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The profession that dare not speak its name

January 28, 2014

Believe it or not, gentle reader, there was a time when a doctor’s exact position on the Continuum of Cool was not determined by how they look with a stethoscope slung around their neck. Back then, with the symbolic power of the stethoscope as yet unrealised, it was all about the lab coat. Legends were built on what was stuffed into the pockets: battered copy of the Oxford Handbook of Clinical Medicine in one, folded-up stethoscope in the other, bleep clipped to the outside of either. If you wanted to make room for a couple of stand-by blood culture bottles or maybe a Filofax, the stethoscope could be worn with ear pieces round the neck, tube snaking down the chest and bell tucked into coat pocket. Either way, patient ID stickers all the way up the arms, hat pins in the lapel, buttons artfully left undone – some missing in action – and there’s your look.

What happened? Well, the Oxford Handbook of Clinical Medicine gave way to Wikipedia and Infection Control did for the lab coats. While some students of NHS fashions hold that the demise of the lab coat made it inevitable that a new way of carrying around the tools of the trade would have to be found, I personally incline to the view that the rise of that whole ‘statement stethoscope’ scene had more to do with the arrival on our screens of the hit US TV show ER. After that, you could almost hear even the weediest SHO thinking ‘hey, with nothing more than the addition of some strategically positioned neck attire, I too could be channelling a George Clooney vibe!’. In this reading, the realisation of the power of the stethoscope may actually have hastened the decline of the coat: the collar interacts awkwardly with the ‘scope and distracts from its clean – yet simultaneously rugged – lines.

Because say what you like, but there is something alluring about that slung-around-the-neck look. It says capable – but nonchalant; brainy – but zeitgeist-y; one of the guys – but also quirky; works hard – maybe plays hard too?; action hero – with a sensitive side. No wonder other grades of staff wanted a piece of it. No wonder recent years have witnessed the rise – and rise – of the lanyard.

Ten years ago, a lanyard was something you found on a boat. Now you’re no one if you haven’t got at least one, and preferably a full rainbow of the damn things. Their apotheosis came last week in an op-ed piece in the Nursing Times entitled ‘Display Staff Roles on Lanyards to Improve Patient Experience‘. Noting the problems patients encounter in trying to distinguish different staff roles from the colour of their uniforms, a project was initiated whereby different coloured lanyards (with the wearer’s job title printed on) ‘could be used to identify ward matrons more clearly’. Following the success of this ‘others started to ask if they too could have lanyards’. I’ll bet they did. Who wouldn’t want to look cool at work?

To be fair, there is also a utilitarian explanation for the popularity of lanyards. With smart cards and switch cards now almost universal, it’s obviously necessary to have a way of keeping them accessible, especially if they are required to unlock doors. But the question remains: if patients can’t tell the difference between staff on the basis of colour of uniform, is it really realistic to expect that they will be able to do so on the basis of colour of lanyard? Will they understand that the various colours represent different job titles and not just personal whim? Will they be able to read sideways-printed job titles? How do students and agency staff fit in? And do lanyards also send out an unintended message: ‘I’m far too busy to actually tell you who I am, so just read it, will you’? In this scenario, lanyards don’t solve the problem – they contribute to it.

The power of Dr Kate Granger’s ‘hello my name is’ campaign is that it’s not just about names. Rather, it neatly encapsulates (in a single hashtag) the ongoing power struggle between staff and service-users which characterises the modern NHS. The focus on names (or rather, the apparently routine discourtesy of staff not telling patients their name and job title, which was the impetus for the campaign) has put this issue firmly at the sharp-end. Patients. not unreasonably. believe that nurses and other health professionals hold all the cards – they know all the personal details and they control both the environment and access to treatment. Demands to be informed of the names – if nothing else – of the staff they encounter are an attempt to redress this perceived imbalance.

Staff, on the other hand, view things differently. On their side of the fence, a request for a nurse’s name can be seen as tantamount to a declaration of hostilities – because it could be the precursor to a complaint, and once they’ve got your name, they can include you in it. The virtual disappearance of the once-ubiquitous-now-rarely-seen name badge could be attributable to this fear. When you’re wearing one of those (so the logic runs) they can get hold of your name and you’re not even aware they’re doing it.

More worryingly, the stand-off over names could be symptomatic of subconscious beliefs about patients’ trustworthiness and even of a cultural norm of patients ‘knowing their place’ and not expecting more than they already get. The patient as ‘alien’ – not like us, in short. Management schemes to compel staff to give their names are likely to result in ever-more creative strategies to avoid doing so (aimed not at punishing the patients but at confounding the managers) and resistance based on the idea that one’s name is one’s personal property and control of how the individual uses it is beyond the remit of NHS diktats.

The question of how much information patients have the right to know about staff has been complicated by new anxieties about identity and privacy inherent in the age of the internet and social media. Quite possibly, this has led to an increased sense of vulnerability amongst patients too: we do know an awful lot about them. Giving one’s name is only a first step however; it’s crucial that we don’t turn this valuable initiative into yet another exercise in ‘box ticked, job done’. Far more important is that it becomes symbolic of a reciprocal and collegiate approach to health, in which the patient, rather than being ‘alien’ is an equal partner. The defensive reluctance of some nurses to take even the first steps along this road is symptomatic – again – of the profession’s insecurity and uncertainty about its true purpose. But rather than force the solution (in typically embarrassing nursing fashion) to fit the entirely unrelated logic of some passing fad, shouldn’t we instead try to understand why, despite the Twitter campaigns, despite the media exposure, it still keeps happening?

For the Nursing Times article on lanyards, see: http://www.nursingtimes.net/opinion/in-the-hotseat/alice-webster-display-staff-roles-on-lanyards-to-improve-patient-experience/5067129.article

For a nice example of how listening and making a connection is about much more than simply giving a name, see this student blog: http://nursepraylove.wordpress.com/2014/01/28/the-importance-of-listening/

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