oxygen?\u201d<\/p>\n<p>\u201cI don\u2019t know Sir, I\u2019ll go and see,\u201d came the reply from the nurse.<\/p>\n<p>He appeared with a rusty oxygen concentrator, which he wheeled along the ground. We couldn\u2019t start it and so, while I made attempts to fix the concentrator, the nurse wiped down the yellowing pair of nasal speculae with a rag.<!--more--><\/p>\n<p>\u201cSurely you must have some oxygen and a mask?\u201d I asked. \u201cThis is a hospital.\u201d<\/p>\n<p>With a characteristic shake of the head, the nurse replied, \u201cThis is India.\u201d<\/p>\n<p>This has stayed with me. The acceptance that they couldn\u2019t provide even the most basic therapeutics\u2014and that we shouldn\u2019t expect them to have any equipment\u2014has troubled me since. How would they ever improve healthcare if their expectations were so low?<\/p>\n<p>Just recently, I have begun to notice this creep into work in the UK; \u201cWell, it\u2019s the NHS . . . what do you expect?\u201d The problem is that if there is no expectation of improvement, then the comment is self-fulfilling. The blame can\u2019t lie just at the lap of senior clinicians and managers; it is down to all of us to try to improve. This means cleaners, the volunteers in the League of Friends teashop, the nurses, midwives, physiotherapists, occupational therapists, social workers, junior doctors\u2014all of us.<\/p>\n<p>Few of us like change and our response to it follows the <a href=\"http:\/\/en.wikipedia.org\/wiki\/K%C3%BCbler-Ross_model\">K\u00fcbler-Ross model of loss<\/a>. That is: denial, anger, bargaining, depression, and acceptance. Many people get stuck in one of these, which is definitely maladaptive and can be pathological. However, the K\u00fcbler-Ross model misses the final stage, which is \u201cresolution.\u201d This is the process in which you can use the negative experience to improve. This is an active process and that means that you have do something.<\/p>\n<p>Part of this is cultural. Earlier this year, I was in Atlanta in the United States. \u201cGeorgia Tech\u201d is the state of Georgia\u2019s science based university. As I jogged around the well funded campus\u2014with its own baseball, American football, soccer, softball, and tennis stadia\u2014students and faculty members were wearing the campus T-shirt, which in big yellow letters stated: \u201cWe can do that, we go to Georgia Tech.\u201d It seemed unlikely to me that any institution in the UK would be able to produce a T-shirt like this without being a laughing stock. But we don\u2019t need T-shirts to shout about how good we are, we just need to be good.<\/p>\n<p>Most of the problems of the NHS will not be solved by people just accepting poor standards. They won\u2019t be solved by people saying, \u201cWell, it&#8217;s really difficult.\u201d It is really difficult and you need to try, and then fail, and then try something different. Failing and trying again is incidentally something that doctors, as a group of first time high achievers, are not good at.<\/p>\n<p>Money alone won\u2019t cure the NHS of its ills either. Effort, being bothered, flagging up patient safety issues, not allowing standards to slip, working with all of your colleagues (including the cleaners, porters, and other doctors) are small ways in which we can all effect improvements that cost nothing.<\/p>\n<p>Real improvements come from system changes, but we have to point out where those systems need changing when they are bad and celebrate them when they are good. Even stalling in the \u201canger\u201d part of the Kubler-Ross model can be useful if a sufficiently large group of people feel angry enough and use their anger to pull in the same direction. But please don\u2019t get stuck in \u201cacceptance\u201d of sub-optimal practice and standards, because that won\u2019t help you and it certainly won\u2019t help your patients.<\/p>\n<p><em><strong>Ben Gibbison<\/strong> is a specialist trainee in the Severn Deanery.<\/em><\/p>\n<p>Competing interests: None declared.<\/p>\n<p>Patient consent obtained.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A few years ago, I was climbing in the Indian Himalaya. After driving to the road head, we walked for four days to our base camp. There, one of our [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/12\/05\/ben-gibbison-well-its-the-nhs-what-do-you-expect\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236,447],"tags":[],"class_list":["post-32919","post","type-post","status-publish","format-standard","hentry","category-nhs","category-india"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Ben Gibbison: &quot;Well, it\u2019s the NHS . . . what do you expect?&quot; - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/12\/05\/ben-gibbison-well-its-the-nhs-what-do-you-expect\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ben Gibbison: &quot;Well, it\u2019s the NHS . . . what do you expect?&quot; - The BMJ\" \/>\n<meta property=\"og:description\" content=\"A few years ago, I was climbing in the Indian Himalaya. 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