I am re-reading Catch-22.
When I first encountered this book, I was in my early 20’s, I can remember enjoying it and, moving on to one or another of Joseph Heller’s novels written in a similar satirical vein.
Well, fast-forward 20-odd years and for whatever reason, maybe because I am older, more worldly or battle-scarred myself, I am finding some of the chapters hilarious. I mean, actual ‘laugh-out-loud’ and, for anyone who knows me, this isn’t my usual style; I tend to be a serious, silent and usually hidden-away reader.
(Another of Heller’s books, springing to mind – ‘Something Happened’)
Anyway, what could it have been that has changed in me beyond my getting older?
Well, I think particularly the sections where characters, often in leadership positions expound their life’s philosophy – why they do the bizarre, absurd, paradoxical or odd things they do;
I am not going to give you examples from the book as this isn’t an English Essay – I’ll maybe leave that to my son.
What struck me was the similarity between bad leadership as described in the 256th US Army Air Squadron and… you guessed it, the NHS.
(Admittedly there are no bombing runs in most UK hospitals)
It was reading the book and thinking about NHS leadership that that took me to the sub-set of leaders in the NHS who are doctors; in fact, they could be anything, but as I am one, that is the group with which I have the most familiarity.
It goes something like this…
Good doctors who become leaders in the NHS tend to be good at what they do and those who are good leaders were or are good doctors.
You might think this is self-evident, a tautology that isn’t worth expressing.
Well, you see, there are aspects of this which are opaque.
What makes a good doctor?
The attributes roll off the tongue – caring, compassionate, dedicated, intelligent, skilled, hard-working, focused, fun.
Not all of these are mutually inclusive, although I think to have the ‘ideal’, you need most – a caring, compassionate doctor who is rude, bullying or a bore is not what anyone wants and would struggle to get through the ‘good’ door – although, they might be able to tick so many revalidation or appraisal boxes that they can squeeze past the assessors.
This is one of the similarities identified in the Catch-22 absurdicon; Generals and Corporals advancing through the ranks not because of their prowess or goodness, but for other either more mundane or obscure reasons – nepotism, politics or the infamous Peter Principle;
What makes a good leader?
Well, they are caring, compassionate, dedicated, intelligent, skilled, hard-working, focused, fun.
Yes, I just copied and pasted the sentence above.
This ultimately leads to the absurdity that I believe connects Catch-22 with the NHS, the reality that the general (or doctor) who has potentially been the least caring, compassionate and so on, potentially rises to the top, whilst the other flounder.
Many, indeed, most, in my experience anyway, tend to opt-out; keeping their heads out of management and leadership and getting on with the job – these are the foot soldiers no one is particularly interested to read about.
It’s the mavericks, charlatans and clowns that keep us going.
Where does this take us?
Well, I haven’t finished my re-reading and I can’t remember the end of the book; things tend to roll-on.
A little like the NHS; yes, we have had the election and yes, the end of the month will happen, and we will move-on. Nothing halts time. The fires Down-Under continue to burn, people vote for unbelievably bad people, the sun sets and rises the next morning.
It is worth the worry?
I’ll let you all in on a secret that has been getting me through for the past month; this might shine a light on my lack of communication with others (I appreciate this is getting a little off-topic, but it connects with the absurdity).
Sometime just before Christmas I deleted the Facebook and Twitter apps from my phone. I also got-rid of the BBC News. Gone. Admittedly I didn’t delete the accounts, or, you would not be reading these words.
I know this might seem like the worst kind of burying one’s head in the sand approach to life, but, when you think about it, when all around you is madness (interspersed with most folk just being regular people, getting on with their lives), opting-out isn’t that bad.
I am still on email and I haven’t started wearing any disguises when I go out in public, although that might come, so I am still here – I am just hiding, a little, which seems the thing to do if I am to avoid either Catch-22’s, tyrannical leaders or dodgy doctors.
Patient – I have a really sore head.
Doctor – I think you need a scan.
P – When?
D – Today.
P – Something serious?
D – Probably not, but best to check.
P – Can you make me an appointment for today?
