Are you an artificial person? Lessons from Mid Staffordshire

The recent Francis report [1], from Mid Staffordshire NHS Foundation Trust, highlighted evidence of National Health Service (NHS) services devoid of care and compassion, shocking the nation. It is difficult to understand how individuals choosing to become healthcare professionals (HCPs) could reject their professional values and behave in such a counterintuitive way. A major reason why patients may perceive their care to be inadequate is attributable to what is termed the ‘artificial person’. According to Wolgast [2], the artificial person is one whose words or actions are considered to be the actions of another person. By using the organisation, in the case of the NHS, the artificial person may be an HCP who speaks and acts in the name of, and on behalf of, others. This helps to remove the personal responsibility that HCPs feel towards their patients. Due to perceived limited control over their own time management, a lack of time allocated to being with patients [3], and time pressures [4] associated with deadlines and increasing administrative demands, HCPs end up toeing the line set by managers, senior staff, doctors and administrators. Examples of responses from artificial persons to patients include: ‘I’m only following orders’, ‘It's not my fault, and I wish I could help, but it's not the policy of our hospital’ and ‘It's not my job, but if you go and see X then they might help…’. In North America, the prevalence of HCPs becoming artificial persons is increasing [2] and [5]. The findings revealed that the effects of an artificial person on the patient are: perceived lack of good medical care and compassion, feelings of anger, and reduced adherence and motivation within care to maintain or change health behaviour. The findings also revealed that becoming an artificial person led to HCPs feeling demoralised, becoming someone they do not want to be, and leaving their post.

In addition, and contributing further to patients’ perception of inadequate care, by toeing the line and given the time constraints, artificial persons severely limit their ability to offer the UK Government's vision for the NHS [6]; that is, a personalised patient care journey. For example, artificial persons curtail empathy. They also display a lack of narrative competence which is essential to personalised patient care [7]. Narrative competence within the HCP–patient relationship, as defined by Charon [8], is concerned with an ability to ‘listen to the narrative of the patient, grasp and honour their meanings and be moved to act on the patient's behalf’ (p. 1897). Change is required, given the threat to caring, compassionate and personalised care, and the potential for artificial persons to undermine government ambitions for the NHS. This change places a collective responsibility to respond with the individuals and institutions, as the NHS, HCPs and policy makers can all act to prevent people turning into artificial persons or to deflect them away from being artificial persons. However, research has yet to consider the NHS in the UK, although the most recent evidence [9] illustrated the importance of a novel voluntary service for neurological patients that encouraged personalised care. This experience helped students to recognise the importance of personalised care which was highly valued by the patient. In summary and drawing back to the Francis report [1], physiotherapists need to better understand what went wrong in Mid Staffordshire NHS Foundation Trust, and identify and eradicate unacceptable practice from all clinical settings. Further research on the artificial person may be helpful.