Will more choice help us through the maze?

Patients will want to take the path that leads them to the healthcare that they want, at a time when

Choice is often touted as a panacea. If you give people the power to choose you make them responsible for their own destiny rather than treating them like commodities on a conveyor belt.

But what use is having an array of options if you don't understand the consequences of your selection? Healthcare, and the bureaucracy that shapes it, changes swiftly and it takes an astute, almost abnormally interested individual to keep track of the various bodies operating in one's local NHS, let alone at national level. There are primary care trusts, hospital trusts, community trusts, foundation trusts - and most recently, "super surgeries", or polyclinics, which are being built in certain areas to give patients far greater access to healthcare services.

Alongside all of these alternatives, pharmacies are being recommended as places for patients to go to seek medical help for what they perceive are minor problems. The press that surrounds the promotion of pharmacies is mixed: some say the advice given is inadequate, others concur that another avenue for people to obtain healthcare guidance can only be a good thing.

Of course, it's a no-brainer that greater access to healthcare is beneficial, especially in overcrowded or remote areas. But how are members of the public meant to know which source of medical advice is most appropriate for them? Joe and Jane Public may have an inkling as to what constitutes "primary" care, but as the boundaries change and services that used to be hospital-based are offered in new settings, confusion is likely to result in them resorting to visiting the most familiar setting: the GP surgery - if they can get an appointment - or, at the weekend and evenings, A&E. The NHS Direct helpline earns praise and criticism, with negative comments along the lines of, "They just told me to see my GP", to positive accounts of lives being saved thanks to timely advice being dispensed.

Seeing a door marked “consulting area” in a pharmacy helps to embed the idea that asking advice is expected, is welcome

There is no obvious consistency when it comes to the healthcare facilities in area A or B. Why should patients know that a pharmacy is linked to the local GP practice, which in turn falls under the aegis of the primary care trust (PCT)? They may view the pharmacy solely as somewhere to pick up some paracetamol and toiletries, failing to appreciate that the pharmacist can offer far more than a swift exchange of prescription docket for packets of pills and ointments.

Indeed, if patients have only ever used their pharmacist as a post-GP stop-off to collect new medication, they need to be made aware that the professionals behind the counter can provide a range of guidance. Some pharmacies - the major chains - have installed quiet booths within which consultations can take place away from the other shoppers. Seeing a door marked "consulting area" in a pharmacy helps to embed the idea that asking advice is expected, is welcome, and is not an added extra that interrupts the flow of pharmacy life.

However, while some patients will feel confident enough to seek advice from their pharmacist, either because they trust them or are aware that dispensing advice is the done thing, others prefer the continuity afforded them through their GP. The same principle applies when considering the move to polyclinics. People value the connections they cultivate with various health professionals. These relationships are intimate and are not to be underestimated, as they can drive individuals towards, or away from, particular sources of healthcare.

That said, the problem remains that, when someone approaches a pharmacist for advice, they are perhaps relying on diagnostic skills being better than the profession demands. This is not to denigrate the pharmacist in any way, but pharmacists lack the medical training and records that GPs have at their fingertips, so is it not imperative that the two professions work closely to deal with patients in a mutually accepted, consistent manner, referring to each other when necessary?

Where there are numerous healthcare options available, all parties must collaborate, not compete. This will help make it obvious to the layman or woman that these seemingly disparate parts of NHS healthcare fall under one umbrella, that they communicate, access common information (that is safely and accurately maintained) and are working together to drive up health standards by putting patients at the centre of all decisions. Only when all the potential participants in a person's quest to achieve good health are integrated can people be successfully guided through the maze of options available to them. Who does what, where, why, and how, will become obvious through good practice.

It doesn’t matter to patients that a procedure once carried out in a hospital outpatients department is now taken care of at their local GP practice

The NHS, an unquestionably mammoth, dynamic organisation, will seldom be transparent to the average patient but, if further entry points are introduced to the system that merely serve to compound confusion, this would be a missed opportunity to truly widen access. Yes, in the short term, seven-days-a-week health centres will benefit those who cannot take time off work to see their GP, or who cannot wait the best part of a day to have a routine blood test carried out. However, there will be gaps or duplications in commissioning and priorities that would be shamefully senseless in an environment where money is tight and the ultimate goal of high-quality patient care is common.

