Altruism

David Church

doi:10.3399/bjgp12X659187

I can half agree with your comments, but not the other half.1 Your quote from Aneurin Bevan can be interpreted in various ways, in particular, many terminal patients have stated that they would prefer to expire in ‘a gush of warm sympathy’ at home or in their local cottage-hospital rather than many miles distant from friends and family in a big sterile impersonal clinical setting.

You quote Nye’s ‘efficient if cold altruism’. While we need to question the efficiency of the organisation of larger institutions and distances, we also need to take a moment to consider their ‘altruism’. The ‘big hospital’ is no longer altruistic in its management style or operation: it works for money from the commissioners of care, and often is seen as being sly in its pursuit of profit. A number of the staff remain altruistic, enthusiastic, and dedicated, but this attitude does not fit with management styles, and is being actively driven out of clinical staff, with barriers to flexibility and altruism and rewards for the opposite throughout juniors’ careers. We can already see the effects; no longer looking at what is possible, but at what seems to benefit the individual, in terms of career progress.

We need a shift in managerial attitude away from the merely financially measurable, to a holistic approach to all the functions of the hospital. We need a pervasive change in attitude in the community, to rediscover the values of altruism, mutual support, and community pride. Many may consider these too close to religious aims or virtues, but is that wrong?

Real achievement can be made in the face of adversity outside huge institutions. If people will persist in getting ill and having accidents in our rural areas, it is prompt access to local services that is needed, along with the ability to tolerate difficult conditions, stabilise patients, and fix those who then do not need to make long, expensive journeys to big hospitals, rather than the ridiculous campaign for a big, efficient hospital right next door to every patient.

So, yes, I treat wet, muddy patients on occasion, and manage them in the expectation they will have a cold shower back at the camp-site, but also have to pick out those where I believe this will not do, and instruct them to get someone to drop them off at a ‘big hospital’ on the way home some hours later, or even commit one of our rare precious ambulances to do the job.