“Initiatives like the “productive ward” just about sum up the “modern” approach to nursing.”
I must confess I don’t know much about the Productive Ward programme, other than that Ducky Crippen got all hot and bothered about it a while back, and E seems rather excited by it now. Apparently it’s the epitome of all that’s wrong with nursing.
A quick disclaimer: I’ve never used Productive Ward, and don’t know anyone who has. I also note that Beakie doesn’t know any nurse lecturers who teach it. Just to obscure things further, a lot of the website appears to require a login, which presumably you get once you’ve purchased the package. Still, people seem to be steamed up by it, so I’m going to use the limited information available to me on the website to try to get some idea of what it’s all about.
Okay, I’ll start by browsing through the blurb:
Following a period of intensive testing and development with a number of acute trusts in England, the NHS Institute has now launched a series of modules that enable ward staff to increase the time spent on direct patient care.
Releasing Time to Care -The Productive Ward focuses on improving ward processes and environments to help nurses and therapists spend more time on patient care thereby improving safety and efficiency.
So, basically it’s a training package on time management? Okay, tell me more….
I’ll have a peek at the module structure. Hang on, there’s a fancy graphic.
And it’s in the shape of a house. Which is nice.
A ward leader implementing the Productive Ward will start with the Ward Leader’s Guide. Then, with the ward team, they will first work through the foundation modules (Knowing How we are Doing, Well Organised Ward and Patient Status at a Glance)
Ah, I get it. So, those three modules, they’re the foundations of the house. So presumably “toolkit” must, erm, the wall? I dunno.
Actually, thinking about it, I’m going to imagine “toolkit” as a rather nice set of patio doors. I just feel like it.
Anyway, the foundations:
Knowing How we are Doing
Developing ward based measures to help the team make informed decisions.
Well Organised Ward
Make the ward areas work for your staff so that your staff don’t have to work around the ward areas.
Patient Status at a Glance
Patient information that improves communication, patient experience and patient flow.
All of this is a bit vague on detail, since I’m only getting access to this little house-shaped summary. That said, this foundations stuff sounds like reasonably common-sense stuff. It also sounds like it would look nice with some quality linoleum..Oh wait, that’s just my imagination running away again.
Anyway, moving on to the….er…the mezzanines?…there’s some more specific stuff.
Meals:
Reduce the time the team spends physically delivering meals and allow more time for the team to assist with feeding and ensure proactive nutritional assessment for the patients in their care.
Okay, that’s fair enough.
Medicines:
Ensure medicine rounds do not clash with other ward processes. Reduce interruptions on staff and ensure everything is ready.
Also fair enough. Though personally I learned early on to “reduce interruptions” in meds rounds by the simple expedient of inviting people to fuck off if they tried to interrupt me while I was administering the meds. It was blunt, but effective.
Admission and Planned Discharge:
Remove the rush of admission and discharge by making the process planned. Ensure the team launch social and support functions, to aid discharge, at the correct point in the patient journey.
I know that Ducky Crippen hates it when these things refer to a “journey”, which I must confess does reek slightly of management-speak. That said, management training types aren’t exactly the only people who can be capable of using language that would make the Plain English Campaign weep into their copies of Roget’s Thesaurus. What’s that profession that says “polyuria” for “pissing a lot” and “nocte” for “at night”…?
Shift Handovers:
Reduce the time the team spends on handovers, while making the information handed over more appropriate, easier to remember and easier to understand.
Ah, a subject that’s close to my heart. The importance of getting the handover done and dusted without spending ages on trivial details, waffling on or going off on a tangent about some completely separate subject. Especially if I’ve just finished a night shift and want to get home without having to spend half an hour waiting for people to stop wibbling about the X Factor. As with med rounds, I find that the threat of violence can sometimes be helpful in this regard.
I guess I should ask myself the question, would I want to do this course myself? To be honest, I think the ward I’m on at the moment is running pretty productively as it is, thanks to a combination of manageable patient numbers, a decent manager, good staff morale and a general atmosphere of mutually supporting each other…Yeah, I know, and on an NHS ward as well. I’m just as amazed as you lot. Then again, that in itself probably says a few things about what makes for a “productive ward”.
All in all, I can’t say I’m in a rush to go out and do the Productive Ward programme myself, but at the same time I can’t see why some people seem to think this is somehow bringing about the collapse of Western civilization.
