Why some People are Angry with the NHS

 

Short Answer: some of us feel angry (as part of adjustment to Loss) – and some of us throw our emotions at our nearest and dearest – or at those who are trying to help us.

Very Short Answer (excessively simplified….): ‘I hurt inside so I’ll throw my pain at you’

Is this a good thing? NO  - let’s look at the how and why… the Long Answer…

Everyone has suffered loss over the past 18 months, many people great loss such as jobs, livelihoods, deaths of loved ones. People have felt imprisoned, unable to enjoy liberty. We’ve been unable to access so many things we used to. Pingdemics are NOT amusing. Lockdown and the vaccination programme have undoubtedly saved lives – but…

This has led to pent-up need and demand, accompanied by the emotional effects of Loss. Unmet medical need includes conditions ‘put on hold’. People were told to Save the NHS, by not seeking attention. People may have ignored their own red flag (important) symptoms. Some routine care was postponed.

 

The Loss emotions (Emotional Logic tells us) start with Shock – held there by Fear. Fear has ‘helped’ keep Britain locked down – the frozen fear whilst imprisoned, deprived of liberty. As our frozen fear melts, we need to release it. Mammals can freeze in fear (parasympathetic shock) – and ‘play dead’. Once the threat has disappeared, the mammal recalibrates by shaking to discharge the fear – just like a dog shaking off water. Humans forget to do this – yet any vigorous activity or exercise can help – or even shaking arms, legs and torso! You may wish to try it (possibly in private…).

As we recognize our losses and move from Shock and Denial to the next stage of trying to prevent the loss, we transit Anger and Guilt. After that, as we try to recover our losses, and reconnect with our Values, we have to transit Bargaining and the flat low energy state of Depression (this is not clinical depression) as we move to Acceptance.

How does this relate to our wonderful NHS, especially the front doors of Primary Care and Emergency Departments? The NHS holds a very special place in the hearts of people in Britain, as articulated in Roger Taylor’s ‘God Bless the NHS’, a place as close for some as their own family. Why so?

When we are sick or ill, or worried that we are sick, we may seek support and attention. We may forget our own resources. We wish for attention, diagnosis, treatment and of course reassurance. We want questions answered, by someone in authority: What is it? Why me? Why now? What’s going to happen to me? What can you do about it to help me? And what can I do about it to help myself? People still think about the NHS as ‘My GP’ or ‘My Hospital’, ‘My Nurse’, ‘My Pharmacy’ or any of the other wonderful services provided. And the NHS is excellent at providing Compassionate Care – that’s why we work in it, to give the same service as we would wish to receive. Sometimes we fall into the trap of assuming, or hoping – or at least wishing – that our GP (or any other health professional or doctor attending to us) is omniscient, omnipotent, clairvoyant and has a magic wand - as well as unlimited resources, medical expertise, and ability to make things better.

People, coming to terms with Loss emotions, have pent-up Demand of illness, physical, mental and emotional needs to access NHS Services.

What about Supply in the NHS, Primary Care, ED and Secondary Care? Currently, the need for attention is high – because of pent-up Demand, loss emotions, and a heightened level of health anxiety in society. Operations postponed, wards and theatres repurposed, waiting lists increased, treatments delayed, and access to Primary Care has felt difficult. What about the reality? Operations have been postponed, waiting lists have increased, yet hospitals have been busy, with staff working flat out. In GP Practices, other than a brief lull in April 2020, have been working harder than ever. Current demand is up by 20-30% on pre-pandemic levels. Current supply of consultations is higher than before. But with PPE, ever-changing protocols, telephone, online or other remote access before face-to-face, results to process and other unexpected work transfers, it has become harder, and more effort, to provide the same amount of medical activity – let alone address the higher level of demand seen at present. Hospital staff have had many challenges and frustrations as well, and tragically around the country health staff have lost their health, or even their lives, from this disease. Illness abounds, including, utterly frustratingly for patients and doctors, long COVID. Many in society, NHS staff included, are exhausted by the effort of the last 18 months – often ‘Holiday Deficient’, toiling on regardless of own needs for many months, keeping to rules and just ‘keeping on keeping on’.

National media messages can be unhelpful, sometimes full of doom and gloom – one might have thought from some national comments that GP practices had not been working – and had to be told to ‘Open up’ again. The truth, of course, is very different. The day job has continued - yet feels like working through treacle. The success of the vaccine programme from Primary Care Networks and MassVacc centres has been tremendous – and although some are volunteers or returners, much of the work force has come from Primary Care – in addition to the day job! Around 800,000 in Somerset as I write – in addition to the day job. Well done Somerset! (We sympathise that the media, especially national, can be tempted into the Drama Triangle of Victim, Rescuer and Persecutor. Why? Like soap operas, the emotion sells news. As a fan of BBC Somerset, I have to say that local radio successfully avoids these games)

Who are the Gatekeepers? GP receptionists are often the frontline – and so can be the focus of distress and frustration, sometimes manifesting as anger. Online access may take some of the demand – AskmyGP and others – but people (we are all social creatures) want a friendly reassuring welcome. At least one Somerset practice, faced with an angry demanding patient, feared for staff safety and had to call the Police to remove him. Others have had complaints – which we should see as a symptom of society’s distress – two major organisations I know well have received more complaints in the last six months than in the previous five years.

