NHS: a giant Diogenes syndrome
Adhi (V Adhiyaman), geriatrician and Chair of Welsh council of the BGS. Tweets at @adhiyamanv
Diogenes was a controversial Greek philosopher who lived in the fourth century BC. He was a cynic and rejected many conventional ideas and lived in a large clay jar in the city of Athens. He lived in a squalor and rejected ideas of normal human decency.
Diogenes syndrome is a disorder characterized by self-neglect, domestic squalor, apathy, compulsive hoarding of garbage and more importantly lack of shame. The syndrome does not refer to the intelligence or the philosophies of Diogenes but rather refers to the way Diogenes lived. A person with primary Diogenes syndrome is intelligent but aggressive, stubborn, suspicious, emotionally labile and has an unreal perception of life.
There are many similarities between the current NHS and Diogenes syndrome. Despite living in inappropriate and unsanitary conditions, a person with Diogenes syndrome feel very comfortable in those situations. NHS Hospitals are overcrowded and we admit and treat patients in all sorts of inappropriate places. Sick and medically unstable patients spend a lot of time in the ambulances parked outside the hospital, trolleys in emergency departments and corridors, observation units, waiting areas and treatment rooms.
One can see paperwork scattered everywhere, clinical notes in loose sheets, drugs charts in wrong places and misplaced results. Elderly patients get stuck in trolleys and are unable to get up and walk even to the nearby toilet. Even though the staff struggle to keep the place clean and tidy, it becomes an impossible task and the grim reality often hits the media. This mayhem is seen across all the hospitals in the UK and is repeated every day.
Many years ago, clinicians would have fumed at the thought of admitting and treating patients in such places, but now we have accepted it as a norm and have learnt to be comfortable in these situations because we feel we have very little say or control over the current situation. A person with Diogenes syndrome has a disordered sense of reality, unreal perception of life and will engage in endless debates to justify his ideas and thoughts. This is very commonly seen amongst our policy makers, commissioners, decision makers, strategic consultants, the list goes on. Over the last few years views on seven day working, weekend mortality, funding for the NHS and junior doctors contract have reflected this syndrome. We have seen plenty of empty promises and aspirations to achieve targets without any sense of reality and insight.
A person with Diogenes syndrome exhibits unpredictable mood swings, aggressive and stubborn behaviour. These traits are seen in people with managerial roles at bed meetings and management meetings where they make unreasonable demands including discharging patients earlier, without adequate arrangement of social care, spot purchasing care home beds for short term gains etc. We frequently hear simplified arguments: ‘if we could reduce the length of stay by 0.5 days, we could solve the bed crisis’. Little do they realise that a mathematical solution to address a complex human problem is impossible. Many fail to appreciate that patients are in hospital for medical and social needs and are frequently stuck in hospital because of long delays in transfer of care.
Diogenes was said to have gone around the country with a lamp in the daylight ‘looking for an honest man’. NHS has been looking for honest and understanding political leaders and policy makers for years without any luck. Until this happens NHS remains the biggest sufferer of Diogenes syndrome.