Bøger af David Zigmond

What is culture? Is it possible to change this by direct action, or does it develop its own life? Our NHS healthcare has developed characteristics none had planned or now wish to be identified with. We have a crisis of depersonalisation: patients frequently report shocking failures of humane care, while staff are unprecedently demoralised and weary. Serial experts sound reassuring and resolute, then fade away. This book makes another kind of offering: a collection of letters and submissions from a long-serving frontline medical practitioner. In missives to newspapers, professional journals, politicians, senior managers and colleagues he describes his experiences and conundrae, his understanding of these, and then his remedial suggestions. From his long view David Zigmond attributes many of our current welfare problems largely to a seminal folly of our industrial age: that we can produce and manipulate complex human care and welfare as if they are manufactured objects. But such procedural manufacture then supplants our relationships, and the language, skills, imagination and emotional life that make these possible. The writing is challenging and demanding but it is rewarding with insighted, incited and incisive wit, unusual and substantial ideas and evocative human descriptions.

The last two decades have seen a disturbing and growing disparity emerge in our publicly-administered healthcare. Generally, while our technical interventions for the curable get better, our other human engagements and understandings get worse. This is happening despite energetic political commitments, enormous funding and numerous specialist training and regulatory bodies. Why? This second volume of the Anthology documents this new era and proposes that the technical and managerial approaches that are so helpful in tackling curable diseases (the 'factory') are now serving us poorly elsewhere - the larger fraction of our healthcare where we need, instead, personally attuned contacts of flexibility and imagination (a 'family'). The complexity of this errored evolution and its consequences are demonstrated by lively and engaging vignettes of healthcare encounters linked by wide-scoped and unusual explanations.

Our patterns of illness, then the communications and activities we fabricate to address them, are often rich in unobvious human meaning, and thus opportunity. Yet overzealous pursuit of scientific approaches can here have paradoxical effects. This is because our diagnosis and therapeutics are systematised to short-circuit those very human vagaries that confer meaning. This first volume of the Anthology comprises earlier articles exploring the networks and meanings increasingly ignored by, then obscure to, medical practice. Many subtly coloured case examples help the reader navigate and decipher our shared human complexity in ways that can lead to therapeutic benefits otherwise elusive. The writings range widely: from psychosomatics to the personal vulnerabilities of healthcarers; from placebo psychology to the power of language; from the elements of psychotherapy to the follies of medically-modelled psychiatry. The breadth of enquiry is conveyed in a way that will appeal to a wide range of readers: with careful precision yet human nuance and hue.

Why, as our technology gets better, does much of our human contact and understanding get worse? How does this happen in our publicly accountable healthcare, and what is its cost? This anthology draws from nearly forty years' writing that describes and dissects encounters on the frontline of the NHS. The complicated problems and situations are captured in language that is wry, lyrical and trenchant. Beneath the very wide range of subjects lie the basic questions of Welfare and social psychology: What do other people want and need? How do we (think we) know? Who decides, and how? This book's unusual perspectives challenge many of our now dangerously sleep-walked maxims.

The King's Fund's report Reforming the NHS from Within questions the wisdom of decades of structural reform within the NHS. The report's author, Professor Chris Ham, argues that a confused cocktail of markets, regulations and targets has detracted from more positive possibilities. He offers a more human account of the kinds of changes that would help strengthen the NHS.But does the King's Fund's critique go far enough?David Zigmond argues that there are even graver issues to consider. The National Health Service, at its best is about supporting and sustaining thoughtful, caring and knowledgeable relationships between professionals and citizens. But too many managerial initiatives undermine agency and harm relationships. Treating staff like robots, or patients like items on a conveyor belt, is dehumanising and dangerous. Much more attention needs to be given to the factors that strengthen our relationships: Doing things at a human scale - not progressively more giant Working with trust and flexibility - not meaningless regulations Providing security and freedom - not financial penalties and incentivesZigmond's work explores the limits of industrialised healthcare and calls for fresh thinking about how to restore and protect the human dimension of the NHS.