D – No, you need to go to A&E and wait a few hours before another doctor decides whether you need the scan, then you need to wait for the person who does the scan to decide that the scan is appropriate; then you will wait for the scan to be seen by another doctor who will say whether it is OK or not and they will pass that information on to the doctor you saw in the hospital – or, another doctor as that doctor might have gone home and passed your details across (so long as they didn’t forget to do the handover) and another doctor will have to decide on the basis of the information the first doctor and the radiology doctor has provided whether it is something serious or not, in which case, if it might even be potentially a little serious, even after the scan and seeing lots of different people they will ask another doctor to see you; you might have to wait 12 hours to see that doctor and hopefully at some point in all of this someone will have thought to give you some paracetamol and not just focused on the pain as being something separate from you and ultimately, because of systems and processes you will be shipped, always, or often, it seems at two in the morning to the admission ward, where a bleary-eyed doctor will ask you questions the preceding four or five doctors and nurses have asked you and you, equally bleary eyed will answer, and as it is by then three in the morning, a decision will be made to wait and see what another doctor thinks when they come round; in turn of course, they might wonder whether of all the conditions your pain could be it is one of those obscure, niggly ones that don’t show-up on scans (or blood tests or other assessments) and, it would be worthwhile keeping you in for another test, a lumbar puncture is a good one, which entails sticking a fine needle into the gaps between your back-bones and extracting cerebrospinal fluid for analysis (yes, this being the stuff which keeps your brain afloat) (and, you can’t really knock them for being thorough) of course, the removal of floaty fluid can cause a headache which whether your first headache has gone or is still there will not necessarily help in establishing if there is anything actually wrong, but will help take us closer to the absolute truth, whether the pain is just a pain or something else. Indeed, but eleven the next evening you might wonder what is going-on, yet, by then many other doctors, nurses, porters and support workers will have come and gone and you might not be a deal further forward, but yes, it is likely you will have to wait another day to find out whether the pain is ok, the scan normal, the lumbar puncture, blood tests and other assessments are fine and you can go with a, ‘let us know if there are other problems,’ or, ‘We will see you in clinic in six weeks,’ which will lead you to a period of doubt as to whether there is actually something wrong with your brain or head or the doctors are just wanting to be reassuring; all this stress might affect your sleep, it might make you worry, it might even, give you a sore head.
The book ahas some very funny sections – mostly to do with Colonel Cathcart and Milo Minderbinder (the guy in the photo at the top with the egg – bought for 7 cents each, sold for 5 but still making a profit for the syndicate) – both of whom represent the madness or folly of organisational hierarchy and free market capitalism.
Yet, there is a theme that runs-through the book that I can’t leave. Yes, it is the sexism; again, probably demonstrated by the picture above – essentially the book has nurses who are game for the follies of soldiers in hospital, occasional old woman/man and everyone else, all of whom are whores.
I don’t know whether Heller was a sexist/mysoginist or not or that was the experience of soldiers back in the day; essentially it is a difficult area and one that doesn’t fit with humour.
6 thoughts on “Catch-22, doctors, leaders and the NHS (healthcare, military and other absurdities)”
Highly entertaining yet incisive analogy . Have ordered Catch 22 in audio from library. Possibly only skim read many moons ago. Does seem a strange system where one is passed from pillar to post and for tests already stressful..
Laughter is the best medicine!
Plus it did seem possible that the latest news may have been ‘ next year in Jerusalem/Caledonia/Erin go bragh ‘ ( at suitable educational interval).
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Your last paragraph made me laugh – probably the first time since I came out of hospital a few weeks ago that anyone’s even guessed what happened then. (Thankfully no lumbar puncture though.) It’s decades since I read Catch-22 and can’t really remember it but do recall I laughed then.
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I think you would be surprised how common this is – for people to come in and out of hospital and both the doctors and the patient having no idea what was wrong or has happened to them – there are so many perspectives that rarely are what the patient, doctor, nurse, therapist see are aligned and even when they are this is rarely communicated adequately.
Oh – planning to add an addendum to this on; for all the book is amazing and very funny it is also very sexist which gets quite tiring after a while; sure he was a writer of his generation and you can’t whitewash the past, but worth considering.
I realise it’s common now, but I wish it weren’t. Much as I love living where I do, the healthcare here has seemed abysmal until I went to England (I’m in rural Wales) to a hospital there, and eek – horrible experience, truly horrible. Now I wonder if it wouldn’t be like that anywhere in the UK.
Years ago, when I went to the same hospital (on a Sunday afternoon, and I’d thought I was having a heart attack, but turned out I wasn’t) it was great – got seen within minutes. Had never had that happen to me, but then I had to repeat everything I’d said to everyone… and it really wore me out. This last time though I was on a trolley for 12 hours, and – haha – your mentioning 2am, rang true, as that’s when I got to the ward – and I just think… “FFS, is there any hope for good healthcare anywhere on this island of ours?” I suspect not.
Personally I’d let the sexism of the book stand. That sort of thing annoys me, too, but it was what it was.
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The NHS thing is perplexing.
The NHS was my main reason for splitting with everyone else I know who is Jewish and following Corbyn; even overlooking his anti-israel stance.
The organisation is being twisted, distorted, suffocated but lack of investment and bizarre targets, restrictions and yes, hierarchy.
I know the NHS is brilliant. And, yes, if you need a lung or liver transplant or certain expensive drugs it is great – even if you are very sick with pneumonia or a heart attack; it breaks down when you are old or you don’t fit a convenient diagnostic box.
The BMJ this week talked about the need for more generalists – or, rather speclialists like me who also look further than a specific organ or bacterium;
All this is great although they don’t quite acknowledge how incredibly hard is it to even do what I do, or have done – all in the name of improving care for people .
I am like one of those multimorbid, long-term conditions trying to fit into a pathway; were I a straightforward doctor, say heart or lung specialist, content with hosptial life and so on, I’d be fine; frustratingly I am me!
All this is person-centred care for patients as well as support for staff; my aspiration for a person-centred NHS is a dream I have yet to realise.
A lot’s got to change before you can fulfill your dream for the NHS.