Lucky, lucky me. I got another letter. It’s a very important letter, as it informs me of  an appointment with a consultant, a very important person. So, this blog celebrates the importance of consultants. Sort of.

The Health Records Department invites me to attend an appointment with a consultant or one of the team – as, clearly, the task of telling me who I will see is way beyond the hospital logistics. But I started wondering …. How do you (the hospital people) speak of yourselves and how do you speak of me?

Well, the letter is written first person plural, apart from the first sentence, so it uses the pronoun ‘we’. But when you look closer, you realise that in the letter who is speaking changes all the time. Consider:

I am pleased to inform you….

We can offer you the choice of a further appointment

Although we will do our best to keep to your appointment time, delays may sometimes occur.

We do hope you will help us to improve the service we are providing…

Within one letter, I see at last four different ‘speakers’. First, there is the person referring to her/himself in the first sentence, then there are people who arrange things. Then the people behind ‘we’ must have changed, as surely, it’s not the Health Records Department who are not responsible for keeping the time of the appointments. Who the final ‘we’ is really beats me. The hospital? The trust?  Whoever it is, it is unlikely to be any of the previous speakers, I think.

So, let’s consider it.  The initial ‘I’ is relatively uninteresting, probably driven by politeness, but what of the changing identity of ‘we’ – it has three different identities, and yet, the pronoun suggests that I am spoken to by the same sender throughout the letter, even though it cannot be so. You might say that the hospital/trust takes on a uniform identity, speaking with one voice. I, on the other hand, think that things are a bit more complicated, as the letter hides the identities of those who actually do speak to me. The uniform ‘we’ might construct a corporate identity, but at the same time, it hides who actually speaks to me. It’s worth reminding ourselves that hospital don’t speak. People do.

Incidentally, the really funny thing in all this is that again, just like in my first post on communication skills, I read about things ‘occurring’.  Let’s read a sentence again:

Although we will do our best to keep to your appointment time, delays may sometimes occur.

The ‘we’ does its best, isn’t it lovely, but delays simply occur. Once again, when bad things happen, there is no one behind them. But, I suppose, at least it’s not the patients. Thank you!

But about me? Here is the crucial paragraph:

If you cannot attend your appointment for any reason, please let us know as soon as possible so that we can reallocate your appointment to another patient. If you do not attend without informing us you may be referred back to your GP and may not be offered another appointment to see the hospital Consultant.

Consultants, I salute you. From now on, I shall not dare use small ‘c’ when I write about you. I shall endeavour even to speak with capital ‘c’! In case you wonder, yes, apart from the name of the hospital/trust, this is the only noun in the entire letter which is spelled with a capital letter. But then, consultants are very important people, aren’t they? And patients, like me for instance, should be reminded of it all the time. Lest we forget. Should we change ‘appointment’ to ‘audience’? Just a thought.

So, how am I spoken to? Well, first, it’s through the imperative, even though politely, I’m instructed to ‘let them know’, but then I am actually referred to directly:

If you do not attend without informing us you may be referred back to your GP and may not be offered another appointment to see the hospital Consultant.

It’s a nice conditional in which if I don’t do things, things will be done to me, in a sort of ‘or else’ talk. But my question is: Where is the polite and pleasant person so pleased to inform me? Gone, as are all the niceties and now I am being warned, or is it threatened? But what really gets me is that ‘we’ disappears again. You see, the sentence is entirely about me – I am (through the pronoun ‘you’) the grammatical subject (and the theme in the theme/rheme structure) in the three clauses. But why?!  If you threaten me with telling on me, at least have the decency to say that you will do it, hey?

And so, throughout the letter, I am either instructed to do things (bring the letter, a sample, medication) or told that things will be done to me.  But then comes the last sentence – it’s brilliant:

We do hope you will help us to improve the service we are providing by adhering to the above requests.

All becomes clear. You improve your service, because I do what you want me to do. And if I don’t comply, you – it’s sooo clear to me – can’t improve the service and we, the patients, get what we deserve. And perhaps here we come to the essence of what patient-centred care means. It means that I am responsible for lack of your improvement! I shall walk to the audience pounding my chest and mumbling: Mea culpa, mea culpa, mea maxima culpa.

Now, just to make sure. Yes, I am certain that unattended appointments are a problem, so are absent letters, references, samples and medications. I also understand that in order to deal with them, patients should be aware of this, you might even need to warn patients of consequences (like telling on them to their GP). But then, I have never missed an appointment – why am I being threatened? Also, I can think of a number of ways in which to write a letter which urges me to make sure that I do attend my appointment, yet, it is without a threat of withdrawing medical care for ONE unattended appointment (note that the letter does not say that it applies to ‘recidivists’). I would, humbly, suggest also a paragraph about what happens to you, when you don’t deliver. There is an interesting imbalance of consequences, isn’t there?

This letter is, again, about power. This time, however, is not about medics’ power, but the power of an institution. It tells me to do things, it threatens me, finally positioning me as responsible for lack of improvement in what they do. You? Well, for you ‘delays occur’ and, anyway, you hardly do anything for me, apart from threatening me. Moreover, the only thing I can do is tell the institution that I cannot attend the appointment. Nothing else. That’s the space I am offered. Which is, I must admit, something. Of course, the space comes with strings attached – I might not be offered another appointment to see the hospital consultant. What am I saying!? I grovel and apologise…. Obviously, to see the Consultant! With the capital ‘c’ and I do wish there were more. Like the very capital or extremely capital  ‘C’! Sadly, language has not caught up with your importance, Consultants, so perhaps, instead, I could suggest more capital letters. Something like:

Appointment to see the Hospital Consultant

And do remember, ‘audience’ is still up for grabs. It would become so much more Kafkaesque, I think. Me? I’m resigned to becoming Dariusz G.