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Doctors go back to basics

BMJ 2007; 334 doi: (Published 22 February 2007) Cite this as: BMJ 2007;334:429
  1. Theodore Dalrymple, writer and retired doctor

    Of what use is literature, especially to doctors? This is a question that has long troubled me and would continue to do so even were my medical and literary accomplishments far greater than they are. As another literary doctor, Somerset Maugham, once put it, by the standards of what eternity is it better to have read a thousand books than to have ploughed a thousand furrows?

    This, however, is jumping the gun a little, for just as the existentialists say that existence precedes essence (or is it the other way round; I can never quite remember), so literacy precedes literature, at least now that the age of the epic poem is definitively in the past. And the administrators of at least one NHS trust appear not to be fully convinced that the hospital consultants in their employ can read, at least if one is to take seriously the implications of a little leaflet attached recently to their monthly payslips.

    It was entitled Skills for Life: A Guide for Staff. The trust, in that high-flown, bureaucratic language that derives inspiration equally from the preacher and the secret policeman, declared that it was “fully committed to equipping all employees and teams with the skills, knowledge and attitudes required to improve and deliver services.” I am not certain how one equips people with attitudes, but it all sounds a little re-education camp-ish to me. One could almost write a satire on the subject, were it not that these days satire is prophecy.

    The leaflet informs the consultants that “Following the introduction of the NHS Knowledge and Skills Framework (KSF), the Trust recognises that for all posts, learning and development is crucial for career progression. This means that as an employer our aim is to improve basic skills in the workplace by developing and providing support to ALL members of staff as part of the ‘Widening Participation' agenda.”

    Among the things to be imparted to consultants by courses of three hours a week for 10 weeks, free of charge and presumably during working hours, were literacy and the ability to read instructions, as well as familiarity with the metric and decimal systems, and addition, subtraction, multiplication, and division. The leaflet asked for “self-nominations” for “Workplace Learning Champions” who should be “committed towards the development of basic skills.”

    Of course, we all have gaps in our education, or what the leaflet calls “a Spikey Profile.” “Many employees,” it tells the consultants, “have what is considered a Spikey Profile. Some people may have excellent literacy skills, however may not be at the same level when it comes to maths or vice versa.”

    Help is at hand, however. “More courses and information is available on request.” All you have to do is contact the Non-Clinical Vocational Training Adviser, or the Vocational Training Manager, or the Clinical Vocational Training Adviser, or the KSF Staff Implementation Lead. If by any chance none of them is in when you call, you could try the Basic Skills Agency, or the National Institute for Adult Continuing Education, or the Adult Basic Skills Strategy Unit.”

    Someone in authority in the NHS has obviously read Alice in Wonderland and taken it as an educational blueprint: for the teaching of Reeling and Writhing, Ambition Distraction, Uglification and Derision, as well as Laughing and Grief.

    The administrators of at least one NHS trust appear not to be fully convinced that the hospital consultants in their employ can read

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