The ragged trousered patient?

‘Why does it have to be so complicated? It is so frustrating. I just wanted to do something useful,’

My Canadian friend’s irritation with the increasingly impenetrable language that we are creating around ‘public involvement’ was palpable. It was not the first plea for common sense to prevail I heard last week. It will certainly not be the last.

Coming away from the discussion I worried that we might be in danger of losing people if we are not careful.

After all, is it any wonder that they feel dissuaded from shaping alternative ways of providing health and social care if the first thing they encounter is a load of people wagging fingers at them for not using the right words? Before they even get to feel the hostility of the system behind it.

And what are those words? Well, take your pick.

Engagement, participation, citizens, patients, public, people, service users, consumers, customers etc etc. Now we also have ‘leaders’ – a term that has been neatly purloined by policy-makers on account of the fact that it feels a whole lot less challenging than the alternatives. After all, the way they see patient leadership, it is about making you and me more like them. Mmmm.

But they are not the only ones. I was so angry a few weeks ago when I heard a good colleague of mine denounce someone as being a professional public involvement person (i.e. they get a salary for what they do).

Are we not on the same side? Are we really saying that these ‘so-called’ professionals have been placed there by the state. C’mon, how ridiculous and childish can we get? I thought we were about inclusion and support not divisiveness. After all, we are in thus together.

Fact is there isn’t a ‘right’ or a ‘wrong’ word. More over, those who tend to preach that they are practicing ‘pure’ this or that in the name of others, are often doing quite the opposite. And imperfectly at that. Because we all are. Because we are having to do this in the real world and not in the pages of an academic journal or policy document. And it’s going to take time for the lexicon to settle down and we can’t force it.

My own theory is that the reason we are becoming so bogged down in language is because academics and policy-makers have been allowed to dominate the debate. But they love this stuff. They can talk it for hours. Like pigs in muck. He says fondly. And they really do get paid for it not that I have a problem with it.

Reminds me of the treatise I got from another colleague about the fact that if I was going to use the word citizen I better read the academic literature first. I felt like sending back Socrates’
definition of citizen as ‘member of a community’ as being pretty good and much cheaper.

Ok rant over. I do of course understand the need for greater precision around the meaning of the words we use. In fact I sometimes think it would be a good idea to develop a periodic table of ‘public involvement’ showing the relationship between all its different elements. And the value and validity of each.
But it must not become a barrier to people feeling able to join us and find their own identity within this emerging messy thing that I choose to call ‘public involvement.’

And yes, I have put my chosen terminology above, in inverted commas, aware that is contested by some. But that’s the last time.

Well, for the moment. Needs must as they say.

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