5 ms·

Maybe this is the reason that the certain other BDFL is still in service? Maybe it's part of psycho-hygiene in order to be able to continue? I sincerely don't k

• DanBC 8y ago
  I work in patient safety in English MH settings. The culture you describe is toxic, and I would have reported all of those HCPs to their trust (using the trust complaints process), to the CQC, and possibly to their professional registration bodies. > is part of psycho-hygiene that allows the people to be able to continue to work and keep a certain distance. It's also a culture of de-humanisation that allows abuse to continue unchecked. You find this culture in every patient safety scandal: winterborne view, mid-staffs, morcambe bay, cornwall, etc etc.
  • sheepmullet 8y ago
    > The culture you describe is toxic How? Which parts exactly? > It's also a culture of de-humanisation Again, how? I find it creepy that without any specific examples provided you would report them. Surely that creates a toxic culture.
    • jf- 8y ago
      Belittling vulnerable people, behind closed doors or otherwise, is not a part of any healthy culture.
    • DanBC 8y ago
      The context is someone hearing comments that were "shocking", and that were so shocking they could only be delivered behind closed doors. This is a good, but not infallible, sign of a dysfunctional culture in health care. It might be fine in other industries, but in health care there are strong links between this culture and poor, harmful, practice. It's interesting that making a complaint is seen as a negative thing to do: if there's no basis for the complaint no action is taken. Action is only taken - the compaint is only negative for the HCP - if the HCP has done something wrong. > and seeing how the staff was venting, talking and joking about patients - once the doors were closed. I was very shocked, The standard you walk past is the standard you accept. Have a read of the reports I mentioned to see where this toxic culture leads. Here's mid Staffs, but they all say the same: Mid Staffordshire: https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry https://www.gov.uk/government/publications/report-of-the-mid... > During the course of both the first inquiry and the present there has been a constant refrain from those charged with managing, leading, overseeing or regulating the Trust’s provision of services that no cause for concern was drawn to their attention, or that no one spoke up about concerns People need to speak up. And when they do speak up, they need to be listened to. > Negative culture > While it is clear that, in spite of the warning signs, the wider system did not react to the constant flow of information signalling cause for concern, those with the most clear and close responsibility for ensuring that a safe and good standard care was provided to patients in Stafford, namely the Board and other leaders within the Trust, failed to appreciate the enormity of what was happening, reacted too slowly, if at all, to some matters of concern of which they were aware, and downplayed the significance of others. In the first report, this was attributed in a large part to an engrained culture of tolerance of poor standards, a focus on finance and targets, denial of concerns, and an isolation from practice elsewhere. Nothing I have heard in this Inquiry suggests that this analysis was wrong. Indeed the evidence has only reinforced it. The first point in the executive summary to the Winterbourne View report says this: > The abuse revealed at Winterbourne View hospital was criminal. Staff whose job was to care for and help people instead routinely mistreated and abused them. Its management allowed a culture of abuse to flourish. Warning signs were not picked up or acted on by health or local authorities, and concerns raised by a whistleblower went unheeded. The fact that it took a television documentary to raise the alarm was itself a mark of failings in the system. Staff didn't go to Winterbourne View and immediately start punching people in the face. The abuse started with a culture of dehumanising these people, and closing off the wards to prevent criticism. > The Serious Case Review also sets out very clearly that for a substantial portion of the time in which Winterbourne View operated, families and other visitors were not allowed access to the wards or individual patients’ bedrooms. This meant there was very little opportunity for outsiders to observe daily living in the hospital and enabled a closed and punitive culture to develop on the top floor of the hospital. Patients had limited access to advocacy and complaints were not dealt with.
  • meshko 8y ago
    I agree. I know some doctors and while they do tell stories about the patients (obviously completely anonymously) and sometimes have a laugh about them, you can always feel certain base level of respect, love and care, not unlike someone telling about their kids doing something silly. Good doctors don't dehumanize their patients, ever.
• tripzilch 8y ago
  > one of the doctors, when she saw my shock, took me apart and explained that this behaviour, so shocking it might be when seeing it for the first time, is part of psycho-hygiene that allows the people to be able to continue to work Did you consider that her taking you apart and explaining it away with that excuse is just as much part of her "psycho-hygiene" that allows her to joke about the suffering and mental well-being of the human beings explicitly left in her care, without feeling bad about it? I mean, what the hell? I trust my therapists not to laugh about my issues behind my back just like I trust the chef cooks at a restaurant not to spit on my food. Even if in most cases I won't be able to tell, it's a matter of trust and professionalism. I have to trust them on this. I HAVE to be able to honestly believe that a therapist or psychiatrist with a professional attitude and ethics will NOT joke about the most embarrassing issues I trust them with, the moment that I turn my back. Otherwise you can't do therapy with them. Therefore whatever the hell this doctor thinks they're doing, is very unprofessional. No matter the excuses they told you. I mean if you need this sort of disrespectful "psycho hygiene" for your mental well-being, first consider if you're even cut out for the job. Maybe look for other parts of the mental health sector, with patients whose problems you find less hilariously funny. Finally, if you really found your calling in one of the rather serious, dark corners of mental health care, the ones that are truly as taxing that merely working there requires counselling lest you burn out, then do exactly that. Vent at a counsellor. You can even joke at them because they're bound to a professional secrecy. Your colleagues aren't. They may be to your patients but not to you and that's the point. It needs to be separate. And also VERY importantly, that counsellor will tell you when you actually cross the line and venting turns bad. In a social group, between colleagues, and a psychiatrist should know this, there is no such check. There's group pressure. Boundaries are tested. Someone says "maybe that's in bad taste", but next week two other people do it, and the someone doesn't want to keep nagging at colleagues, so the behaviour gets normalised. Boundaries have moved. Now you have a proper toxic environment. And then at some point, a young new 20-something staff-member joins, is shocked about the lack of professionalism. Now they have to be taken apart and explained why this behaviour is considered okay and is normalised. But says who?? There is no oversight, no checks, it's just social pressure and venting between colleagues. Who's there to say "this is enough and this is too much" and how are they qualified to make an objective call about it? Just out of curiosity, what country's mental health care were you talking about? The quality of that varies widely enough that sure there's enough places in the world where if your story is the worst that is going on, it's probably good and at least it's not neglect or abuse. It's a matter of how high you put the bar. Regardless, a psychiatric doctor shouldn't actively rationalise this behaviour to newcomers. Quickly getting back to the BDFL topic: There are many ways to handle pressure etc, and the ones that do not require you to occasionally "explode at someone", are in fact healthier and better for one's mental well-being.