Intended for healthcare professionals

Education And Debate

How work can be made less frustrating and conversation less boring

BMJ 1999; 319 doi: (Published 18 December 1999) Cite this as: BMJ 1999;319:1633
  1. Theodore Zeldin, fellow (theodore.zeldin{at}
  1. St Antony's College, Oxford OX2 6JF

    Editorial by Clever

    The frustrations of relationships and of work are at the root of much illness in today's society. Technology cannot do much more to relieve them; it cannot tell people who to love, what to think, where to go, or what to do for a living. So medicine, which remedies the suffering which results from such decisions, needs additional partners to modify behaviour harmful to health. To find these partners it must reconsider its assumptions about how people come to change their behaviour, both in private and at work.

    Summary points

    Work can be reorganised to prevent it being demoralising, blunting sympathies, and narrowing horizons

    Jobs do not need to turn people into part time slaves

    Barriers between professions can be breached to provide more varied stimulation

    New methods of conversation can produce radical changes in people's sense of their own capabilities

    Doctors are well placed to show how work and enhancement of personal life can be reconciled


    This article is based on two books I have written, one of which contains long bibliographies. 1 2 It also reflects the first findings of my ongoing project on the future of work, supported by the European Commission, which involves studying a wide range of occupations from the point of view of how their frustrations could be diminished.

    How do people change their ways?

    We have long been taught that important changes are brought about by the discoveries of geniuses, by mass revolutions, or by the influence of exceptional leaders. On the other hand, we are also told that we live as we do because deep economic forces, historical traditions, or the traumas of our infancy—none of which we can easily avoid—make change difficult. There is some truth in both opinions. But they miss a more decisive factor.

    The central impulse in the history of humanity has been the search by individuals for partners, lovers, gurus, or gods. Encounters with an unfamiliar person, idea, or situation have shaped individual lives and given them a direction. When two people meet there is a possibility of their combining to produce something that has not existed before, just as in scientific research it is often the combination of ideas from two disciplines which sparks off a discovery. It is true that many people have a narrow range of acquaintances and tend to absorb only what confirms their existing opinions. But fear, which is a major obstacle to change, is constantly being diminished by meetings that turn the unfamiliar into the familiar, even though new fears often arise to replace old fears.

    How does conversation influence behaviour?

    The ideal situation in which to tame fear is in private, where it is possible to accept criticism of your opinions without shame. Today, it is in conversations between a man and a woman when each treats the other as an equal that the most important changes are being brought about; in doing this they are carrying out a minirevolution, since the world has hitherto been firmly based on inequality. Conversation is becoming the experience which, more than any other, teaches us how to empathise with people different from ourselves and to develop respect for them. Women have made an ever developing conversation the criterion of a good marriage, and it is also becoming a model for other relationships, including those at work.

    Conversation can be recognised as the principal instrument of change now that we are beginning to realise that laws and guns are incapable of altering mentalities and that change is superficial if mentalities are not altered. But change cannot be achieved by any old conversation, in which people seek simply to pass the time agreeably without necessarily revealing much of themselves or else try to impress others with their rhetoric or arguments. Nor is “better communication” (advocated as the universal remedy) enough if it is merely regarded as a technique that can be taught in a few easy lessons and if it focuses simply on the transmission of information.

    A new kind of conversation is necessary to give expression to a broader range of our hopes. It becomes possible when we believe that we are incomplete and need to share in the experience of others in order to become fully human. In such a conversation, there are no winners or losers; the aim is for each to get into the skin of the other, to feel what they feel, and to emerge with an understanding and emotions which neither had before. Conversation thus becomes an adventure whose outcome is always uncertain; when it is successful, it contributes to establishing equality between the participants.

    The old conversation was for people who accepted etiquette—saying the right thing at the right time—as the best way of preserving harmony between people. The new conversation is for those who wish to diminish misunderstanding, cruelty, and unnecessary suffering and who, rejecting hypocrisy and cynicism, believe that humans are capable of doing better.

    Embedded Image

    (Credit: MARK HUDSON)

    Why are people finding it difficult to have satisfying conversations at work?

    Conversation is as important at work as it is at home. There used to be factories with notices saying, “Talk less, work more.” But talk has become an essential part of most forms of work, and the higher up you are in the hierarchy the more you talk. Meetings occupy an ever growing portion of working time. However, it is becoming increasingly difficult for people to understand what others are saying. We are all being trained more and more to be specialists, each with a technical language and allusions impenetrable to others.

    At the same time, more people are keen to obtain wider satisfactions from their work. Financial reward is no longer an adequate sign of success. If you are made a bore by your work, if what you do harms others, if your work does not give you opportunities to widen your curiosity and to lead a more interesting life, then you will be judged a failure as a human being, however exalted your position in the office.