Also, I can honestly state that as management initiatives go, this one pales in comparison to some of the ridiculous frippery I got frogmarched into back in my former existence as a call centre minion. Now that was an environment in which managerial idiots really got to roam free. Don’t get me started on the training sessions where we had to wear fancy dress. Or the telecom company that did some market research that said when customers get a fault in their phone line, they want an apology, so instructed the customer service monkeys to repeat “I’m sorry that your phone’s not working” as soon as the customer said they needed to report a fault. Or being expected to type a code into your computer to indicate that you were going on a toilet break…
Honestly, and people wonder why white-collar workers sometimes snap and go on the rampage with an assault rifle. Quite frankly, I’m amazed it doesn’t happen more often.
“want to get home without having to spend half an hour waiting for people to stop wibbling about the X Factor”
Oh my god yes! Don’t get me started…bunch of fuckwits. I am starting to wish some of those tasers the police are getting were coming to us. I’m sure they would speed up the handover after they stopped convulsing.
I’ve never heard of the productive ward stuff. Possibly we have been learning about it under the lesser known title of ‘common sense’?
My thoughts exactly CD. Good nursing teams have been practicing this for years and don’t assume that we need training days on it. However, with all management thingys they assume that they have to teach us to suck eggs to justify their jobs.
Z an entire post for my benefit I am honoured!!
But are you defending this rubbish or not? It’s not entirely clear from your post. And how about answering the question,
Q: Do you need a degree to tidy a cupboard?
Also with regard to your comment:
“Also, if modern nurse training is such bollocks, why am I such a fucking good nurse?”
An empty vessel makes the most noise, have a good night.
Any nurse that can tell a consultant to fuck off and keep his/her job is a good nurse.
There’s a lot more of that sort of thing here. This time it’s the patients turn, since the public circumcision of Scott Junior, dampened your ardor.
@E
But are you defending this rubbish or not? It’s not entirely clear from your post.
I’m not defending this rubbish. I’m discussing this rubbish. There’s a difference.
An empty vessel makes the most noise
Indeed it does, E, indeed it does…
As to The Productive Ward, time management is something nurses do terribly badly. Small example: I remember banging my head against a brick wall as a practice development nurse trying to get people to see that writing notes as you went along was better than saving it all up to write in one big splurge at some arbitrary time in the shift. The most ridiculous thing was people writing their notes on bits of paper to transcribe into The Notes at a later, arbitrary time.
Anything that helps nurses to use their time more effectively is Not A Bad Thing.
Some traditions are hard to change Beakie. The daily gossip whilst writing the notes is as innate to nursing as the jammie dodgers with a cup of tea. Neither will easily be eradicated.
That particular tradition needs to change and soon. Not making contemporaneous notes is not only incredibly inefficient, but also detracts from the accuracy of said notes and leaves the note-maker open to all sorts of trouble should said inaccurate notes suddenly find themselves being pored over in an inquiry.
“I’m not defending this rubbish. I’m discussing this rubbish. There’s a difference.”
but you agree it is rubbish.
“An empty vessel makes the most noise
Indeed it does, E, indeed it does…”
Where as the best you can manage beakie is to sound like a cracked one.
I’m not that bothered by it either way, E. I don’t particularly have any urge to do it myself, but I’m also slightly mystified as to why this sort of thing is supposed to lead to the collapse of nursing.
It’s a training course on time management. Nothing more, nothing less. If other people found it helpful to them in terms of running the ward, then good luck to them.
The Armed Forces have deployed to Iraq and Afghanistan and are fighting with distinction without a single “productive” platoon or “practice development” Sergeant. I`ve no idea how they manage.
Contemperaneous, verbatim notes, in quadruplicate, are the future.
The hospital I work in is partaking in ‘Productive Ward’. I’m not sure if the trust is at large; or whether its just our hospital. Anyway, it hasn’t been brought in where I work specifically as yet; but there are number of wards who piloted the scheme and are now fully ‘productive’ (sic).
All I have noticed is that outside each of the wards there are big display boards publicising information such as: staff sickness rates, infection rates, numbers of formal patient complaints, bugeting, incident form rates, and so on. They are all in pretty coloured pie and bar charts, illustrating the monthly trend over the past 18 months and comparing the specific ward results to trust targets and trust averages.
I’m sure someone told me it was the NHS version of school league tables – trying to create an open culture and give patients more information about their hospital. “The trust” is applying for foundation status so perhaps they thought this would strength their case??
