Guitar riffs in threes, songs that go on forever, earnest men with straggly hair and long beards: the truth is, one man's progressive rock is another's nightmare. I know this because my older brothers hate the stuff even now, probably thinking of it as intrinsically linked with the genetic mutation that they suppose gave rise to me. Still, I don't pretend to like their music either. But the strange thing is, we grew up together and yet despite that came out with different expectations of music.
Before you feel tempted to deride my preferences yourself, at least acknowledge that, as cool as it might once have been to favour The Jam and Haircut One Hundred (progressive rock was never ‘in’, sadly), at least I didn't grow up into a public relations manager or an accountant. So life has a way of levelling these things out.
Which brings me onto the topic of performance-related pay. The link here is obvious: some like it, others hate it. Being progressive and bearded (well, until last week at least), it ought to be obvious which is my preference yet nevertheless I cannot decide.
As the nation dips into recession, mirroring the pattern forming in the rest of the world, our esteemed bankers, who loved performance-related pay, turn out to have loved it more than anything else in their working lives. Their judgements of risk have proven to have been skewed towards promoting corporate risk in order to maximise their personal rewards. Instead of seeing bonuses as a welcome reward for hard work, the culture in banking appears to have become one of the reckless pursuits of bigger bonuses and to hell with the rest. This is akin to what I presume can be the only remaining prompt for the Rolling Stones to announce another world tour.
Maslow, in his theoretical hierarchy of human needs, put jobs and money low down in his schema, meaning he rated them as basic motivations. But being low down also suggests that higher level needs can be strong motivators once job security and financial security are accounted for. Esteem, self-actualization: stuff like that. And yet these higher needs are often overlooked when considering what makes us want to do our jobs. Is money over-rated as an incentive because it also fits with the prevailing ethos of only valuing what can be counted? I wonder.
The funny thing is, when I started at medical school, still too young to be bearded but relatively hairy for all that, the big sell was about professionalism. Part of that was undoubtedly self-congratulatory, you're-joining-a-club-boy kind of stuff; but part of it was also to highlight that we should abide by a code of conduct that, well, if it did not render us as pure as priests at least it put clear water between us and the likes of Gary Glitter. The message was that we should do the best by our patients and let the rest sort itself out. I was so taken with this I nearly bought a fob watch.
The idea of a code of conduct that levered our ethical position above that of the common man was echoed by a description of the distinction between a tradesperson and a professional I was once given. The difference, I was told, is between the customer always being right and sometimes needing to be told he is wrong. The duty of a professional is sometimes to refuse the sale.
So therein lies the challenge. We cannot escape the fact that governments like performance-related pay, indeed that it does help motivate and provide funds that drive improvements in some situations. But to be professional means that we must retain our judgement over when our motive is primarily the bonus and when it is primarily the welfare of our patients. As long as our inspiration tends to the latter, we remain professional. If we slip into pursuing the bonuses as an end in themselves, we will have become indistinguishable from tradesmen. Or worse, bankers. Or worst of all, bankers who never liked progressive rock.
- © British Journal of General Practice, 2009.
