There is a simple reason why patients always look like they’ve disappointed you when they tell you they haven’t got any medical history of note. The clue is in the question: it invites an affirmative response, but they are obliged to respond negatively. Instead of relishing their good health, they feel they are letting us down.
In all our relationships we thrive on pleasing others: smiles are reciprocated, warmth is reflected. Although aiming to please is a basic human behaviour that pervades our lives, time and time again we conveniently forget this. We persist in surveying our workforces asking whether they are stressed and then not only accept this, but feel obligated to do something about it.
I have recently been supporting an unhappy bunch of workers in senior professional roles. They have reported their “high stress levels” – whatever that means – and their employer has responded in the traditional manner with one to one and group meetings, a new stress risk assessment, and offers of occupational health and counselling support.
My unhappy employees were carefully selected. The seniority of their roles and the size of their salaries reflect the nature of their work: highly mobile and geographically isolated highly autonomous with limited direct support and supervision very varied and unpredictable highly complex and uncertain. In fact, all the things that they are reporting as the source of their stress.
So first we ask are you stressed, and they say ‘yes’. Then we ask whether any of the Health and Safety Exceutive’s factors are relevant, and they say ‘yes’. Then we suggest referral to OH and counsellors, and before you know it, we’ve generated a few more sick workers.
My unhappy bunch are either over-promoted and disaffected, unable to cope with the demands of the roles they chose, and yet unwilling to move on, or they are capable and committed workers on whom unreasonable demands have been placed. They are probably a bit of both. But one thing I am certain of is that they are not ill. The solution to their problems is more likely to be found in the vacancy bulletin than the counselling suite.
Time for changes
The biggest of all staff surveys was recently published: the annual NHS employee survey by the Health Commission. It tells us NHS workers are stressed and employers will focus yet more attention on wellbeing programmes and counselling services (if only to distract attention from management interventions). What the report does not do, is highlight the need for increased or targeted investment in evidence-based OH services and research into effective interventions. This cycle of relying on affirmative answers to polarised questions cannot be the best route ahead.
Is it time for us all to turn our back on this industry we’ve helped create? To stop asking if workers are stressed, and ask whether they can cope? To stop legitimising ineffective interventions and demand more investment and research? And to stop medicalising challenges at work, but help managers and employees understand that work is supposed to be challenging?
Dr Richard Preece is a consultant occupational health physician