The Armed Forces have deployed to Iraq and Afghanistan and are fighting with distinction without a single “productive” platoon or “practice development” Sergeant. I`ve no idea how they manage.
Man compares apples and oranges. Looks a tit as relevance escapes everyone. Again.
People in offices, maybe even practice development nurses, produce infantile coloured in houses like the one at the top of the page. Not difficult, at all, to spot the relevance for you. Relevance to the real world is the important issue. The Armed Forces are, by a country mile, our most impressive and respected public serevants. We should be looking to learn from their example. If you ever emerge from your ivory tower, Beakie, take a trip to Gosport and ask the locals how they feel about the demise of the last military hospital, many of whose services were available to civilians.
In what way does time management have nothing to do with “the real world”? And again, loving the non-sequiturs here OSB.
Beakie, take a trip to Gosport and ask the locals how they feel about the demise of the last military hospital, many of whose services were available to civilians.
Speaking as someone who grew up in Plymouth, I remember the Royal Naval Hospital, which was closed down at the end of the Cold War, and the staff moved to the nearby Derriford Hospital, which is now jointly staffed by NHS and Royal Navy clinicians.
Derriford Hospital has made headlines in recent years for having the highest MRSA rates in the UK.
Beakie, May I suggest that the house would look better with a round, square and arched window. Carry on with the colouring in and heres hoping Santa brings you some new crayons.
Never been to Plymouth and I`ve not heard of Derriford Hospital. I`m guessing the military hospital has been closed 15 years ( at least ). I would be extremely surprised if there are still Naval clinicians working in Derriford. I`ve had treatment at military hospitals in Germany and Belfast. Mrs. OSB has been to Gosport on many, many occasions and spent months at the Joint Service Rehabilitation Centre, Headley Court – which is, and has been for some time, the only in-patient facility owned and run by the military. They were all gleaming.
BTW Haslar Hospital, Gosport would have been closed years ago if it wasn`t for massive, local, civilian pressure in a marginal constituency.
And while I`m ranting. This government finds money for practice development buffoons, their coloured houses, stress buckets and pathetic little problem solving flowcharts. Meanwhile, private soldiers blown up looking for WMD`s are accommodated 8 or 10 to a room in bunk beds at Headley Court. Not even a budget to paint the walls apple green or or orange so Beakie can differentiate between a military hospital and a civilian one.
*yawn*
Will you ever get a new act?
*awaits OSB spluttering with rage that I have somehow disrespected soldiers by yawning at his tedious posturing and coat-trailing*
Beakie, You are the smug child who has just learned to tell the time / tie his shoelaces / ride a bike. So you`ve learned to play a straight bat. This wouldn`t have been impressive if you`d have picked it up at the outset, it was a very obvious strategy. However, considering Mr Ian has been demonstrating the technique for ages and it was even recommended to you it`s remarkable you`ve finally grasped it. The walls of the tower must be porous after all. It`s like tectonic shift but reality filters through in the end.
As it happens I don`t think you disrespect the troops. I also agree with you that time management is important. Remarkably, I`m also of the opinion that contemperaneous notes are of value. Though I didn`t need a practice development clown to tell me.
Let`s try something revolutionary shall we ?. If a ward isn`t managing its time effectively, or if it`s dirty for that matter, why don`t we forget about crayoned houses, flow / pie charts, initiatives, forums, focus groups, policies and philosophies, sack the boss and get a new leader. Preferrably, someone with an awareness of the principles of leadership. Where might we look for some guidance ?. Let me think ?
Z can blame the MRSA at Derriford on some ( probably non existent ) residual band of Naval personnel. You can claim that the NHS has nothing to learn from the military, you can even persuade yourself that the military have never run a clean, well regarded hospital. But you`re both wrong.
Beakie, You are…
Could you maybe once in a while, whenever you’re grown up and ready to, perhaps mount a proper argument instead of just having yet another tedious, spluttering, purple-faced boring old rant at me? Try it.
You can claim that the NHS has nothing to learn from the military, you can even persuade yourself that the military have never run a clean, well regarded hospital.
Nobody has claimed any of this, of course. But splutter on, splutter on.
Much as I enjoy this, I`m desperately short of time.
