If a week is a long time in politics then the last year must have seemed a tortured eternity for Nick Clegg. A year ago he enjoyed a sudden surge in popularity after the pre-election television debates. Commentators had started to predict the death of politics, as an increasing apathetic electorate got weary of spin, sleaze, and soundbites. Then he started to impress in those debates. He represented the reasonable voice of a new politics, calling for what was right for the country rather than scoring narrow political party points. For a brief mayfly summer the jaded electorate started to trust a politician again. Politics is dead, long live politics. But suddenly, he was actually in power, not preaching from the sidelines, and reality began to bite. His popularity plummeted. His party also sank in opinion polls and recent actual election results have been abysmal. His key policy of AV has been rejected, he is the least popular of the major party leaders, and the target of rancour not just from the general electorate but his own grassroots party workers. The wheel has turned full circle and he seems to to be seen now as the personalisation of the cynical career politician he had previously been railing passionately against.
There is a treacherous gulf between preaching on the sidelines and actually having to get on with it in a flawed real world. That doesn’t seem to stop people giving disproportionate recognition to the armchair pontificators. There’s certainly no shortage of people commenting on our work as GPs. Think tanks, narrow-focus czars, academics, or journalists needing a hard hitting story, are all queuing up to give us the benefit of their wisdom on how to do things better. Yet the world they see from their particular sideline, is a clean rarified one which doesn’t match the complex, messy reality of workaday health care. Many of these commentators seem to view consultations as a straightforward discussion of simplistic facts. In reality they are often messy, with tangled inner workings. Perhaps I should whisper this, but it’s not just doctors who have failings, patient behaviour can also be flawed at times.
But the experts see clear and simple ways of controlling the real world. A recent BMJ report1 on improving child health states that 36% of referrals to paediatricians are potentially avoidable. This is a remarkably precise figure given that they go on to qualify it with the vague ‘potentially’. It makes me think of Vic Reeves’s quip that 88.2 % of statistics are made up on the spot. ‘Some GPs do not even know how to hold a baby’, shouted another headline recently, a statement taken directly from from Sir Ian Kennedy’s report2 into childcare services. This turned out to be an unsubstantiated comment passed on to Sir Ian by an unnamed doctor, Yet it appears in his report as a hard fact. I find it bizarre, when many GPs are parents themselves, that this is accepted as hard fact. It makes me wonder how reliable other parts of his report are. We all think we can do other people’s jobs better. Sometimes looking in from the outside can give a valuable perspective but often it misses the detail that makes things more complicated than they seem. As Kipling didn’t say — If you can keep your head when all around you have lost theirs, then you probably haven’t understood what the hell is going on.
Of course ignoring all outside comment and questioning leads to complacency. We need the critics and commentators to make us better and more accountable. I think those of us at the coalface would listen more readily if the comments came with the acknowledgment that their view was also imperfect, if they showed occasional humility and recognition of the Clegg effect.
- © British Journal of General Practice, January 2011