Conflicting Views and Power
What follows is a series of emails that were sent yesterday and today in
the UK. What these contain is essentially two opposing views on free
will, authority, legitimacy and openness, and an ongoing event that is
open to theoretical analysis, but not with any specific details, the
reasons of which will become clear.
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I've just got off the phone with the Assertive Outreach's secretary
again today after another day has passed without being updated on any
progress, or the lack of, on the matters we discussed earlier this
week. For example, you stated that a Section 117 could be arranged in
'days', and yet there hasn't been even a phone call to update me on
this.
I've already made clear that, in my considered opinion, it is best if
discussions about the release of information surrounding my medical
history is finally removed from the diagnostic process. Therefore, I
would prefer that anything you or other staff have to say about this is
put in writing, whichever way you choose - i.e. on paper or via email.
I understand that I will not now hear anything until next week. Again,
I think it would benefit you if you appreciate that such delays are
little more than an annoyance when they are not even well communicated,
and would be deemed unacceptable in many other organisations.
-------------------------
All the points below are duly noted! However, as i have already
explained the process to obtain access to your medical records is via the
formal process that I have described to you. If you have not yet
received the requested paperwork this is not a hold up on my behalf as
you witnessed me request the form to be sent out and i was told in your
presence that it would be sent out the day that i had called to your
mum's address. If this has not arrived then i'm sure that it will do in
the next few postal days. Secondly, regarding your text message - you
seem obsessed with finding some way around the system in order to access
your notes on the presumption that you will be denied access to the info
that you require. As i have suggested many times previously it is always
better to deal with issues as they arise rather than presuming the
worst. The only thing i can suggest is following the appropriate
protocol for accessing your notes and see what the outcome of this is.
If you wish to continue to seek other avenues then i wish you luck but
fear you will be unsuccessful as patient notes are in no way shape or
form covered under the remit of the new foi act. You requested that i
let you know if i have any alternative ideas - i don't have any and this
is the only reason i have not thus far replied.
On your point regarding the 117 I have discussed the matter with Dr F-
and he is happy that we could discharge you back to the care of your GP
in theory. In practice this requires some liaison with your GP and a
formal 117 discharge meeting. this will need to be booked with A- Dr
F-'s secretary who is currently on leave and will quite simply require an
agreed future plan of care with your GP and the attendance of an ASW to
complete the paperwork. I stand by my point that a meeting could be set
up very quickly but I can see no good reason why this requires us to rush
through a process for the sake of formality. you appear happy to see us
occasionally at present and I would suggest that within a few months we
can work our way through the practicalities in order to do things
properly. Actually your status of patient in the trust makes no
difference to your ability to access your past files and so the 2
activities need not be related in the slightest.
Finally, I am concerned at your apparent need for immediacy. I do not
believe you unwell at the moment but am concerned that you seem to expect
immediate results from structures within an organisation that can be
(necessarily?) beaureaucratic. I am completely powerless to change these
systems and in fact am employed to work within them. I can only advise a
degree of patience in order for us to work through the processes which
exist (whether you or i like them or not). I hope that you also
appreciate that I am primarily community based and do not often get
opportunity to sit in the office and reply to e-mails. Behind the times
in the NHS we may well be but unfortunately things are as they are.
I hope that this provides you with some clarity as far as i can offer it
----------------------------------------------
> [quoted text muted]
Yes, the form has arrived, and if you wish to suggest you are utterly
reasonable, you are well within your rights to do so. However, anyone
exposed to the inconsistencies of medics' statements - along with the
emotive nature of those statements - about withheld information would
have to conclude that your approach here suggests a continuance of
the same approach, vulnerable to the same long-term failures.
This is why I consider it best to remove the very debate of withheld
information from medical personnel since they are also charged with
making diagnostic decisions, and conflicts of interest are not
inconceivable. The integrity of medical diagnoses can only be better
served by such a division. If you are tempted to respond that this is
merely asking for preferential treatment, then perhaps the
long-standing inconsistencies over information have influenced
everyone's approach.
> [quoted text muted]
Here is the problem and this is one of the reasons why the policy has
been a long-term failure with long-term implications for a number of
people. I have been powerless in discussions about withheld
information since the decision was made to withhold information to the
extent that medics were compelled to contradict even themselves. In
light of this, I have no input in any decisions or opinions regarding
this whatsoever, including even making the case to anyone who could
influence matters.
