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Plagued by the voices of the lifeworld

Copperfield thinks he must be going mad. Or maybe it's just the latest advice from the King's Fund, on the 'therapeutic relationship', that is completely loopy

Copperfield thinks he must be going mad. Or maybe it's just the latest advice from the King's Fund, on the 'therapeutic relationship', that is completely loopy



It's not a fortune, obviously, but I do get paid for writing this blog. And just occasionally, I feel I'm taking money under false pretences – because the blog writes itself.

This is one of those occasions. Because I have just read a paper from the King's Fund called, ‘Measuring quality in the therapeutic relationship'.

Well, OK, I didn't read it. There's some paint drying I need to keep an eye on. But I had my attention drawn to the appendix.

This is, and I quote, a ‘Checklist for reflection: are my therapeutic relationships as good as they possibly could be?'

Before I go any further, I should point out that the two authors of the paper are Trish Greenhalgh and Iona Heath, two prominent GPs I have enormous respect for.

I can only imagine that they had nothing to do with this appendix, or that they were having a bit of a giggle. You decide. Because here are selected but verbatim highlights from the checklist.

• 'Have I created the optimal structural preconditions for high-quality therapeutic relationships?

o Are my consultation slots 10 minutes or greater?

o Does my practice operate a personal list system?

o How easy is it for patients to obtain an appointment with the doctor of their choice?

• When considering my consultations with patients

o What proportion of the talk is socio-emotional (‘care-talk') as opposed to task-focused (‘cure-talk)?

o To what extent am I able to connect emotionally with my patients and show unconditional positive regard for them, thus allowing any ‘hidden agenda' to surface and be dealt with?

o To what extent do I acknowledge the patient's personhood and autonomy and accept ‘the voice of the lifeworld' as legitimate in the clinical encounter?

o To what extent am I able to use the spoken (and enacted) dialogue between myself and my patient as a tool in clinical management?

• What efforts have I made in the last year to reflect on, and improve, the humanistic and relational aspects of my practice? For example:

o Membership of Balint group.

o Other group-based reflection opportunities?

o Individual mentoring or supervision?

o Peer observation of other practitioners?

• If I consistently score poorly on the above, am I in the right job – and/or do I need additional care or support myself?

• To what extent am I about to eject the contents of my lunch all over my computer screen?

o A bit

o A lot

o In spectacular projectile fashion?'

Only one of the above questions is fabricated.

NB Dr Copperfield is prepared to donate his fee for this blog to the ‘Voice of the lifeworld' fund, if anyone can tell him what the hell that is.

'Sick Notes' by Dr Tony Copperfield is out now, available from Monday Books.

Copperfield

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