I recently had a brush with bureaucracy that I would like to share with you. When I say ‘brush’ I really mean being scraped – naked and handcuffed – at high speed by a fast car over a gravel road in the middle of nowhere late at night with the lights off. But I survived and recovered fully with no long-lasting sequelae.
Let me set the scene, with a disclaimer that what I am about to say has been changed for many tedious reasons, mainly to do with my career and sanity. For sake of argument and for the purposes of anonymity (so beloved and demanded by our beloved and possibly demanding regulators) I will refer to the person/persons in question merely as ‘comrade bureaucrat’ and their place of, err, work as a certain collective, central politburo committee in an organisation that I will refer to as, say, um, err, let me see, the NHS-SSR. Obviously this has nothing at all to do with a three-letter acronym soon to be receiving (allegedly) £350 million/week from a newly foisted, sorry, democratically determined government. And for those of a more cynical nature, the six-letter acronym I have presented may well mimic a rather large organisation with at least some pockets of brilliance which we have all heard of but may not have direct experience of. And in case any of the more literary types are reading this, there is absolutely no similarity to any of the more famous books written by either Mr George Orwell or Mr Franz Kafka. Not at all in any shape, size or format, although I can highly recommend their work, and rather strongly too. Especially at the present time in history.
So, with all this in mind, here is my sordid tale in brief. I am lucky not to work in any of the glorious industrial production units of said NHS-SSR but part of my work does involve meeting with comrade bureaucrat as they regulate part of what I do. Or they think they do, which is not quite the same thing. As tends to happen in politics and the real world, some comrades are more equal than others (despite clear, supporting evidence) and some tend to suddenly disappear, never to be heard of again, with new names appearing on a regular basis from some outer gulag where their services to the suffering are rewarded with a position in the politburo. This seems to occur at the end of a less than glorious career and mainly seem to be of the ‘male, stale and pale’ ilk, although there are some exceptions.
Anyway, the latest incumbent wrote to me advising that everything I do, think and feel, just by dint of the thought-crime of holding a medical degree (and a licence to practice medicine in the Disunited Kingdom) requires his approval.
“Really, I said?” “But that is not what our glorious and noble regulator, the GMC (Glorious Medical Council) has said. Nor does the glorious and noble Law state this. Can you clarify the legal and regulatory basis for your pronouncement?”
Clearly I was risking excommunication to a remote gulag (or possibly worse, a full-time, permanent position with regular on-calls in one of several District General Hospitals in the back of beyond clearly in need of this revolutionary’s skills and abilities).
Comrade B. duly wrote back saying that, “you are a doctor therefore everything you do is my remit and if you do not obey I will strike you down with mighty thunder”. Actually, he didn’t say that, but I suspect he wanted to. I was threatened with excommunication, beheading and worse, though, unless I did what I was ordered. (I did forget to point out that there would be few things worse than beheading but I managed to refrain and have since reflected on this thoroughly and discussed it all with my appraiser, so that’s all right then).
Despite my jovial tone, I was not amused as essentially I was being told to break the rules and to reveal confidential details of work that did not require a licence to practice medicine and were protected under Law. So when in doubt I sought advice and did some research before proceeding. I checked the rules of where I was doing the reactionary work in question and lo, it stated clearly that confidentiality was mandatory and that this could not be broken, even for Comrades in the Central Politburo Committee. I sought advice from legal colleagues (they really are lovely and helpful) and was advised that the threats made against me were also not appropriate and that I should escalate this. So I did. I did some research and found out the name of the Glorious Leader of the whole NHS-SSR and wrote to him, explaining my plight and providing details of why Comrade B was wrong. I presented and explained the three statutes which supported my views, as well as the Statutory Instrument and the relevant case law. After this I bad tearful farewells to my beloved and settled back nervously with my battered suitcase of essentials to await my one-way ticket to oblivion.
But nothing much happened, and eventually, some weeks later, I was contacted by one of the Great Leader’s minions who wanted some further details and promised an extensive inquiry. This did not happen (obviously), nor have I ever received any form of acknowledgement from Great Leader. But what did happen was that Comrade B was suddenly replaced, a new apparatchik appeared in post and my concerns were eventually sorted and it all settled down, relegated to history.
There is obviously more to this story, a lot more actually, and some details have had to be changed/omitted/re-imagined etc to protect the guilty (well, they are bigger than I am). It is sad that this sort of situation remains common, at least in healthcare, and I suspect that a lot of people, not just doctors, have been faced with silly bureaucracy which has no basis apart from some jobsworth abusing the power they think they have because they can.
This is just the sort of situation that mediation may have helped, in case my pleas involving reason, logic, justice and the inconvenience of the Law did not work. I have found that organisations do not follow their own policies or guidance, and the guilty usually have no knowledge of the Law. Even worse, perhaps, they have no interest in finding out. It is ironic that those in charge are sometimes the worst culprits, that they lack insight (as well as skills, ability, competence, a dress sense and much-needed mouthwash) and do not check their facts before they make their silly pronouncements. Licenced doctors have a duty to obey the Law and being told not to can count as what the lawyers call an ‘inchoate’ offence, which sounds rather painful. Clearly not following the Law and merely obeying orders is not defendable, yet this still seems to happen rather a lot despite all the policies, guidance, regulations and verbiage about how dreadful this is and how it must change. If you don’t believe me, look into the history of medical regulation (I have) and learn enough French to translate the following: “plus ça change, plus c’est la même chose“. *
So next time some faceless bureaucrat has a go at you for no obvious reason apart from thinking they can, stick up for yourself, making sure that before you act you get advice, have read the relevant policies, guidance, regulations etc that govern what you do, not forgetting to consult your contract of employment. Unlike you, perhaps, I am lucky to have a ‘portfolio career’ in which I do multiple jobs in multiple places for multiple employers, yet this can (and still does) cause difficulties for the small of brain who cannot compute that we are not all the same and that careers nowadays can be diverse and ‘different’.
Finally, if things fail, which they can, sadly, there is nothing to stop you from suggesting mediation as the way forward. This may well save you (and them) a lot of angst, time and trouble and usually works well. Oddly, and coincidentally I just happen to know some very good mediators…
* “the more things change, the more they stay the same”.
Consultant psychiatrist with extensive medicolegal, managerial and judicial expertise acting as medical consultant to ASM and an accomplished linguist and academic.