Speaking constructively

A number of people have told me that my ‘clinical’ posts are aggressive, moaning, difficult, unconstructive, provocative, leaving no space for a discussion. I’d like to respond to these voices.

So, are my ‘clinical’ posts all that above? Yes, I think to some (perhaps even considerable) extent they are. Do I aim to make them so? No, not really. In fact, what you see are versions which are always significantly toned down, combed over to look as polite as I can manage. What you see is the bare minimum, the bottom line. I am also delighted to report that no one has ever said my posts are impolite. Strong, yes, impolite, no.

It’s time to explain. The way I see it is that when I am asked to be ‘constructive’, I am really asked to be respectful. After all, I am addressing the royalty, I mean, the doctors, the crème de la crème of the society, so, I should address them with a slightly bent knee, gratefully genuflecting as I write. After all, I can only be a source of useful information. My anger, my disappointment, my pain, my sorrow, my suffering apparently are not good enough. They should be mitigated in the posts, otherwise the posts are not constructive enough.

But there is more. You see, sometimes there is nothing constructive to say.  What exactly am I supposed to say about three nurses walking into my doctor’s surgery, without knocking, when I discuss the possibility of having cancer with him?! If they, he and the hospital do not understand how unacceptable it is, not only do I not want to be constructive, I have nothing to say to them all. I can only be angry! Or when I am told I look for an illness in myself, or when the doctor doesn’t even look at me as they type ‘the notes’. I really don’t think there is anything constructive to say. And no, I’m not really open to suggestions.

Under my last post, Dr John Launer wrote:

I used to find your blogs too provocative and non-constructive but have gradually come to appreciate them as representing an essential voice of patient protest and sometimes anger that we need to hear.

This is very important to me and I appreciate John’s comments very much. They point to another important aspect of being ‘constructive’. For me in order to be constructive, I need to be acknowledged as a partner. Not as a provider of stories, a source of ‘constructive’ information or patient opinion and feedback, with which you will do whatever you wish. In fact, I always think that my feedback first must be authorised as feedback; if it’s not ‘constructive’, it doesn’t count and can be dismissed.

And if anything, I want to be part of the conversation. But that can happen only if my anger and the rest of what I feel is acknowledged. Without the acknowledgement, without the conversation partnership, ‘constructive’ talking is moot. Who cares how constructive I am, if you can reject whatever I say, as my constructive post becomes ‘feedback’ rather than part of a discussion.  And as long as you can do whatever you wish with what I say, as long as I am just a provider of patient opinion, ‘constructive’ means genuflected, respectful. And I don’t particularly want to genuflect.

Now, I am not certain at all that this is the way. Perhaps speaking constructively, neck slightly bent down, is the way. The problem is that, for me, it’s not enough. Maybe it’s the insignificant pain which, after a while, just gets to you and you can’t speak constructively. And what’s left is simmering over into a blog post.

  1. I agree with your point that something there may be nothing to say about a clinical consultation or intervention. I can, however, sympathise with clinicians who may feel worn down by some of these criticisms.

    I am a social work academic and practitioner. As an academic I can see the need to change the conversation through critiquing approaches and ideas. When you are a practitioner, posts or articles which are primarily negative can feel quite different. Many practitioners are inept or arrogant, but many others would like to be reflective and would like to change their practice for the better. Calls for constructive criticism can sometimes be an appeal to think together about how change might be brought about.

    To give an example, as a social work student I remember reading a long critique of social work practice in a text books. The author provided a long list of criticisms about the profession and its failings. I agreed with many of the points, but when it came to the conclusion, the author briefly stated “it [social work] could be so much more than this”. This left me feeling somewhat disheartened because it was very difficult to see how practice might be improved.

    So, in conclusion, I do agree that criticism is necessary, but also feel that we as academics also need to apply ourselves to showing how the conversation might be changed. This is much more difficult than critique, but is something I think we need to apply ourselves to more.

    1. Dariusz Galasinski

      Thanks for your comment. There is no doubt that some clinicians might be worn out by criticisms. But then, let’s not forget that some patients are worn out by making them and hitting the wall in the process. Let’s also not forget that it is considerably easier to ignore patients’ comments than it is to make them.

      As for what makes a constructive criticism, I still feel that it is those who are criticsed who set, or at least want to set the rules what constructive is. I don’t think this is helpful.

      And just to repeat the point. I have heard/read about the need to ‘listen’ so many times that one might be forgiven for thinking that the horse has been flogged to oblivion. And yet, apart from the rhetoric, I still (and I speak only for myself) cannot see it in clinical practice. Put differently, how many times do you tolerate someone walking into the consultation room completely ignoring the fact that I might be actually talking about highly importatnt and emotional things. And afer your level of tolerance disappears, I think that ‘being constructive’ just doesn’t arise. And I’ve had enough.

      So, on the whole, yes, it’s good to show how converstation can be changed. But that implies that conversation can happen. And I am not entirely certain it can. At least not always.

  2. Sharp mind. Quick tongue. Zacietrzewienie (sorry, I couldn’t help myself, this word sounds so delightful) – in a good way. Thank you for still being you, but in even better, refined state 😉

    1. Dariusz Galasinski

      Thank you for remembering me – we live in our students, I think. You’ve made my day (after all these years). I’m moved.

  3. I’m glad my comments on your last blog were *constructive* 🙂 Seriously, I think doctors and health professionals have a lot to learn from patients who are angry, bolshie and even impolite. Maybe as you suggest, we expect negative feedback to come nicely packaged – and dismiss it if it isn’t. I’m sure this expectation contains all sort of prejudices, including cultural as well as psychological ones. It’s interesting that there are so many courses nowadays in “Dealing with Difficult People” but I haven’t seen any on “Learning from People You Find Difficult”,

    1. Dariusz Galasinski

      Thank you for your comment, John. Your point about dealing with difficult people is very well made.
      (Incidentally, can doctors be ‘difficult people’ or is it reserved only for me/us?)

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