Normal or deviant? – culture in the caring professions

I have just been to the Lilly Lecture at the RCP in London, and owing to the fantastic opportunities to discuss the evening with colleagues after the lecture, I failed to ask Don Berwick a question that has been plaguing me.

In a guardian article Prof Berwick is quoted as saying that one of the problems at Mid Staffs was the normalisation of deviance.

My simple question is ‘have you got this the wrong way round?’

I personally feel that the medical tradition I have grown up in has not been one where the norm used to be total concern for the patient at the centre of every activity, but instead the legacy of 500 years of medical tradition where the doctor usually holds all if the cards and deals them to the patient.

I don’t mean to say that doctors are universally uncaring or dissociated from the suffering of their patients – far from it. But I feel our heritage points more to a culture where patients have not always been the centre; but -an increased transparency, patient involvement and empowerment have redressed some of the balance, and instead of a normalisation of deviance, we (society) have developed a new set of expectations against which the old normality fail to satisfy and it’s vestiges continue to fall short – and it us this which now appears as deviance rather than the expected or desired norm.

A moot point perhaps – but if we are to truly address the culture of the caring professions – we must understand where normal sits, and not put the cart before the horse.

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