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VIOLENCE IN THE NHS One factor that is still making it difficult for the NHS to tackle violence, verbal abuse, and much of the underlying tension in its environment generally, is its reluctance to look at the issue from the perspective of the offending patients themselves. Where their friends and relatives are also involved, they should be regarded just as important in providing feedback. Little or nothing truly unbiased, or without an undercurrent of almost wholesale condemnation, is ever heard of these people. The circumstances, wholly or partly responsible for their behaviour, the causes of crime, are seldom set out fully anywhere, as though it all just happens in a vacuum. Of course, whatever the circumstances, violence is not something anyone would wish to condone. But it's also quite unreasonable to suggest, as sometimes appears to be the case, that every patient, and their friends and relatives, who ever succumb to a regrettable act of disruption, necessarily belong to an identifiable class of mindless degenerates. This appears to be a diversionary tactic at best. Any unbiased survey should show there are, among those so lumped together, a sizeable proportion of normally as good citizens as anyone else. Some may once even have worked on the other side of the divide. None, certainly, would ever have dreamt of going to hospital one day just to pick up a fight. What seems to happen so often is not beyond comprehension. Traumatised as these patients may be already, they become exposed to yet more stressful situations, at a point you rather expect things would begin to get better. Loss of control becomes hard to avoid. Today, there are many such situations in the NHS acting as triggers. Of course not everyone reacts in the same way. There are those who, in similar circumstances, would resort to formal complaints (revealing perhaps how close they themselves get to uncharacteristic behaviour), and even those who can't understand what the fuss is all about, being so satisfied. This, however, is by no means proof of malevolence on the part of the more susceptible among us. These adverse situations are commonly attributed to a chronic lack of investment into the NHS. It is true that there's much more going into it now. But it's still not clear whether the old trend is about to be reversed. There's always the danger that more investment might rather consolidate it with yet more cosmetic measures, short sighted innovations and an excessive flow of cash in unclear and mysterious directions. One true indication of progress would certainly be the extent to which the conflicts between the NHS and its users subside. The process, however, is still unlikely ever to be complete or as nearly so as possible until there has been a change of attitude as well on the part of a significant band of diehards. There has been, and still is, a tacit assumption that doctors and nurses particularly are above saying and doing anything that might ever provoke an angry reaction from a patient. Or if it should ever so happen, depending on their mood and temperament, you should either concede them that right or privilege, or be prepared to emerge as automatically guilty in the event of a confrontation. Of course, there are very many good doctors and nurses, and other health professionals, who are highly respected and revered by their patients. Despite any displaced aggression they might suffer from bullies on either side, they never allow their bedside manner to be tainted by a generalised hostility or intimidating pomposity. They have got in their nature what pacifies even an agitated child. Events in recent months, and the force of public reactions to them, have had the effect of sobering up a few of their colleagues, too. The blind tribal loyalty to their group so characteristic of them has loosened somewhat. A legitimate complaint against one no longer goes down as an effrontery against all. Many have even developed the extraordinary courage to whistle blow on the rogues and incompetents among them, thus saving more lives. There are many ways in which certain doctors and nurses can themselves offend and provoke perfectly good patients to react in an uncharacteristic manner. They are too well reflected in the scores of cases that come before their disciplinary committees and the courts, let alone lesser ones dealt with otherwise, to need a detailed description here. Indeed, let's face it, so much in recent years has emanated from that side, and of such tragic nature making it hard even to imagine that any patient could ever do anything comparable in cold blood that it's truly amazing there has not been a more severe backlash from the general public. We have seen incredible self-restraint even on the part of those directly affected. Psychiatric patients, it is said, account for the highest proportion of the 65,000 or so cases of violence reported for one year. Now, if we add to their number those who are victims of overwhelming conditions, those provoked through lack of social and psychological skills or sheer rudeness on the part of health professionals, those acting under the impulse of some physical affection, or temporary aberration - well, it even further reduces the number of pure thugs and habitual troublemakers (intoxicated or not), instead of letting it continue to obscure the likely nature of the crowd. Nor are psychiatric patients all necessarily abusive or violent, though this notion still gets peddled in society today. Ironically, many of them suffer the more in this culture today simply because they can't generate enough of the thunder and lightning it takes to attract attention. Where violence or a tendency to it is not a concomitant of their conditions, it may still be presumed that an aggravation has resulted from some shortcomings in their physical or social environment. The widening flap between health professionals and patients, with this tacit assumption that the former can do no wrong, is fraught with the danger of making even those elaborate complaint procedures look like mere whitewash. Not many people are really satisfied with them as a means of obtaining redress or saving others from similar perils. If they were good functional safety valves, much pressure would be diverted that way. This very state of affairs could further encourage a culture of grin and bear it among certain people, while others resort to cringing and fawning (Third World style), just to relieve or mask a feeling of being oppressed as well. It could spell more trouble for the NHS if conflict should then arise between this class of patients and others of a bolder disposition. There won't be much good stuff here for the spin-doctors. There are of course many other sources of conflicts besides those seen here from an outside perspective. They may be all covered by now in a massive literature that's been produced, even further revealing the yawning gap between available knowledge and actual practice. But at least we also know now, rather more consciously, that not every patient involved in an untoward hospital incident is necessarily a drunken thug or habitual troublemaker, as the old self-serving mindset would have it. Ingrates who wilfully and deliberately inflict physical and emotional pain on those serving them in their moments of need should get what they deserve by due process of law. Tough on crime, yes, but don't under any circumstances overlook the causes of crime as well. It would be sheer repression to impose a double punishment on those who only happen to beunfortunate victims of the gross (remediable) deficiencies of the NHS. S. BEESOON USEFUL LINKS David Glass's relatives were put in prison because they attempted to protect him from doctors. Their story can be read on www.david-glass.com Angry Patient Abuses Blair Record Complaints Against Nurses Hospitals to ban Violent Patients violent
to staff Public Not Alone With Physician Complaints Complaints Against Doctors up by a third Rise in attacks on staff " blighting
NHS"
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