Reviews Soundings

All Russian to me

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7573.865-a (Published 19 October 2006) Cite this as: BMJ 2006;333:865
  1. James OwenDrife, professor of obstetrics and gynaecology
  1. Leeds

    My wife is learning Russian, apparently for fun. Subjunctives in Cyrillic, she says, are light relief from the bureaucracy of general practice. Our house is filling up with the works of Pushkin and books about Russian history. Vaguely interested, I found the country's troubled past hard to understand until I noticed the parallels with the NHS.

    For example, two centuries ago the czar and the ruling class spoke French whereas the serfs spoke Russian. How on earth could two groups who had to coexist speak different languages? Then I remembered the NHS's managerial memos with nouns like “stakeholder,” verbs like “drill down,” and all those trendy abbreviations. Staff involved in patient care don't talk like that and have silent, serf-like contempt for those who do.

    Then, during the communist era, Soviet policy was decreed by a leader in Moscow and applied, blanket fashion, across the country. Small town apparatchiks knew that disobedience meant death. Today, NHS middle managers believe their jobs (not their lives, admittedly) are on the line if they fail to implement the schemes of Downing Street advisers. Decisions come from large buildings in Leeds and London but are rarely announced. Instead, all trusts miraculously have the same cost cutting ideas at the same time. Only when the serfs go networking, perhaps at meetings of the Royal College of Serfs, do they realise what is happening.

    When public announcements are made, they take the form of what used to be called “propaganda” and is now “spin”. The Russian people would be told that the state was making more combine harvesters than ever before, and the books would be cooked to prove that nobody had to wait more than six weeks for a tractor. How nice it would be if the NHS, besides using similar techniques, went the whole hog and produced totalitarian artwork. Staff would be inspired by posters of square jawed doctors and nurses looking upwards, fists upraised, with guidelines unfurling behind them.

    And finally, when the Soviet Union fell, the oligarchs took over. Young men became fabulously rich in mysterious ways and bought foreign football clubs. We serfs suspect that some people are doing very nicely out of the NHS. And if we find our premiership team playing PFI Moscow, our suspicions will deepen.

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