Tevye and QI

Today was incredible.

I experienced a blend of all that is good, uplifting and special in the NHS.

I was talking to a group of Foundation doctors about Quality Improvement. They came from across South Yorkshire and it was inspiring to be in a room with so many bright, young people, all of whom, (it appeared) were on my wavelength in terms of how we provide care – what it is, how it should run and be organised; how patients should be approached (with sensitivity, thoughtfulness and creativity) and, yes, caring, compassion and humour.

So, I wish to thank those doctors who spent a few hours with me today.

What I found particularly surprising, and, perhaps unexpected, was their lack of awareness of Tevye!

This came-out when we were discussing the reasons that we frequently remain stuck in patterns of ineffectiveness or mismanagement, why patients are transformed from people into unit numbers or forgotten pathologies – why we do what we do and we keep doing it… Tradition!

None of them had seen the musical (or film) (or were willing to admit the fact). Fiddler on the Roof, was something I grew-up with; I wasn’t quite weaned on Tevye’s tallisim, but the little village of Anatevka, with folk singing, dancing, praying, arguing, debating, discussing, is a core aspect of me; Tevye the milkman – Topol to those in the know, was a Hollywood character vibrantly alive in my childhood who was always ready to spring into song and dance, to stroke his beard and ponder, ‘What if the Czar…’

Tradition is a strange concept in the 21^st Century; iPhones, the internet and artificial intelligence aren’t things you consider when the word is mentioned. Indeed, I wonder to what extent tradition affects most of us on a day-to-day basis;

There is another word, which I am sure, were I talking to my local rabbi when I was a youngster, would have been alien… Is tradition not just habit – doing things the same way, repetitively, again and again without necessarily considering why?

Habit is a fundamental of being human; without habit we would not be fiddling with iPads or game consoles; habit is the inherent human capacity to learn and assimilate ways of being, ways of doing – brushing our teeth, eating our meals, driving to work, it is what enables us to ‘park’ our consciousness and attend to other things – thinking, dreaming, imagining…

When we are functioning habitually, perhaps you might say, on auto-pilot; these are the times when we are most human, when we are liberated from our corpore sano – to plan ahead, dream, wish, ponder;

Does my dog ponder what would be? I will never know.

I do however ponder… What would be, if we were allowed to adopt, to capture the buzzing, the fizzing, the 100 miles an hour psychical energy contained within a group of 50 young doctors, all of whom are happy to explore ways to make things better (that is the ‘QI’ – the ‘Quality Improvement’) – I was heartened to learn that some of the doctors had turned-up with the title of my talk and nothing else… how to make things better.

If we could be liberated from the shackles of the system, of the absurd, ?diabolical pathways of postgraduate medical education that have taken-over medicine in that past 15-odd years, and doctors were allowed to let their natural talents, creativity and thirst for care drive them forwards, we would have a system of healthcare (or health and social care, if the concept was stretched) that was actually suitable, appropriate to those who turn-up at the doors of hospitals, GP surgeries and clinics seeking support, rather than the hobbling, mostly, outmoded 1960’s model of care that we currently offer; beyond the systemic arguments, and oversimplifications relating to days of the week and survival –

I thank the doctor today who expressed that it ‘Wasn’t just Hunt, but the whole Tory party’ – that are behind the disillusion of our system.

Re-imagining, re-thinking new ways of care, of support, of sustaining ourselves, both in terms of society and as individuals is long overdue in the UK, unfortunately, you cannot build a New Jerusalem but just taking-away, you need to provide support, nourishment, succour to the builders, if you hope to have something that is fit for purpose, not bogged-down in habit, tradition and ‘the way we do things round here’

Let’s keep fighting!