I`m afraid it`s you with the paucity of proper argument. I don`t think you disrespect the military because you`re oblivious. I understand that you`re from a social grouping that has cause to loathe the BNP. However, you`ve no more ( and certainly much less ) cause to loathe them than I have to loathe the IRA. If Gerry Adams is whacked tonight, I`ll sport a cheesy grin tomorrow. But there`s a difference. I feel no revulsion. I can understand, perfectly, how a kid from West Belfast comes to join the IRA. Similarly, I can understand how a 74 year old granny comes to join the BNP. You`re thinking is all skewed. What a nonentity politician from Ulster has to say about homosexuality and an Asian getting dogshit through their letterbox are bigger political issues, to you, than 300 servicemen getting sent to their deaths by a lying government. Nick Griffin`s the anti – Christ. Tony Blair`s benign.
Similarly, your professional thought patterns mirror your political ones. You never, for a moment, stop to think that those at the coalface are sick to the back teeth with the incessant productive ward, protected time hectoring nonsense of professional development knobs. It`s become white noise. You have no clue as to why so many have donned their ear defenders and switched off. A coloured house as part of the solution ?. Are you having a laugh ?. Just fuck off and leave us alone. Send us a positive message. Show some belief. We can figure things out for ourselves. When I was 21 years of age the army gave me responsibility for getting an armoured regiment ( 52 main battle tanks and their entourage ) from A to B, at night. As a 42 year old staff nurse I had ask for a signature from a fuckwit modern matron to get £1.99 out of the cashbox. Says, it all really. Coloured house micro – management. Shove it.
The bigger picture remains a mystery to you.
As for your views on education. If modern day comprehensives are the answer, God only knows what the question is. And I know, without a shadow of a doubt, that you look at some of your students and think bloody hell, you`re thick. Still, now that FOFO ( fuck off and find out ) education prevails at least you don`t have to stand there and teach them anything.
As I said, come back when you can mount a proper argument instead of a constant stream of ad hominem rubbish.
Damn – pressed send too soon.
I wanted to add that I’m sure I’m not alone in thinking that your “contributions” have poisoned the atmosphere on this blog in recent weeks, leaving many decent contributors unwilling to post for fear of getting the same hairdryer treatment from you.
Wasn`t it you who introduced the “if you don`t like it, fuck off elsewhere” argument to Mental Nurse. If it`s sauce for the goose……… Why don`t you resurrect the rotting corpse that was your own blog and see if you can induce the supposed multitude of lurkers to actually comment.
Unfortunately OSB, it’s happening the other way around. Battle traumatised troops are going to be <a href=”:http://foundationtrustwatch.blogspot.com/2008/11/excellent-trust-wins-mod-contract.html”looked after by our local fuckwits.
This is no joke at all when you look at their performance on the {battle}ground.
I tried to follow the {rhetorical} argument here, but got distracted by the argument.
Without commenting on the substance of the issue, I would like to say the thought of OSB lining ‘em up in the car park of Mental House and nutting ‘em appeals to me immensely.
Poo. That went wrong.
“Excellent” Trust Wins MOD contract
Ah, Beakie, thought you were “loving the non sequiturs”, whatever they might be.
In many ways it`s not fair. You have no direct impact on my practice. You get the “hairdyer” as you represent, almost perfectly, the type of muppet who blights my working day. Unlucky
As for whether I deter others from contributing, I don`t know and I don`t lose sleep. MN didn`t seem, to me, to get any healthier when I bowed out a while ago. I`ve also admitted that I could well have been the primary reason for Malcolm Roff`s disappearance. However, you`re one cheeky bastard. You`re assumption of proprietorial rights which weren`t yours to assume and haughty “fuck off, if you don`t like it” tone saw off Mo, one of MN`s most inoffensive, insightful and humourous contributors. ( at least I`m selective in my fire ) It also deters the Charge Nurse from commenting as he should. E doesn`t know whether to stay or go.
It`s a shame your initial comment to the Getting Rich post demonstrates you are capable of coherent thought but most of your output is drivel. I`d be gone for good if I didn`t feel compelled to return from time to time to point it out.
Socrates, I`m very well aware of where the troops go now – a military wing of a NHS hospital – although I haven`t been there myself. Anecdotally, it was a shambles but now it`s been gripped ( I`ve no doubt that was by the military ). Sorry if I sound cynical but alarm bells start ringing when Trusts are classified as excellent.
Almost your entire time here is spent in digging at me, despite you knowing virtually nothing about me other than that I work in a university. Your posts are a form of bullying, and I for one won’t be providing you with any further ammunition.
