Transactional and transformational healthcare


In life

There are

2x of interaction;


The first,


I give,

you take.


Quid pro quo.


A pound of wheat






Transactions are the basis of life,

they are the mechanics;

the organ-grinders

the fuel.


Transactions aren’t bad,

nothing good

or bad,





this is the interaction that results in a change in the giver and the taker.

both sides of the equation







It is


and adult,


you see,

These shifts can take time.


Not wanting to over-complicate,

veer into almondbread,

Let’s stick with the original concept.


You see,

I have been thinking about this in relation to health and care.

For, there are transactional and transformational

Elements to both.


Next weekend we are providing the population (at least,

If you are over 65 and one of our patients) the flu jab (or, jag, if you are Scottish).


This is,


expose arm

And off you go.

One, two, three.


Vaccination transaction.


Chick, chak.


Ebb and flow.


This is not to say this encounter is just a swap, there is more.

On Thursday we are having a Covid Conversation – (details at the end.)

We are discussing video conferencing and clinical consultation.

This is the way in which lots of patient-doctor interactions are conducted.

Although video, this includes phone-calls too.

Everything is done to minimise face to face interaction and the risk of spread.

For the most, this technology is great.

Indeed, it saves time and effort; no need to sit in a doctor’s waiting room, no need to drive or take time off work – presupposing you have a car and a job.

You are beamed-into the surgery, they are projected into the palm of your hand.

Many questions can be answered this way.

It’s good for rashes, and perhaps pains, as in, it hurts ‘here’

This is transactional medicine.

It is hard to estimate what proportion of healthcare interactions this covers; perhaps 60 to 70 per cent.

Suffice it to say, many people when worried about something don’t have anything wrong, or if there is a disorder, it is self-limiting.

And, this strategy for clinical interaction should suffice. (phone or video) (additionally, presupposing you have a smartphone, or a regular phone and you are able to use the device – you don’t have cognitive or sensory impairment that gets in the way).

The remaining 20, 30 or 40 per cent of healthcare problems don’t work on video, either because video is not available or, the problem is not one with a straightforward fix.

When clinical sleuthing is required, the building, developing or extending of relationship, when acknowledging body-language, the order of words, emphasis, posture, the direction of gaze, when one must ask the same question in different ways, to clarify, assess pallor or the rate or depth of breathing; and then, there is physical contact – no feeling the pulse, rhythm, volume;

This is surprising to me, as, when Covid started I wrote something about the way in which clinical examination had become irrelevant – if a patient has a pain or weight loss or vomiting, the diagnosis nowadays is made on the basis of blood tests and CTs or endoscopy; for much of the 20th century when technology was not available, a stroke or cancer were clinical diagnoses and likely were as often right as wrong.

With the coming of Covid and the shift to video, I found that I feel like a call-handler, a technician, missing-out on salient information that could steer diagnoses and care.

And, so, I have come full circle.

The transactional elements of my role will almost certainly be replaced by robots – indeed, you can Google your symptoms and reach a reasonable diagnosis, yet, the deeper interactions, the ritual transformation that relates to doctor and patient, this is hard to transform into an algorithm, given the complexity, given the uniquely human elements of the encounter.

I was reading in the New Yorker over the weekend an article which described the way Covid has robbed us of smiles, handshakes, kisses and hugs.

Transactions are expendable, transformation is not, transformation is human.


Meeting number 8 = 3rd September 11.00am to 12.00 noon

Meeting focus – we suggest this may be an ideal opportunity to discuss ‘remote consultations’ some themes may come out of the prior webinar

Please follow the link below to join the conversation

Join Microsoft Teams Meeting

+44 113 486 0108   United Kingdom, Leeds (Toll)

Conference ID: 563 319 746#

Local numbers | Reset PIN | Learn more about Teams | Meeting options

Join with a video conferencing device VTC Conference ID: 1267580063

Alternate VTC dialing instructions


We look forward to welcoming you and encourage you to join the conversation

Again – apologies for the layout; still struggling with the new editor; as if CV wasn’t enough…

Published by rodkersh1948

Trying to understand the world, one emotion at a time.

One thought on “Transactional and transformational healthcare

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