Patient/Professional Divide


We often talk in terms of us and them. Both users of services and providers of services. Quite often though, we are the same people. I work in a psychiatric hospital – that’s where my office is. Work defines me to a large extent. But I, or people close to me, use the services that I provide.  Yesterday, we took a referral for the mother of a colleague who works in a different office but whom I have worked alongside for years. Last year, I put in a care package for the father of the manager of a care agency that we are contracted to use.

My father, too, lives in sheltered housing (in central London, still  but in a different borough) which is provided by the council and has a care package from his local authority. I am a patient myself when I haul myself to my doctor’s surgery and am nervous enough to have something about white coat effect scribbled across my own notes when attempts are made at blood pressure readings and I stress constantly about wasting my own doctor’s time when I do (rarely) haul myself around the GP.

A very good friend of mine, a child protection social worker, suffered from severe post-natal depression to an extent that she was off work for a considerable amount of time and unable to go back to the same position. She still suffers.

The people I work with and around use the services we provide. When I was doing my ASW course, one of the social workers had been a patient in a psychiatric hospital herself for an extended period and another of the students described to us all in minute detail, the effect that sectioning had had on his mother and his family dynamics since that time.

We often talk in terms of us and them – if it isn’t explicit then it is implicit. Who are we trying to fool? Perhaps it is easier to work within systems when there is a divide in place. When we empathise but not too much. Not so much that we relate to our own experiences.

We don’t talk about our own experiences of being a patient or a user of the services that we (or our colleagues in different boroughs) provide because it detracts but it does put things into perspective a little.

I don’t usually attend my father’s care reviews – I leave that to my sisters to manage (or actually most of the time I know he’s well able to advocate for himself and probably does a better job of it than I would – of course, if I felt he needed it or had cause to complain, I’d nose around but actually he receives an incredible service).

Perhaps that’s one of the differences between working in adult and children’s services. It is a bit less ‘us and them’. We use the services. Our parents use the services. We want them to be better. We want things to run smoothly.

We want the services to be there and to be robust for the times when we reach an age that we need support.

A few weeks ago, I was called out in an emergency to the local A&E to see a woman who had been admitted following an assault by her partner. She had early-onset Alzheimer’s and although she did not need to be admitted, she could not return home. Shelters that exist in the area where I work are very limited in terms of particular needs and so we needed to think of solutions. She had been a social worker until a few years previous. Now, she was struggling to remember her address.

Of course there are more ties that bind us to humanity than a profession but sometimes it does cause us to pause for thought.

‘PERCHANCE he for whom this bell tolls may be so ill, as that he knows not it tolls for him; and perchance I may think myself so much better than I am, as that they who are about me, and see my state, may have caused it to toll for me, and I know not that….

Who casts not up his eye to the sun when it rises? but who takes off his eye from a comet when that breaks out? Who bends not his ear to any bell which upon any occasion rings? but who can remove it from that bell which is passing a piece of himself out of this world? No man is an island, entire of itself; every man is a piece of the continent, a part of the main.
If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were: any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.

John Donne

8 thoughts on “Patient/Professional Divide

  1. Well I heard it ring! It’s doing Jingle Bells right now!
    🙂 There is a post that follows on from yours that one day I will write……Funny when the bell tolls the rats usually abandon ship……

  2. Interesting post. John Donne’s poem has been one of my “key texts” since I discovered the metaphysical poets as a young teenager. Also Corinthians 13.

    Anyway..After 20 years practice,. I’m an ASW and Practice Learning Co-ordinator I make a point of being very open about a number of things – to the point , possibly, of vulnerability, but I’ll deal with that if it comes. I am a former “young carer” of a grandmother with a diagnosis of schizophrenia: that impacted upon my mother’s ability to parent , affected my devleopment and my particualr psychopathology. I have a history and a present that demonstrate vulnerability and strength, in spades. I have a belief that “professionals” should live in the communities we serve.

    I do attend my parents’ care reviews (with my dietitian sister) and I get very cross about the dichotomy that’s posed between service users, carers and professionals. Personally, I’m all three. The fact that I have always acknowledged ,and used that knowledge, makes me a more effective social worker, I believe. Service users and carers seem to agree, from feedback via colleagues.

    The people who worry me are professionals and student professionals. It’s ok to be a lecturer and a practising social worker; but a lecturer and potential client? “How can [I] be objective”. Fascinating. It seems like our colleagues and students can only handle people in silos: people who define as service users, or carers, or professionals are ok. Overlaps (especially the professional + 1 or more), are not. I suppose it’s a grandiose denial. To coin a phrase.

    Whatever it is, it’s an impoverishment thatpersists in qualified worker.” Not me guv.” We need – with greater or lesser subtlety! – to take a battering ram to it. The key divisions are not service user/carer/professional – we know that from the struggles of the 1970s (Camden Housing anyone?). They are about access to and control of ( or not) resources. We have a common cause to be made.We just have to find the opportunitues: ward closures, access to treatment ,personalisation – they are there for joint action to be taken.

  3. How absolutely spot on. My mother had Alzheimers and actually ended up on a section at one poinr – it was very very hard but it brought it home to me that we are all service users or potential ones. Similarly, my husband was killed in a road accident – the police who came to tell me had been with me as colleagues two days before – it made it harder not easier

  4. 3 cheers for that. I spent last thanksgiving getting my 10 year old psychotic niece admitted to the psych hospital and 6 months before that was in the ER with my suicidal mother. I myself needed some help with anxiety this spring. Mental illness effects everyone and there is so much more that connects us as human beings than should divide us.

  5. Silvawingz – Thanks – I can hear a faint ringing sound myself!
    susielil – Thanks for that. I agree that the distinction between professional/service user/carer is strange and tenuous. Personally I think it is a massive boost to the service if people who provide them, use them and work to improve them. Otherwise it becomes a faceless service ‘for others’ which is easier to detach from.
    Caroline – that sounds so difficult.
    IJ – yes, I like that about there being more that unites us than divides us. It works on so many levels!

  6. Oh, we’re certainly not immune to the monkey wrenches life can offer. It’s a hummbling process, being submitted to the services we provide.

  7. We are all people, really – and as a health professional the thing I offer is my humanity, and that I know a bit about what has worked for others. If I was in the situations that some of the people I see, I’m sure that I would also be challenged as much.
    I have disclosed to people I work with that I am a ‘consumer’ (I hate that word!). I do it very selectively, but I do it to show that I am still learning too. What has offended me the most as a ‘consumer’ is the suggestion that the health professional I am seeing is either immune from challenges of life, or that they have somehow got it all together.
    Great post, great quote too!

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