It doesn't matter to patients that a procedure once carried out in a hospital outpatients department is now taken care of at their local GP practice. No one bothers - and neither should they - that funding for a health check comes from primary, rather than secondary care coffers. As far as the taxpayer is concerned, they are paying for the lot.

People will take the path that gives them what they need when they need it. If that means going to A&E because their GP practice has unacceptably lengthy waiting times, so be it. It doesn't have to be that way but patients may not know any different and, until they do (which is the responsibility of NHS providers), change may be hard fought and "choice" may simply equate to confusion.

Joy Persaud is a freelance journalist and can be reached here.

This article first appeared in the 03 November 2008 issue of the New Statesman, Israel v Hamas

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Tweeting terror: what social media reveals about how we respond to tragedy

From sharing graphic images to posting a selfie, what compels online behaviours that can often outwardly seem improper?

Why did they post that? Why did they share a traumatising image? Why did they tell a joke? Why are they making this about themselves? Did they… just post a selfie? Why are they spreading fake news?

These are questions social media users almost inevitably ask themselves in the immediate aftermath of a tragedy such as Wednesday’s Westminster attack. Yet we ask not because of genuine curiosity, but out of shock and judgement provoked by what we see as the wrong way to respond online. But these are still questions worth answering. What drives the behaviours we see time and again on social media in the wake of a disaster?

The fake image

“I really didn't think it was going to become a big deal,” says Dr Ranj Singh. “I shared it just because I thought it was very pertinent, I didn't expect it to be picked up by so many people.”

Singh was one of the first people to share a fake Tube sign on Twitter that was later read out in Parliament and on BBC Radio 4. The TfL sign – a board in stations which normally provides service information but can often feature an inspiring quote – read: “All terrorists are politely reminded that THIS IS LONDON and whatever you do to us we will drink tea and jolly well carry on thank you.”

Singh found it on the Facebook page of a man called John (who later explained to me why he created the fake image) and posted it on his own Twitter account, which has over 40,000 followers. After it went viral, many began pointing out that the sign was faked.

“At a time like this is it really helpful to point out that its fake?” asks Singh – who believes it is the message, not the medium, that matters most. “The sentiment is real and that's what's important.”

Singh tells me that he first shared the sign because he found it to be profound and was then pleased with the initial “sense of solidarity” that the first retweets brought. “I don't think you can fact-check sentiments,” he says, explaining why he didn’t delete the tweet.

Dr Grainne Kirwan, a cyberpsychology lecturer and author, explains that much of the behaviour we see on social media in the aftermath of an attack can be explained by this desire for solidarity. “It is part of a mechanism called social processing,” she says. “By discussing a sudden event of such negative impact it helps the individual to come to terms with it… When shocked, scared, horrified, or appalled by an event we search for evidence that others have similar reactions so that our response is validated.”

The selfies and the self-involved

Yet often, the most maligned social media behaviour in these situations seems less about solidarity and more about selfishness. Why did YouTuber Jack Jones post a since-deleted selfie with the words “The outmost [sic] respect to our public services”? Why did your friend, who works nowhere near Westminster, mark themselves as “Safe” using Facebook’s Safety Check feature? Why did New Statesman writer Laurie Penny say in a tweet that her “atheist prayers” were with the victims?

“It was the thought of a moment, and not a considered statement,” says Penny. The rushed nature of social media posts during times of crisis can often lead to misunderstandings. “My atheism is not a political statement, or something I'm particularly proud of, it just is.”

Penny received backlash on the site for her tweet, with one user gaining 836 likes on a tweet that read: “No need to shout 'I'm an atheist!' while trying to offer solidarity”. She explains that she posted her tweet due to the “nonsensical” belief that holding others in her heart makes a difference at tragic times, and was “shocked” when people became angry at her.

“I was shouted at for making it all about me, which is hard to avoid at the best of times on your own Twitter feed,” she says. “Over the years I've learned that 'making it about you' and 'attention seeking' are familiar accusations for any woman who has any sort of public profile – the problem seems to be not with what we do but with who we are.”

Penny raises a valid point that social media is inherently self-involved, and Dr Kirwan explains that in emotionally-charged situations it is easy to say things that are unclear, or can in hindsight seem callous or insincere.

“Our online society may make it feel like we need to show a response to events quickly to demonstrate solidarity or disdain for the individuals or parties directly involved in the incident, and so we put into writing and make publicly available something which we wrote in haste and without full knowledge of the circumstances.”