    Why are so many jobs frustrating?

    Most of the jobs available today are failing to meet these wider criteria because they were invented to satisfy economic purposes rather than to enable people to grow intellectually and culturally. They will become increasingly inadequate as people receive more education and hope to find work that will expand both their horizons and their abilities. The leisure society has tried to compensate for the frustrations and narrowness of work by giving people free time in which to indulge in activities they care about more passionately. But this is no longer an acceptable panacea. Many more of the new generation are saying that getting a job is not enough for them; they want a job which is fulfilling, useful to others, and involves contact with interesting people.

    The middle class professions have ceased to be as liberating as they once were. Their members complain that the pleasures of their work are ruined by stress and that they are not properly respected or understood. Even the most eminent people often hide bitterness behind their fame. Doctors are not alone in finding their residual prestige hollow when so much of their work does not use the skills they value most. Teachers are equally demoralised. Bureaucrats have never been so abused and have never felt so much like spiders entangled in their own webs. Accountants, despite their increasing influence, are having doubts about their ethics. And business leaders, despite slimming their firms down as though they have anorexia nervosa, have not succeeded in winning the loyalty of their employees. In Britain, only 8% of people say that they have the same values as their employers.

    What kind of new jobs do we need to invent?

    So it becomes necessary to start again from scratch and rethink the way we work so that we can get out of it what we really want. Too many people are part time slaves, subject to the demands of others, doing work irrespective of whether it contributes anything to their own flowering and their capacity to relate to others. The ideal human being used to be one who obeyed orders, who did his duty, or who was as efficient as a machine. But today the Renaissance man, who broke with the idea that every person must stick to his last and have a fixed place in society, is a more inspiring model, showing that human potential can be expanded. He was a farmer, architect, poet, and diplomat all at the same time. But we need to go further than he did and to reshape our vision of work in the future so that it incorporates the ideals of both sexes.

    We need specialists, but they can no longer be the only crowning glory of our educational system. We also need generalists who are able to make sense of what specialists do, not only in one particular branch of knowledge but across all spheres of work, and who are capable of having conversations across the barriers of professional jargon.

    How can new ways of working be developed?

    To develop generalists we need an alternative form of postgraduate education Instead of narrowing the focus of their interests, students would spend, say, three months in each of the main branches of human activity. They would not try to become experts but simply to become familiar with the methods and languages, experiences, and problems of agriculture, manufacturing, commerce, art, and different forms of public service. Unlike the random work experience and work shadowing available to students at present, the real aim of which is to find the right niche among the existing multiplicity of jobs, this would be a more systematic and wide ranging investigation of the world of work, designed to lead to the invention of new kinds of job.

    People already at work, and frustrated by it, would then be able to do something more constructive than warn off the young generation; they could collaborate in giving them experience of different ways of working and help them to remould the tasks that are worth doing into shapes that are not distorted by futile chores. Work can be changed only by cooperation and conversations between those with experience and those who are not yet sucked into the system.

    What can doctors do, apart from curing and caring?

    The healthcare profession contains a vast reservoir of potential going to waste, of talents which are not properly appreciated, and of conversations which never take place. Doctors who “to remain sane” choose to work part time, combining medical care with something completely different, are already trying to redesign work. But their individual experiments would have an important impact on the quality of work in general if they collaborated with other professions to guide young people in new directions. Routine jobs, and ones which leave no time for anything else, remain satisfying for many. And these people have a right to go on as they are, provided that they do not impose their tastes on others. However, we also need to invent jobs which exercise a greater variety of the lobes of the brain and more strings of the heart and which incorporate breaks and diversions into other fields. Without such breaks creativity cannot be sustained.

    Technology cannot arrange that. But that does not mean that there should be divorce between those who rely on technology and those who emphasise care. The two must know how to converse and to learn more from each other. Technology is not just concerned with economising effort and increasing comfort. It has its own poetry, seeking marriages between human intelligence and the mysteries of nature. The really big scientific inventions have been inventions not of some new machine but of new ways of talking about things. Technology is particularly instructive in its attitude to failure, which is its central concern; it recognises that every machine and every structure has limits. The lessons learnt from working with things are not irrelevant to those who work with people.

    Humans cause themselves a lot of misery bemoaning their limits. But there are ways of expanding our confidence: we have only to look at history to see it being done again and again. The most effective way has been by bringing together people who have never realised what they have in common, and different kinds of work which have never known what they could achieve in combination. We need intermediaries to help bring that about. That is why I should like doctors to look beyond the problems of their own profession and participate in the creation of less frustrating and narrow work for other people as well as for themselves.


    • Competing interests


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