A Class Act

“…and the Universe, … will explode later for your pleasure.”
~ Douglas Adams, The Restaurant at the End of the Universe

A friend of mine was told by Australia’s welfare system that his work as a simulated patient for medical training was “unrealistic”, and that he should find a different field of work.

An article by the Village Voice explains what he does nicely:

The “standardized patient” concept is about fifty years old, developed by Dr. Howard Barrows, a neurologist then at the University of Southern California; he later introduced his proposals at Southern Illinois University. Barrows saw a need for students to learn to problem-solve on their feet. Feeling that mere paper-and-pencil exams wouldn’t, by themselves, create strong doctors, he pioneered a new way to evaluate and build clinical skills: by training actors to simulate patients.

They also explain why simulated patients became a thing:

Why the push for clinical competence…85 percent of all malpractice suits in the U.S.A. are based upon a failure of doctor-patient communication. It’s not that the doctor didn’t know enough… [It’s that] he or she did not communicate well enough with his or her patient!
Zimmer, Elizabeth, “Playing Sick: How Actors Are Making Better Doctors”, The Village Voice, 2016 August 31

In essence the Australian government through their job centres took it upon themselves to decide whose job is worthy and whose not, without consultation. And yet the role of simulated patient is critical to developing competent doctors who are better able to save lives.

Our government’s approach is reminiscent of science fiction writer Douglas Adams’s concept of the “B Ark”.

The Golgafrinchan Ark Fleet Ship B was the starship designed to transport a certain segment of one planet’s population to a new world, before their old world was met with some sort of certain doom. The population was lied to about this doom in order to convince a segment of the population to willingly enter the ark and be intentionally crash-landed on Earth.

The population was divided in this manner: all those who ruled, thought, or did what was considered useful work stayed behind, and those who held apparently useless jobs, defined here as the telephone sanitisers, account executives, hair dressers, tired TV producers, insurance salesmen, personnel officers, security guards, public relations executives and management consultants and other such roles, were sent to what might be their final resting place.

This is written to be funny, but even Adams recognises the plan is problematic. We learn that later the planet meets its end when everyone dies of a disease carried by unsanitised phones. In this scenario people are being divided by class almost as if it is a genetic difference. Those who don’t measure up are sent off in a manner intentionally meant to ostracise and potentially kill them. This is in essence what was done from the late eighteenth century to the early nineteenth century by the British to their own impoverished classes. They tried to cleanse their country of this class of people by sending them to Australian penal colonies.

The German nation experimented with ethnic cleansing and we point at them going, how horrible. However, we should be looking at ourselves because we are continuing systems not only of ethnic cleansing by the way we are treating refugees and the original peoples of the US, Australia, and elsewhere, but class cleansing through severe mistreatment and abandonment of those who are most vulnerable. We are allowing those at the top to hoard more than their fair share of the Earth’s resources, and doom those who are then forced into penury to seriously shortened and painful existences. When Australians are so proud of their convict past, I am dumbfounded that they are allowing these stark class divisions to open up.

Of course I may hear some people from the US in particular wail: but we are a classless society! That has been the propaganda for a very long time, and it has never been true. This is a convenient way to create a blindspot in our view on society, while protecting those in the upper classes. I was disappointed when I found a gaping hole in Writing the Other by Nisi Shawl and Cynthia Ward.

Our culture emphasizes certain kinds of differences. It tells us that these differences are the most imp[ortant ones, the ones that truly divide us. For these categorizatiosn, we’ve invented the term “ROAARS.” It’s an acronym. ROAARS stands for Race/(sexual) Orientation/Age/Ability/Religion/Sex. ROAARS differences are highlighted by majority culture. You may notice that one profound difference have been left out of this acronym: class. This was a deliberate omission. As we’ve said, the focus here is on those differences that are generally presumed to be important.
Writing the Other: A Practical Approach, p 5, Aqueduct Press, Seattle, 2005

Shawl and Ward are doing important work. This book should be read and understood. It should also be recognised where they have holes in their outlook and why.

Both the US and Australia have a bone to pick with British hierarchy. The US are very proud of having knocked the monarchy off their thrones in that country. Of course once you have opened the door to violent overthrow of over-privileged leaders, how do you close it again so that the new leaders have some sort of security? Perhaps you make it seem like it’s the populace who decide that certain people are in control. Perhaps you have elections that are over-ridden by an electoral college. Perhaps you make it easier for the wealthy to run for office and vote, and harder for the poor to do so. Perhaps you spread a myth that this is a land of opportunity. We are all embarrassed millionaires! Therefore, when the upper classes are looking down upon the lower classes: it’s not out of their sense of entitlement, but because of your failure to grasp opportunity. And so long as you believe that, you will accept that judgement.

It has been said you can learn as much about a society by what it doesn’t say about itself, as by what it does. In this case I would say we are dealing with crimes of omission rather than commission. They are still crimes. Those at the top who are afraid of change will want to portray change as something likely to be violent. In this manner they hope to gain allies in suppressing those who are suffering. Yet, the more distance the wealthy try to create between themselves and their self-made enemies, the more enemies they create, and the more likely their worst fears are realised.

Change does not have to be violent. It can be significant like when a caterpillar metamorphoses into a butterfly. Such a big change can be frightening, but ultimately elating. We just have to keep our eyes on the butterfly. In this case people have to focus on the joy of living in a friendly world: one where we can trust that our needs are met and that most people we meet are going to be friendly. Surely this is preferable to a hostile world where all you have is a house full of stuff, a computer full of numbers, and are surrounded by people who either hate you or want to use you.

My friend should not be punished for taking up an acting job that helps to create better doctors, simply because others are unwilling to pay him properly and still others have decided acting isn’t a “real” job. Next time you have to see a doctor and are trying to communicate your symptoms so as to receive appropriate help, tell me whether or not you really think simulated patients are unnecessary. Also, next time you look in the mirror wonder whether or not you would be put into the “B Ark”. Finding difference where it is not is the sure beginning of unnecessary cruelty. Be the person who chooses to care and to share. Be the person who is willing to respect others work, and more than that, respects everyone’s humanity and right to life.

Peace and kindness,

Katherine

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