So how can we understand this? One factor is the Drama Triangle of Victim, Rescuer, Persecutor. (Note, we are not calling anyone victims, rescuers, or persecutors – these are psychological constructs from Transactional Analysis’ Parent, Adult and Child and from Karpman’s Drama Triangle). In normal times – and now – rational sensible people see the whole picture, and access services, free from emotion (Adult role). Some people, distressed, drift into the Child role (regardless of age), give up their power, and may feel victim – and look to be helped by someone they trust to ‘rescue’ them – a Parental Role (nothing to do with families, all to do with Transactional Analysis). This is a stable dynamic, as long as the Parent can address the needs of the Child. However, if the Child (as victim) becomes unhappy with the situation, they take back their power, and turn into Persecutor – angry with the person or system helping them.

As we move through unpleasant loss emotions from Shock and Denial, to Anger and Guilt – frustration and complaints become common. It is not until we reach the growth cycle of Bargaining and Acceptance, that we can let go of our losses, and move on. This is Emotional Logic – actually all these loss emotions are preparation states for growth, as we struggle to reconnect with our values.

Another factor is the Inner Chimp. Steve Peters’ Chimp Paradox explains how we each have an Inner Chimp, our emotional brain, as well as our sensible Human.  At a time of inner distress, this emotional Being inside us can throw a tantrum. The Chimp in distress needs either to be exercised, given a banana, or to be contained (‘boxed’). Exercising means taking the Chimp to a safe place, allowing it to ‘let it all out’, listening to the Chimp for as long as it takes’ – and not commenting. Once the Chimp has been exercised, we can reason with it, calming its fears, using facts, truth and logic – this is ‘boxing’ it. The Chimp also needs to feel secure as part of its tribe (many of us have been deprived of our tribal or family security). Alternatively, we can manage our Chimp by feeding it bananas, which Steve Peters states are either distractions or rewards.

For many of us, the Inner Chimp’s frustrations have multiplied over the last months – pingdemics aside – no wonder that some people feel like exploding! However, if we throw our toys out of the pram in frustration, we must be careful not to throw hard toys, and be careful not to throw them at someone else. Society’s fabric has been stretched and torn – we have to mend it as best as we can.

So, what should we do if we are faced with somebody who is angry and frustrated – especially if we are tired or frustrated ourselves? We all need to learn the skills of inner peace, inner calm, and of safely discharging our stress hormones.

As we all know, a smile always helps, even if we don’t fully feel it inside. Try to be your best self, well hydrated, well slept, nourished and supported by team. Care for yourself - and exercise. Just ten repetitions of aerobic exercise – running on the spot, standing up and sitting down, or star jumps can burn off surface adrenaline. Then a brief exercise to get mind into body – and finish with five repetitions of slow deep abdominal breathing can put us into a calm state. And remember to look after your body’s needs – a full bladder stops you concentrating! And seems to stop me being able to listen!

Curiously, shaking off stress does work. We all need to calm ourselves before, and shake off emotion (in private!) after engaging with others – otherwise we project frustration, resentment or gloom, or any other negative state. Next, some calm slow rhythmic regular breaths take tension levels down, as the body and mind entrain to parasympathetic calm.

People need human contact and connection – and many of our patients – many people in society – have been starved of this. As we return to the new normal, we must honour this. It’s always good to talk, to share and not to suffer in silence. A problem shared can be a problem solved! Good conversations and connections at work are just as important as at home, maybe walking meetings in sunny weather? All of this is a real challenge for managers as they help us all navigate forwards – not always easy.

Other peoples’ emotions are their responsibility, not ours – though we may have to help them self-regulate. Please don’t take emotion projected at you personally, however painful and personal it feels – because it is really an expression of that person’s inner state –and may be their Chimp playing up… (like mine does sometimes…)

There’s a whole curriculum of Common Sense, Inner Peace and Emotional Intelligence. It certainly feels that we are being thoroughly tested on how well we know it – as well as Self-Care.

Very Short Solution (excessively simplified…): We only hit out when we hurt inside – so we need all to learn, practice and exercise the skills of Inner Calm and Inner Peace, day in day out… As they say, not a problem, just a project…

Thankyou for all you are doing; Go Well, and thankyou for doing your best, guided by best intention. More on Inner Peace soon…

Andrew Tresidder July 2021