Wednesday, 27 July 2016

Painful choices

There is so much that is painful in the world right now – events in France, Germany and Turkey come particularly to mind – that there is no shortage of things I might write under this heading. I don’t think I have ever known so depressing a time, politically, in my life. But in this post I want to focus on the particular and personal pain that I have been experiencing: dental pain. And more specifically some organizational things around that pain.
In brief, last week I developed a toothache and went to the dentist who booked me in for some treatment. Over the weekend the pain became truly agonizing – I’ve had dental pain before but nothing remotely like this – to the extent that I had to contact the out of hours doctor for some non-prescription painkillers. This process itself was organizationally painful, involving no fewer than five telephone calls, each one acting as a kind of filter. Thus on the first call I was asked a checklist of questions clearly designed to either put up red flags (‘Pains in chest? Difficulty breathing?’) or to process me to the right person.
There’s nothing objectionable about that, although I could see it leading to many false positives and negatives, except perhaps the fact that each subsequent phone call entailed repeating my symptoms and needs (in summary: ‘I’m in agony, give me some super-strong painkillers right now’ which maybe could have been passed on). But what struck me was that when it came to prescribing medicine I was told about various different possibilities and the downsides – for example potential side-effects – of these. So I asked whether or not I should take the prescribed medicine, although frankly I was in so much pain that I would have done anything, whatever the risk, up to and including amateur surgery. And the response is what I want to write about, because it was to say that what mattered was that I had been ‘made aware of the risks and so could make an informed choice’.
It seems clear to me that this has nothing to do with my making an informed choice and everything to do with organizational self-protection. If things went wrong, I could hardly complain: I had been warned of the risks. But I had no way of assessing these risks or calibrating them against the benefits and so the choice did not in any way empower me; rather, it disempowered me in the event of any problem that subsequently emerged. It reminded me of a point made in my recent book on secrecy where we argue that the ‘full transparency’ of the terms and conditions we sign up to when making online purchases is actually a form of secrecy. The T&Cs are so lengthy and complex that no one reads them or could understand them if they did, yet in the event of a problem or dispute we can be told that we had been given full information and had agreed to it by ticking the acceptance box.
Anyway, I took my medicine and all went well in that the pain was somewhat lessened and I had no unpleasant side-effects (on the contrary, a rather pleasant wooziness) and I went to the dentist again. She told me that I had a choice between having root canal surgery or an extraction and talked me through the pros and cons. A choice again, then, and this time not I think one to do with organizational self-protection but reflecting current understandings of professionalism in healthcare and other spheres. I say current understandings because in the past the norm was for health professionals to simply tell you what to do. It was a more authoritarian, paternalistic approach in which the doctor (or dentist) knew best.
That has now given way to a more patient-centred and, I suppose, consumerist ethos in which clinician and patient together make treatment decisions. The trouble is that I really don’t want this, and don’t have any basis on which to make a choice – and it is a particularly bad time to try to make choices when one is in pain. I would actually rather be told what to do: my choice is not to choose, but that wasn’t an option. So the conversation became an exercise in me trying to detect and provoke signals from the dentist as to what she actually thought was the best course of action.
It may seem a stretch, but I think this links to the post-truth politics I discussed in my recent post The Sleep of Reason where ‘expert’ opinion is derided and we have a mixture of a consumerist market for ideas and an implication that how passionately a view is held is in some way an index of its truth. For some, this is a liberation from the tyranny of authority, but it goes hand in hand with a breakdown in trust and a devaluation of rationality. Perhaps this has had some good effects. The deference shown to experts in the past was not always healthy – for example, I can remember my late father always dressing in his best clothes when he had to visit his GP which seems extraordinary to me. On the other hand, the idea that a few minutes on google can enable us to talk on equal terms with our doctors is even more bizarre. In the face of pain, at least, I am a positivist and I want someone with knowledge of the evidence to tell me what to do about it.
Oh, and for anyone interested the decision was to have root canal surgery, starting this Friday. It was my choice, but I reserve the right to moan about it. Pain does not just make me a positivist, it also exacerbates, if that is possible, my propensity to grumpiness, gloom and outright bad temper.


  1. I hope that you opted for root canal treatment, Chris, which of course will have left you with quite a big hole in your pocket. Another side of consumerism.

    Incidentally, there is no exact equivalent to your father putting on his tie to visit the doctor - have you noticed how middle class people in England put on their best middle class accents whenever they have anything to do with health officialdom, but also school or any other sort of officialdom? It seems to me that this is one of the invisible glass partitions which everyone is aware of but few acknowledge. If you want officialdom to respond to you, OK you need not put on your Sunday best, but do put on your best accent.

  2. My girlfriend recently had the same type of problem you did, and it goes without saying that it happened on the weekend. The doctor told us up front that he could not correct the issue with her tooth, but he did offer pain medication. In truth, my girlfriend would have said yes to the first one offered because she was in too much pain to absorb the information.


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