This is the position it was considered best to put
me in at the time and that is what restricts possibilities now. A
concern of mine is that the decision is not open and is certainly not
up for discussion, something that will have an unnecessary effect on my
functioning for life. It was a long-term decision. If it is adhered
to, it will have a life-long effect, regardless of the concerns
and rhetoric implying the opposite.
> [quoted text muted]
With the danger of being open to criticisms of unreasonableness, it's
hardly reasonable to leave people waiting around for others to make
decisions without even informing people of developments that
everyone considers important. A less arrogant and more respectful
approach to people might yield results that are not overtly obvious to
a career nurse.
As for the reasonableness issue that you seem at pains to highlight, is
it necessary to wait for a Doctor's full-time secretary? Does the
Doctor cease functioning if his secretary is not around to tell him
what to do? I was under the impression that staff cover for such
absences, but this may be another example of my unreasonableness.
> [quoted text muted]
It takes seconds to either fire off an email, send an SMS message, even
request of a secretary to pass on whatever message in a call, a
letter or by other means. However, you seem not to value the idea of
keeping people closely informed of what decisions are being made about
key aspects of their lives.
Obvious as this sounds, you really only get one life. This is my one.
I would like to have the ability to no longer live under a cloud
because others ultimately decided that I am not fit to make informed
decisions about it and shaped a mental health approach around that
opinion.
> [quoted text muted]
-------------------------------------
As i said the other day I accept that concerns you have as being
completely reasonable. i am just concerned that you may be looking for
answers which do not exist or for reasons of the systems that are in
place prove impossible to find. I am primarily concerned that your
desire to access your medical records may simply be a wild goose chase.
I (as a career nurse) am aware of the red tape (necessary or otherwise)
that exist within the NHS and often feel that there may be too much but
like i have said systems are what they are and i try to find the easiest
ways of getting everything done that needs doing done. However, there
are times when I have to acknowledge that there are some ideals which i
cannot achieve. This is just life as it is and not life as i might like
it to be! Even if you get to see your notes you are clearly looking for
something very specific and i'm not sure that you will find what you are
looking for.
As for the process of seeing your notes it is not a 'medically led'
process. The medical records dept does not involve medics, they are
administrative staff! As already stated it is a bureaucratic/legal
process and not a clinical one which is why i feel your demands of me are
misplaced! I have already done all i can at this point and i am not
colluding in some sort of conspiracy to stop you accessing your notes.
As for my tardiness in regards to replying to you my understanding was
that we would work through things in due course. I could have sent you a
text back a couple of days ago but i wouldn't have had anything to say to
you. I understand your eagerness to move forward but unfortunately
moving someone out of services must inevitably fall as a secondary
priority in Dr F-'s diary as it is something that can be done at any
point in the future and does not need to be done next week! It will be
done as soon as we have had opportunity to liaise appropriately with your
GP and an ASW. The fact that Dr F- and his secretary have both been away
is really secondary to the fact that until Dr F- has spoken with your GP
and agreed that he will follow up your care we cannot discharge you from
your 117. I will book a meeting once Dr F- has done this! Once again
this is a simple matter of following process!
Also, I believe i have now deleted your texts but my memory of them is
that you asked me to get back in touch if I had any ideas about other
ways for you to get to see your notes. I think i have made it clear that
i don't know and so i have nothing to text you back with.
I hope that we can move things forward in a reasonably timely manner but
the 2 issues as i hope are clear are not entirely in my hands. I have
done as agreed and spoken to Dr F- and gained provisional agreement for a
117 discharge. Dr F- will need to write to your GP and await a reply.
Once this is done we will gladly move forward but I'm afraid there will
be need for a degree of patience. I hope that everything is now clear or
at least as clear as it can be at the present moment.
Having read through what i have written it might be interpreted as being
a little defensive - it is not intended in this light. I am merely
trying to clarify things. I hope that you will take it as such
--------------------------------------
> [quoted text muted]
Well that would be pretty expected if, as usual, the issue gets clouded
and shifted onto irrelevant matters.
> [quoted text muted]
This is odd. In my criticism I did not specify the NHS at all.
However, if you wish to make such assumptions and extend statements in
such a way, so be it. I have to wonder about your perception of the
recipient and what you are trying to achieve if you are making
such extensions and using such terms.