Just a quick response in between the shouting:
Regarding OSB’s comment
I would be extremely surprised if there are still Naval clinicians working in Derriford.
Oh, I’ve been back there in the past couple of years when my Mum had an appointment there. There were still doctors and nurses wandering around in Naval uniforms.
First you were loving it. Then I was boring you. Now you`re being bullied. Bless.
Maybe they`re still there Z, I don`t know. Do they have dedicated wards ?. What percentage of the workforce do they constitute ?. Do they drink too much rum and forget to wash their hands ? To what degree are the Naval clinicians responsible for the galloping MRSA ?. Will it be addressed with bleach and elbow grease or will a coloured house flow chart suffice ? We need to know.
In answer to your questions, OSB:
No they don’t, I’ve no idea, I’ve no idea, I’ve no idea, and I imagine the bleach and elbow grease will be better than the coloured house. This is not me constructing a point. I’m just casting asides.
Anyway, Beakie, OSB, carry on fighting. I’m just sitting here munching popcorn.
Sorry Z, you’ll have to take your popcorn elsewhere. I’ve decided to leave the boorish bore ranting at the wall.
Micro managing is a big turn off for me – but it’s not the people that are being micro managed…. it’s the leaders in ward management who are being told to break it down into small chunks…. micro chunks …
That way you can win the battles and the war.
Coloured houses may not float ya boat – but feedback is good and such propaganda is motivationally effective.
Ok I’m all out of military euphemisms.
Ward “Management” has always been an issue and has been taught under that age old edict:
“Experience is something you get just after you needed it”.
I agree with OSB that nursing needs to have managers who can manage.
I don’t agree it has to be led by the 44th Panzer Division.
Neither of you are right. Neither are wrong.
OSB – it’s not simply a case of friend or foe and it’s not like the military approach is 100% effective guaranteed. But we’re not all fighting and we’re not constantly at war. Military style in in and over as quick as – but look what happens when you mess up and miscalculate your enemy – Vietnam; Gallipoli; – you’ll probably know more. But intended brief conflicts can turn into arduous and costly long affairs – cos they didn’t have their pretty coloured house in order on perhaps only one small detail.
beakie – how can you be a teacher of holism and discount parts of the whole? OSB is a PoV that has to be included in the equation. Some people work that way – and probably because he was conditioned to think direct approach. It has its place of value.
beakie & OSB – I have to declare I find both your manners of argument equally offensive and for one period there, after being OSBs punch bag (or blow wave, whichever) over the coalminers drama – and he briefly departed – I was kinda feeling I was OSBs surrogate replacement for you while you worked through some attachment issues.
Rather than seeking out to single one as the protagonist and yourself as defender – can you not see yourselves both as perpetuators?
I find the pair of you, at best – quite entertaining; at worst – pretty elevated sense of self worth – with your constant display of multi faceted arguing ‘talents’ that always follow the same pattern which ultimately results in the death of another topic. It seems the issue has become not making “the point” or progressing an argument – in it’s philosophical sense – but is most often a platform on which various persons choose to make a point – then spend the entire remainder if their posts on a display of editorial ju-jitsu.
And E is your offspring demon child.
Seemingly delivered by Doc C.
Get over yourselves will you?
Mr Ian,
“I find the pair of you, at best – quite entertaining; at worst – pretty elevated sense of self worth – with your constant display of multi faceted arguing ‘talents’ that always follow the same pattern which ultimately results in the death of another topic. It seems the issue has become not making “the point” or progressing an argument – in it’s philosophical sense – but is most often a platform on which various persons choose to make a point – then spend the entire remainder if their posts on a display of editorial ju-jitsu.”
WTF????
But speaking as an outsider, what is your opinion on the human race?
This is just sooo dreamy on so many levels…
You think there’s a little…sexual tension, Socrates?
Does rather conjour up images of a sweaty Oliver Reed on a bear-skin..
Can I be Oliver Reed, (preferably without Z’s cock in my mouth.)
Wrote all this last night but it would appear my login had expired. The joys of being a technotard.
I may be arrogant, Mr Ian but I`m not sure about the elevated sense of self worth. I`m a Staff Nurse on the wards doing what I rather enjoy doing. I`ve had plenty of opportunities to “further” my career but I`ve ignored them all. Don`t get me wrong, I`m no martyr, if the lottery afforded me the chance to run my own smalholding I`d be gone but as it is I`m a Staff Nurse. All I want is to be granted some faith in my ability and be left alone to get on with it. But, oh no, I am besieged by faceless office dwellers insisting “you don`t do it like that, you do it like this”. Without any consultation the latest coloured house lands on the desk with instructions that I comply.
