Nurses not nurses, doctors not doctors*

The notion, there is no ‘truth only perception’, is usually attributed to the French author Gustave Flaubert. The German philosopher Nietzsche held the view that there is no such thing as truth; there can only be perspective and interpretation, most often guided by an individual’s interests. The process of interpreting sensory information is what we call perception. Whereas perspective is the broader lens, shaped by experience, beliefs and culture, through which we interpret information.

Both concepts are interconnected. My perspective on, and perceptions of the world and how I experience it, determine what is true for me. The same works for others too. Their perspectives and perceptions determine what is true for them. I keep this thought in mind when trying to practice unconditional positive regard for others. I know there are some people who simply can’t be persuaded that the truth they believe in is false. Once I had someone who felt my being a nurse was untrue. This was despite my many years of clinical practice, nurse management and nursing academia. As a result of their persistent claim that I had never been a nurse, they judged me unfit for public service. Such an assertion caused trouble. Thankfully such people are few and far between.

Flaubert was the son of a famous French surgeon. I’m sure that his childhood experiences will have influenced his writing of his most famous novel, ‘Madame Bovary’. In its day (1856), his book was said to be salacious in nature and both Flaubert, and his publisher were charged with immorality. Both were acquitted and the book became a bestseller. Although it would be judged tame by today’s standards, it is still a good read.

I was reminded of the story by a discussion I had last week with mental health Chairs from across England. We were discussing where the future mental health workforce might come from. At my mental health Trust, recruiting experienced mental health nurses, psychiatrists and other members of the multi-professional team can be a real challenge. As a group, we concluded that the future mental health workforce is likely to evolve into something very different from the more traditional workforce we have now. This is not a new thought.

In Flaubert’s book, one of the main characters, Charles Bovary, studies at medical school. He doesn’t succeed and fails to become a qualified doctor. However, back then it was possible to become a ‘Officer de sante’ in the public health system. In this role they could practice medicine, without being able to use the title Doctor of Medicine. After his first wife dies, Charles meets and eventually marries Emma. She is the Madame Bovary in the book’s title. Unlike Charles, Emma wants to climb the social ladder and is fuelled in this ambition by her desire for wealth, influence and passion. Emma eventually kills herself, but not before she has enjoyed (sic) over many years, a succession of affairs and lovers.

The reason Charles was able to practice medicine was in part due to a catastrophic shortage of doctors in France at that time; a consequence of the French Revolution and severe economic conditions. Like today, back then it took many years to train and educate medical students, and so the ‘second order of doctors’ was formed. These were the Officers de sante. They only studied medicine for three years and/or had a slightly longer ‘apprenticeship’ with a fully qualified doctor before they could practice. In the period of scarcity, around 1790, they filled the dreadful lack of medically-qualified practitioners. However, in 1803, their role became unrecognised, Being either a surgeon or physician meant holding a formal medical qualification. That said, in more recent times, 2023, the idea of reviving the concept of a ‘second order doctor’ was once again raised in France. The idea didn’t get actioned. I suggest we watch this space.

Back in the UK, we have a much greater range of health care professionals who practice health care at all levels of service provision. I’m sure that, in the future, the range of health care professionals will continue to increase. Digital technology and AI are already showing us how this might be possible. What we need to do now however, is to create great places for people to work in, find better ways of retaining colleagues and most importantly, look after their wellbeing.

 

*In our house we often treat ourselves to a chicken kiev. As I’m a long-time vegetarian, these are made from plant-based proteins, which we affectionally refer to as ‘chicken not chicken kievs’