Either I have full and open access or I do not. It was made
abundantly and aggressively clear years ago that information would not
be fully accessible to me under any circumstances in the imagination of
those promoting that view. It was a short-term fix that has failed in
the long-term because, even at the point of a supposed discharge, the
policy that supports these roles and ideas is maintained because of
the extent to which that policy could be implemented. Only openness can
bring them to an end, leading to a successful discharge in the
long-term, while restrictions will only maintain them.
The incredibility and failure of your assurances is something to take up
with those people, not me. Certainly that is the case if it really is
the view that I am to regain meaningful independent and productive
living, rather than a convenient misinterpretation of the
terms. Ultimately, I have little, if any, say in whether it is possible
for me to ever live independently and actually enjoy life fully.
> [quoted text muted]
Well, neither am I, considering that there is unlikely to be a rational
and open discussion. It is no real surprise, since I am accustomed to
having people in the unnatural position of being able to ask me
questions about specific topics only to deny all knowledge of anything
related to the specifics of what they have just brought up.
Unfortunately,
medics first established and legitimised this approach after the horse
had clearly and unavoidably bolted from their own mouths. It is a
policy that has been unsuccessful, but seems to have to be seen to be
successful. It really is the stuff of satire and it is something I
never encountered before this policy was implemented.
> [quoted text muted]
Interesting terminology. However, I have already tried to
establish that there is a tendency to cloud the issue, so I will at
least try to buck the trend and avoid being led into irrelevant and
diversionary arguments.
> [quoted text muted]
Actually, I wanted updating because I don't want a cloud hanging over
tomorrow or Wednesday, the dates of the FA Cup Final and the Champions
League Final. The approach you are adopting here is your problem.
Perhaps it would be better to just say that you will endeavour to even
avoid informing me about how I am going to be kept uninformed.
> [quoted text muted]
Then it is a bit silly to be stating that the process could be arranged
in days. Another instance of misplaced assurances, perhaps?
> [quoted text muted]
Wanting an update so I can sit back and enjoy the Cup Finals without
wondering what people with such input are doing is an unnecessary
diversion and a bore, but hardly something to make me lose patience.
The likelihood of a continuation of a series of ridiculous propositions
that maintain a set of roles first established in haste years ago, and
fundamentally and remarkably unchanged to this day, is.
> [quoted text muted]
I am interested in substantial points and in both short and
long-term success. That is, successful independent living. That it has
been suggested that free access to information is inconsistent
with this is, again, something that others had no small part in trying
to influence to maintain that decision. It is as silly an idea as when
it was first put forward.
--------------------------------------
I hope that you enjoy the cup final, there is nothing more that can be
done until next week
Will speak to you again then
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> [quoted text muted]
By which time there will be an effort to bring any discussions back
into the domain of mental health...again, as you've already
attempted to establish with certain terms and ideas. The problem with
non-disclosure like this is that with it comes the likelihood of trying
to engineer and then exploit - however that is justified - flights of
fancy to maintain the whole situation.
Again, this is another way of maintaining the roles and dynamics of this
particular mental health approach, which are impossible to overcome
with non-disclosure - as you are in the process of demonstrating -
placing limits on the success of any discharge and caricaturing my
views on the importance of information. Either I am discharged or I am
not. Non-disclosure essentially means I will never be discharged
partly because it will have been thought necessary to prevent
disclosure, implying that the subject is not fully mentally capable.
And this is decided by whom? The very people who are in the position to
determine all aspects of any discussion related to this, including
setting the terms of how they themselves view and prevent disclosure.
In that scenario, any degree of mental ill-health and any way of
getting there is seen as a price worth paying. In other words, the
essentials have not really changed one jot.
If nothing more can be done on this than another set of confidence
tricks to prevent disclosure, then the policy is that other people
decide without any input from me aspects of the future of my life with
the kind of bad long-term, but self-justifying insight that has
accompanied the past seven years. That is not encouraging or really
well-thought out, like the original decision.
The type of complete authority and control over every single aspect
of information and the roles people have to play to maintain
non-disclosure means that whatever I say is 'predetermined' to not be
accepted. So I should just accept that, like has been suggested
outside of the diagnostic process, not least by medical personnel?
Again, with complete power of processes comes my complete powerless to
question that. The beauty of it is that the longer this policy has
persisted, the more justified the people behind it have thought it is,
and the greater the lengths engineered and thought necessary, even
thought they are self-serving.
I would prefer it for information regarding this issue to be in writing
from you or any of your colleagues.
date: 19 May 2007 12:13:59 GMT
author: Alias
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