I have no idea who most of my tormentors are but it is quite clear a good number of them are academic types or fill some practice development role. Beakie fits the template to a tee, Malcolm Roff to a lesser degree did too. That`s why they get the hairdryer. If they think allegations of bullying ( how pathetically modern Britain ) will pull me up short they can think again. You see what galls me the most is that I feel, rightly or wrongly, that if you leave the wards ( and I generally suspect people leave due to a lack of commitment and / or the fact they can`t hack it ) they should forfeit their right to tell those that remain what to do.
I use military analogies as that is what I know. Your examples are by no means the best but it`s undeniable there have been good numbers of howling military blunders. That said, if you attend military academy you will study the history of warfare back to Leonides and his 300 Spartans. The mental health world has scant regard for its history. Everyone just seems to to gleefully pursue the latest, “cutting edge” intervention whilst thoughtlessly discarding what was good about their previous practice. It is obvious to me that the military, under Nu Labour, were set on a course of submission to the practice development types until operational necessity forced them to return to what they do best. The results, whilst tragic, speak for themselves. A public service can function, commendably well without a coloured house in sight. As for leadership, personal discipline / standards and can do attitudes, rather than crumbling at the first staff shortage / minor obstacle, where else do we seek inspiration.
And let`s not forget there was an economic boom in the 90`s ( I would argue it was built on sand but that`s for another day ). What is beyond dispute is that a lot of tax revenue was raised much of which was directed at the NHS. Some of it was spent reasonably wisely but how much was squandered on the colouring sets. We`re talking vast sums of money which , now the economy is going down the shitter, Darling will wish his predecessor had invested wisely.
It`s not just the military we need to learn from either. We discussed Gerry Robinson looking at the NHS from a business perspective many moons ago. What was clear, to me, from that documentary was that neither invisible management nor the pompous medics could see the way forward. The, rather humble, Charge Nurse had all the bright ideas.
I could ramble on but you get my drift. Those at the coalface just need some respite to get on with what we do. We`re labelled change phobic when we`re simply change fatigued. My message to you, Beakie, is the same as it ever was, you can stick your coloured house up your arse..
Today is a very special day for me. My time and energy will be needed elsewhere. I`m fading away again but I do reserve the right to return.
As ever, I wish Mental Nurse every success.
beakie – how can you be a teacher of holism and discount parts of the whole? OSB is a PoV that has to be included in the equation.
a) Holism is a nice word, and something we all pay lip service to.
b) I am not required to be “holistic” in my posts and comments to this blog.
“I`m fading away again but I do reserve the right to return.” – OSB
-For then shall be great tribulation, such as was not since the beginning of the world to this time, no, nor ever shall be.
-Mathew 24:21
OSB – I enjoyed reading that. And in principle – I’d agree. But in practice – even without the management strata – it does not work so well because many of the little foot soldiers piss about and have no real work ethic. How do you plan to instill that? With a plan!? .. pretty colours… shaped like a house…
It may have gone overboard. But it is the pendulum effect. When things change – they are always done in a knee jerk over-corrective way until it settles down again a new and happy medium.
beakie – you may speak of your own failings – holism is something I encourage. I can reach both sides and all around by sitting on the fence.
But what really gets me about your posts – “I am not required to be “holistic” in my posts and comments to this blog.” – what nonsense is that?
Are you saying that the principles of nursing are an on/off affair? That you can turn on your ‘care factor’ when you’re getting paid for it?
At least OSB is true like an arrow and I’ve no doubt – if he doesn’t agree he says so or knows when best to keep his mouth shut. But I doubt he would pay lip service to something he had no faith in.
Mental health, of all vocations, is one that requires core personality skills. I have long felt your dismissive nature to be reminiscent of burn out.
Oh do fuck off with your pop-psychological insights and your cornflake packet philosophising Mr Ian. There – true and direct enough for you?
Not really. Just revealing.
Revealing that I find you intensely irritating, yes. When have I ever made any assumptions about you as a person? I haven’t, and yet here you are, couching yet another ad hominem attack in a load of verbose noodling about holism. At least when you get shit off OSB, he doesn’t try and wrap it in marzipan.
Now, why don’t you entertain us all with yet another fascinating tour round the contents of your navel.
You want a hug?