Is it ethical to try and engage with busy senior clinicians, if you are trying to alter 'NHS Behaviour'?

Cathy Welch has answered my question:

https://twitter.com/Cjw450Cathy/status/965626997111128065

I’m not sure about the last question- I think it is ethically dubious as risks unsolicited emails, which can be a real problem, especially on work emails,given security issues, etc.

Cathy also commented on something else I wrote in my piece:

https://twitter.com/Cjw450Cathy/status/965628816185020416

I also disagree re: “... engaging with those less-senior clinicians is perhaps ethically dubious):”. Often strongest agents for change is young, energetic generation, not tied down by years of dogma & cynicism. Leadership is not solely the domain of seniority

Answers from Kate Masters:

https://twitter.com/katemasters67/status/966635881833680896

Tricky question. Do I think offering help to find emails is morally wrong? Doubt it. Once the info is passed on, Morality then passes to the recipient on how to use (or abuse) the info.

And a little off the question:

https://twitter.com/katemasters67/status/966637830893170689

On the issue of contacting senior figures, have to say I’ve had some wonderful two-way info sharing interactions with junior doctors and nurses as well as educators/policy-makers. The one person who needs to listen and could do much more is the most elusive..

David Oliver also posted some tweets on this, but I'll leave you to decipher them (these seemed to cover all of the bases, so they seemed to start with a 'it is okay' but turn into a 'it isn't okay' when I read them):

https://twitter.com/mancunianmedic/status/966618414612697089

https://twitter.com/mancunianmedic/status/966619057700163584

https://twitter.com/mancunianmedic/status/966620919866195968

And some more tweets, but we were I think 'drifting off-topic' in the later tweets.

Here is my own answer, to my question.

I admit to having a slightly ‘inconsistent’ attitude, to my own question: to the specific question I would answer ‘yes, it is okay to publish those tips’ - and, if I’d thought the answer was ‘no’, then I wouldn’t have published them!

My own experience, ‘informs my answer’.

I had a bad experience ‘of the NHS’ and I started trying to discuss this with LOCAL NHS BODIES: but quite quickly, I came to realise that it was a local manifestation, of a NATIONAL-LEVEL PROBLEM. And, even while trying to discuss it locally, I found it frustrating that my PCT wanted me to discuss it ‘through a single ‘contact’’ - I wanted to discuss it directly with the people who I felt might understand the problem(s), and might be able to provide useful answers: my PCT refused to facilitate that, and ‘communication through a chain’ has problems, which often become all too obvious quite quickly.

There is a serious problem, with ‘I’m not talking to someone who actually understands this, here’: not so much a local v national issue [although more likely when discussing things at a local level], more an issue with not being in direct contact with the ‘right person’.

In my case – and I can’t believe that my experience is uncommon – the bad thing that caused me to become involved, and the way that the local NHS responded to my concerns, resulted in my becoming distinctly depressed: so, if I ‘generalise’, we have situations in which already unhappy and ‘damaged’ people, who believe they have identified a real problem, are trying to find the e-mail addresses of people who might able to ‘sort things out’. Whether those people can sort it out – or would even be inclined to try to do that – depends on other factors which I will not discuss here: but, ‘the frustration of not being able to even find those people in the first place’ makes those ‘lay NHS Campaigners’ (or, at that stage, more correctly ‘want-to-be NHS Campaigners’) EVEN MORE UNHAPPY/DEPRESSED.

Now – I don’t like that: I want to help those ‘lay campaigners’. And, I know that a combination of sheer luck, combined with personal circumstances [I had the time] and some personal qualities, combined to allow me to establish contact with a number of useful people. It could be suggested, that ‘cleverness’ allowed me to work out those ‘how to find e-mail addresses tips’. I’m not sure that is true – but even if it is, I believe it is the validity of the person’s ‘issue’, not ‘how clever the person is’, that justifies sending those e-mails to people who might be able to resolve the issue. So, I see no problem, with giving the tips.

HOWEVER: I sometimes get e-mails, or tweets, from other lay-folk, along the lines of ‘do you know anyone who could help me with this’. I won’t pass on e-mail addresses that were given to me, or that I had ‘successfully guessed by analogy’, without asking the person ‘can I give this guy your e-mail address?’. But, if the e-mail address is readily available online, and easily found, I might pass on the address or point to where it can be found. I realise I’m being less than perfectly consistent here: and I also point out that you can sometimes become involved in quite taxing ‘don’t tell him who I am, or give him my e-mail address – but my advice to him is ...’ e-mail chains, where you find yourself discussing things with two people, and also passing indirectly between the two of them what they are saying to each other (3-way e-mails are so much easier!).

As one of my NHS England contacts (so – a person with a ‘national role’, not simply ‘a working clinician’) wrote in an e-mail to me, as part of a longer answer to a question I sent:

‘I guess the difficulty you might encounter is that many professionals receive such huge volumes of email - most of which are task-orientated - that there is seldom time to sit back and engage in thoughtful discussion by email. This is particularly true of clinicians - we spend most of our time 'on the road' as it were - doing clinical work, participating in meetings, etc. - which means that our desk time is limited, and has to be devoted to phone calls, writing papers/reports, commenting on papers we're sent and dealing with emails. In no way does this devalue anything you say - it's just having the time to read, reflect and respond thoughtfully is not easy.'

However – on the other side of that issue, I was also told:

'There are a number of laymen who join the various groups and committees and bring views and arguments from a non-clinical perspective to the table - incredibly useful for generating discussion'

I have reservations, about the ‘joining a committee’ approach – as I’ve pointed out:

There is a slight problem, with laymen who embed themselves inside a 'working group' tasked with 'proposing a solution to some specific problem' - it is the equivalent of 'cabinet responsibility' where everyone eventually 'gets behind the proposed solution' [until many years later, when some people will say 'well, some of us felt sure it couldn't work, even at the time']. I do have something of an issue, with 'discussions behind closed doors', and then 'the presentation of a united front around the issue' without people ever being able to see the disagreements along the way. I think that people should be able to see 'the raw discussions' - not just 'the final proposals'.