Junior Doctors and the Dishwasher Dispute

by David Gilbert

April 28, 2016

Junior Doctors and the Dishwasher Dispute


When I was 15, I witnessed my mum and dad arguing about how to organise the cutlery in the dish washer. The dispute escalated.

Soon she was accusing him of being ‘sloppy’ and he labelled her ‘controlling’. The arguments moved from dishwasher to personality faults. The stakes were higher. Cutlery was thrown rather than put away. Both sides invoked past hurts and the discussion moved swiftly to divorce proceedings.

I had no chance to have a say. Perhaps I could have said: ‘if this is about the cutlery, I am sure you could sort it out without shouting, or even divorcing’. Or: ‘if this is about wider stuff and how you feel about the future of the family, let’s all talk’. At the very least perhaps ‘treat me like a grown up here’.

By the time the bitter rows erupted, I was too scared to say anything. When I did raise my head above the parapet, my brothers told me ‘don’t make it worse’. Or my mum or dad accused me of ‘sticking up for her/him’ and got angry with me.

Does this sound familiar? I am sure we all have our versions.

When the BMA and Jeremy Hunt were discussing pay and conditions, patients witnessed them arguing about how to resolve a seemingly technical dispute. The dispute escalated. It was not apparently 'just' a technical issue. Dishwasher technique was symbolic of wider, deep-seated issues.

Soon one was accusing the other of dogmatism or of potentially harming patients (now or in the future). The stakes became higher – this was about how we want to organise the NHS, whether we want better weekend care, or even according to some, about privatisation, etc etc.

Patients have had no say. There has been no discussion with patients and carers about the wider issues above that affect them (as users of the service) or a voice in policy for the future vision of the NHS (as taxpayers and owners of the NHS). Jeremy Taylor, Director of National Voices and I have written about this here.

Now, as belligerence and bellicose rhetoric rise, and as strike action escalates, lots of patients I have talked to are scared of saying anything publically, of asking questions too loudly or having a view - too frightened of the flak to put their heads above the parapet (a forthcoming BMJ article looks at this issue). Offers from patient groups to help have been ignored. See here.

Even writing this blog feels risky. A few people warned me against it. It makes me feel like that scared child again. It should not be the case that I have to defend myself. But I feel so nervous of stepping into this debate, that I want to state that I have worked 30 years trying to support patients to work with clinicians and doctors as true partners within the NHS - see here for example. I am all about improving things together.

With the future of the NHS family at stake, it’s high time for patients to be involved in the trialogue. And please can all the ‘grown ups’ get their wise heads screwed back on and hot foot it back to the table. Before it is too late. Please.


p.s. Any analogy has its limitations. For example, the government and doctors can't get divorced (I hope).  They are going to have to work it out.

p.p.s. There are some articles recently which, from different viewpoints, stress the need for a wider perspective, cooler heads, space for reflection and dialogue. Here are a few which I have found interesting:

p.p.p.s You may not agree with the article, but I hope it leads to more constructive conversations about dishwashing 🙂



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6 comments on “Junior Doctors and the Dishwasher Dispute”

  1. In Britain you have junior doctors and the government, over here in Greece, doctors of the social insurance schemes ousted from their jobs and the gov., pharmacists and the gov., pharmaceutical companies and the gov., public hospital administrations and the gov. all shouting and going on strike on behalf of the patients!! who are not invited at the negotiation table, and watch fearful what is next coming upon them after turning more than 30 of cost of medicines and diagnostic texts to patients, after dismantling primary care, after waiting for months for radiotherapy or an operation at the public hospitals, after thousands of junior doctors have fled abroad..
    Isn't it high time that patients make their voice heard in Britain or elsewhere?

  2. Dissenting views are not a problem as long as rational debate carries on.
    I think a major problem is that the contract has been scrutinised in a way it never would of without the dispute and many juniors realise just how rubbish it is.
    Talk like being told (again this week) literally that we didn't have the wit to understand the contract.
    It does need a deep breath, a long hard look at the problems and a reasonable discussion and a realisation that the aims from both sides are pretty similar just significant divergence on how to get there.

  3. I think your analogy works well David as it shows how arguments can escalate and in doing that lose sight of the real issues.

    I do feel for people working in Public services who feel they are being kicked around and are powerless as I worked in the public service of Education for nearly 3 decades. When the first teacher strikes were called by my union I did one day but as it escalated I resigned from my union as I thought it was the wrong action as it hit young people and families who were not the cause of the problem and some of those children were on the child protection register so were safer at school with us than their families. I could not be responsible for putting them in harm's way for my own personal gain.

    However, now working as a Lay person and patient leader in different roles I see a very powerful medical profession with more levers to pull than I ever had as a teacher so am puzzled that the combined intellects can't find a measured, balanced way through.

    I live in hope that someone will see or ask for my perspective as a patient feeling powerless and scared for the future.

  4. As a doctor, I found this analysis cogent, and the simile with divorce helpful. GPs are trained to consider asking at the end of the consult: 'Yes, but what's *really* the problem?' - and keep asking until they have found the real problem.
    The final trigger for the explosion [the presenting sympton - here, the cutlery in the dishwasher] in itself is trivial, but the underlying condition [unresolved and gradually escalating tensions - here, presumably irreconcilable differences] deeply entrenched.
    The fact that our current media encourage, nay demand, trite tweet-sized sound bites to encompass everything and everything, and suggests that anyone who cannot reduce an issue to such scale doesn't have full command of their topic, does a disservice to truly complex issues, such as what is behind this current dispute.
    I honestly believe that with the current stand-off, we need an authoritative, respected and neutral - but interested - party to help catalyse sensible discussion towards resolution of this debacle. Might the Patients Association be able to help?

    1. Thank you for the thoughful comment. I would also check out my article with Jeremy Taylor of National Voices called 'When Elephants Fight'. In my opinion, an organisation like NV has more cred than the PA. See also my blog on the PA called 'We are all patients? Yes and no' that critiques the notion that PA speak on behalf of patients (they have none on their Board).

      For these two articles - scroll down the futurepatientblog.com site

      I sense there are two possible roles for patients. Firstly for someone like Jeremy Taylor to be part of a mediating body in pay and conditions talks, able to play the honest broker when people make assumptions or claims to know what patients think; Secondly, patients and carers as part of a wider engagement exercise that delves more deeply into some of the contested issues, such as safe weekend working.

      Thanks again for helping to open up the debate.

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