The joke

Arguably the most condemned behaviour in the aftermath of a tragedy is the sharing of an ill-timed joke. Julia Fraustino, a research affiliate at the National Consortium for the Study of Terrorism and Responses to Terrorism (START), reflects on this often seemingly inexplicable behaviour. “There’s research dating back to the US 9/11 terror attacks that shows lower rates of disaster-related depression and anxiety for people who evoke positive emotions before, during and after tragic events,” she says, stating that humour can be a coping mechanism.

“The offensiveness or appropriateness of humor seems, at least in part, to be tied to people’s perceived severity of the crisis,” she adds. “An analysis of tweets during a health pandemic showed that humorous posts rose and fell along with the seriousness of the situation, with more perceived seriousness resulting in fewer humour-based posts.”

The silence

If you can’t say anything nice, why say anything at all? Bambi's best friend Thumper's quote might be behind the silence we see from some social media users. Rather than simply being uncaring, there are factors which can predict whether someone will be active or passive on social media after a disaster, notes Fraustino.

“A couple of areas that factor into whether a person will post on social media during a disaster are issue-involvement and self-involvement,” she says. “When people perceive that the disaster is important and they believe they can or should do something about it, they may be more likely to share others’ posts or create their own content. Combine issue-involvement with self-involvement, which in this context refers to a desire for self-confirmation such as through gaining attention by being perceived as a story pioneer or thought leader, and the likelihood goes up that this person will create or curate disaster-related content on social media.”

“I just don’t like to make it about me,” one anonymous social media user tells me when asked why he doesn’t post anything himself – but instead shares or retweets posts – during disasters. “I feel like people just want likes and retweets and aren’t really being sincere, and I would hate to do that. Instead I just share stuff from important people, or stuff that needs to be said – like reminders not to share graphic images.”

The graphic image

The sharing of graphic and explicit images is often widely condemned, as many see this as both pointless and potentially psychologically damaging. After the attack, BBC Newsbeat collated tens of tweets by people angry that passersby took pictures instead of helping, with multiple users branding it “absolutely disgusting”.

Dr Kirwan explains that those near the scene may feel a “social responsibility” to share their knowledge, particularly in situations where there is a fear of media bias. It is also important to remember that shock and panic can make us behave differently than we normally would.

Yet the reason this behaviour often jars is because we all know what motivates most of us to post on social media: attention. It is well-documented that Likes and Shares give us a psychological boost, so it is hard to feel that this disappears in tragic circumstances. If we imagine someone is somehow “profiting” from posting traumatic images, this can inspire disgust. Fraustino even notes that posts with an image are significantly more likely to be clicked on, liked, or shared.

Yet, as Dr Kiwarn explains, Likes don’t simply make us happy on such occasions, they actually make us feel less alone. “In situations where people are sharing terrible information we may still appreciate likes, retweets, [and] shares as it helps to reinforce and validate our beliefs and position on the situation,” she says. “It tells us that others feel the same way, and so it is okay for us to feel this way.”

Fraustino also argues that these posts can be valuable, as they “can break through the noise and clutter and grab attention” and thereby bring awareness to a disaster issue. “As positive effects, emotion-evoking images can potentially increase empathy and motivation to contribute to relief efforts.”

The judgement

The common thread isn’t simply the accusation that such social media behaviours are “insensitive”, it is that there is an abundance of people ready to point the finger and criticise others, even – and especially – at a time when they should focus on their own grief. VICE writer Joel Golby sarcastically summed it up best in a single tweet: “please look out for my essay, 'Why Everyone's Reaction to the News is Imperfect (But My Own)', filed just now up this afternoon”.

“When already emotional other users see something which they don't perceive as quite right, they may use that opportunity to vent anger or frustration,” says Dr Kirwan, explaining that we are especially quick to judge the posts of people we don’t personally know. “We can be very quick to form opinions of others using very little information, and if our only information about a person is a post which we feel is inappropriate we will tend to form a stereotyped opinion of this individual as holding negative personality traits.

“This stereotype makes it easier to target them with hateful speech. When strong emotions are present, we frequently neglect to consider if we may have misinterpreted the content, or if the person's apparently negative tone was intentional or not.”

Fraustino agrees that people are attempting to reduce their own uncertainty or anxiety when assigning blame. “In a terror attack setting where emotions are high, uncertainty is high, and anxiety is high, blaming or scapegoating can relieve some of those negative emotions for some people.”

Amelia Tait is a technology and digital culture writer at the New Statesman.