‘Hitting Targets’: a poem from a study of cardiovascular disease prevention

Hitting Targets

I love hitting targets

I’m really good at hitting targets

It’s important that you hit the targets

That’s how you’re perceived

And we can do it

I feel torn

I want to hit the targets; I want to be a patient-centred GP

Oh shit, my diabetic figures are really bad

We’re coming to the end of the year

I must sort out a few more people

I’m tempted

She wanted to talk about her anaemia

The nurse appointments are fully booked, it was now or never

It comes up in pink boxes, it’s like someone shouting

I hate myself for doing it

I stuck her on the bloody couch

Her pulses were fine

It wasn’t in the slightest bit appropriate

I wanted to hit our figures

She would be another one towards the target

THINKING DIFFERENTLY ABOUT HEALTHCARE PRACTICES

‘Poetry is language at its most distilled and most powerful.’

(Rita Dove, born 1952)

‘Poetry is the lifeblood of rebellion, revolution, and the raising of consciousness.’

(Alice Walker, born 1944)

The experience of tension and emotional strain highlighted by this poem is not predominantly as a result of witnessing patients’ suffering, but is shaped by the management systems that constrain Simon’s, and other GPs’, work. Based on the concepts and practices of evidence-based medicine, these systems (which include guidelines, economic models, and algorithms) are designed to monitor and improve the implementation of scientific evidence in frontline clinical practice. Although intended to safeguard and improve the quality of care provided, they do not always sit well with the ‘real’ and more uncertain world of patients’ lives and concerns.⁴

Indeed, the dissonance precipitated can feel very uncomfortable for practitioners working at the interface of the worlds of science and a patient’s individual life. As the poem highlights, performance targets accentuate this dissonance as they draw practitioners’ attention towards a limited set of actions that may clash with their clinical experience and knowledge of what is important to (individual) patients. The poem emphasises the limitations of management (scientific) knowledge, which overlooks many of the complexities of frontline practice.

On reading the poem, Simon appreciated the way in which it captured something he felt was important but that he would not have been able to articulate as eloquently or poignantly himself. Others have enjoyed the ‘readability’ of the poetry, finding it more engaging and approachable than typical reports of qualitative research. For Caroline, the process of forming poems from participants’ own words helped to distil some of the tensions that were latent in participants’ accounts, supplementing more conventional techniques in qualitative research. It allowed her to communicate the surprisingly emotive content of interviews (which had been designed to map preventive care processes)⁵ and to bring out the human quality of the accounts (the awkwardness, the contradictions, the absurd) as part of conveying more ‘serious’ research findings.

We share this poem for readers’ enjoyment and reflection, and hope that, in a very small way, we can draw attention to the tensions produced within contemporary forms of healthcare management. We would also like to contribute to a broader conversation about what is important in delivering care and provide a refreshing contribution to the task of ‘rethinking’ some problematic ‘industrial’ practices of care.^6,7