Tom Goodfellow

Juniors, BMA and Hunt need to untangle themselves from the ‘drama triangle’

Years ago I was house surgeon to the late Sir Alan Parks, a past President of the Royal College of Surgeons. I remember him saying that if you are in an argument with the ward sister the first one to manage to say, “Yes, but think of the patient” will always win because they have gained the moral high ground.

These days this would be termed virtue signalling which means saying something to demonstrate what a virtuous caring person you are without actually trying to sort the issue.

Listening to the news today concerning the all-out strike by the junior doctors I was overwhelmed by the volume of virtue signalling on all sides. I suppose that in this toxic dispute we should be pleased that it seems everyone is desperate for our health and wellbeing.

The doctors, led by the BMA, are striking to deliver a safer health service while the Government, led by Mr Hunt, is imposing the contract to deliver a manifesto promise of a safer health service! Can they both be right (or wrong)?

Psychologists frequently use a model of dysfunctional relationships based on the work of psychotherapist Stephen Karpman. It is called the drama triangle and is, in essence, a game with three players: a victim, a persecutor and a rescuer who is constantly applying short term fixes to the victim’s problem.

But a key feature is that as the game proceeds the players will swap roles from time to time. So in this particular game the BMA (victim role) is being bullied and harassed by that dreadful man from the ministry, and in consequence has no alternative but to call the troops out on a series of highly damaging strikes to show the bastard who is really the boss (persecutor role), and also to show how much they care for patients.

Meanwhile Mr Hunt wants to force an unpopular new contract on a reluctant work force (persecutor), but is being bullied by those dreadful intransigent doctors in the BMA who refuse to let him have what he wants (victim). He also wants to show how much he cares for patients.

However, the BMA tells him that if he will just withdraw the threat of imposing the contract then they will sit down and talk nicely with him again (rescuer role); but the behaviour of both parties simply entrenches their position.

Classically in the rescuer role each player may try to enlist the help of external rescuers such as the Labour Party, the Royal Colleges, the media or public opinion, and so the triangular misery-go-round rolls on with no sign of a resolution.

However the psychologists tell us that the only way to “escape” the Drama Triangle is to function as an “adult” and not participate in the game, but to date neither party seems willing or able to do this.

Hunt has handled this dispute badly, but I have a degree of sympathy for him. After all they have been negotiating for three years and the Government has made many concessions to the BMA, especially with regard to protection from unsafe rotas.

I know that all politicians are regarded as lying toads, but third parties have confirmed that agreement has been reached on most issues. The sticking point seems to be rates of pay for working Saturdays – hardly a reason to threaten indefinite strike action.

I also am waiting for someone, junior doctor or otherwise, to explain in detail exactly why they think the new contract will be dangerous for patients and damaging to the NHS, indeed so as to threaten its entire future. Most other hospital staff have to work hours which are not always socially convenient and I am a little bit suspicious that this is, in part, the real issue lurking behind some of the virtue signalling – but perhaps I am being a bit too cynical.

This dispute has gone on long enough and no one will come out of it well, not even the patients for whom the whole business is supposed to be about, and I use the word “supposed” deliberately because I think there are other agendas around.

So to both parties I say get off the bloody triangle, stop blaming each other and start behaving like adults.

And junior doctors, who I admire and respect and with whom I always enjoyed working, please put your placards away and get back to work. The BMA are leading you up a blind alley.

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2 Responses to “Juniors, BMA and Hunt need to untangle themselves from the ‘drama triangle’”

  1. galen says:

    I have to disagree with you. The juniors ARE striking to save the health service. If this new contract goes ahead many will emigrate and it will become impossible to staff the rotas safely.

    If I were a junior I would not work under the new contract. Admittedly when I was a junior doctor we had terribe conditions 1 in 2, 1 in 3 with excess hours paid at 0.33 . This does not mean I would want juniors to do that now. We had a covenant – that life would improve after serving our miserable years. This has been broken for this generation, also the intensity of work is much worse.

  2. Iain Stewart says:

    “Yes, but think of the patient” was not then and is not now a moral high ground arguement.
    Then & now it is a way of putting down your opponent.
    Coupled with the “great & the good” using it to a “junior” is a form of bullying.
    It’s a slur on colleagues in training to suggest they care less about patients then others.

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