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1) In your Assessment and Treatment Unit, don’t assess or treat.  If a patient is a fun person, you can forget about their patient status.   Don’t support their routines – remember, you are here to promote their flexibility, independence and choices.  Unless it’s their choice to leave, in which case remember to keep the doors locked and don’t let on to anyone outside the Unit what the patient’s preference is.  They can’t choose just anything – they must learn to pick from the choices they are offered.  But do remember to do helpfully disorienting things like repainting the rooms of patients for whom order and familiarity is a vital support.  Heap their belongings randomly onto cupboards.  Shrink-wash their clothes and don’t trouble yourself to make sure that the ones they get back from the laundry are the same ones they sent in.  That way they will feel the same as the other patients; it will help them fit right in.

2) Because you are, you know, professionals and therefore omniscient (or as near as makes no difference), don’t bother to take a proper history from the patient’s previous carers.  They’re only family.  Exclude them as far as possible and if by some mischance you are obliged to grant them access, make them jump through arbitrary hoops to get it.  Quoting the patient’s right of self-determination and manipulating the patient’s exercise of said right can provide hours of harmless fun.  If, having gained access to the patient, the family carers subsequently try to raise any concerns with you, downgrade and dismiss them.  You know so much better than they do.  Remember, family carers are likely to be over-involved and unable to see the patient’s best interest clearly.  It is your duty to treat them as the main obstacles to the patient’s progress.  It makes it so much easier to dump blame where it ought to belong if anything goes wrong.  Co-morbidities are not your problem.  They are not what you are there to Assess and Treat.

3) Assume that nothing will go wrong.  Risk-assessment is a tedious process and can distract you from vital paperwork.  Don’t worry about checking that safety and resuscitation equipment is operational.  As long as it’s ticked off on the check-sheet, the actual state, or even presence of the – what was it you called it again? Oh yes, the defibrillator battery! – is an irrelevance.  When you get a nasty surprise like a patient drowning in one of your bathtubs, make sure to document that resuscitation was provided in line with policy and procedures.  If you can ship the patient out of the unit on life-support, then the death will not have occurred on your watch and it will not, nohow, in any way, be your fault.

4) When the patient’s death is certified – elsewhere, well done! – nip in quick and loudly proclaim that this death by drowning was due to ‘natural causes’.  It is natural to be unable to breathe when a person has been submerged for up to 15 minutes.  Water is a natural substance.  Therefore the death is natural.  QED.  If an independent review finds that actually the death was avoidable, try to keep the report private.  Instead, you could send out a letter telling the (dead) person how you are going to manage their information.  If that doesn’t work, make the report’s release as late as possible.  After 6pm should do nicely.  By the next day, all sensible people (and news outlets) will have ‘moved on’ in line with your recommendations.

5) If the report fails to sink without a trace, turn your attention to your deceased patient’s family and friends.  A graduated approach is recommended here.  Start with patronising them.  Referring to patients’ parents as ‘Mum’ and ‘Dad’ is a good start.  Tell them that you understand what they’re going through (see point 2, omniscience, above).  Suggest that they move on.  If that doesn’t work, try harassment.  Pester them for meetings.  A face-to-face meeting should let you annihilate the threat with your superior knowledge.  If that fails, try innuendo and smearing.  It’s maybe not a good idea to suggest directly that they are linked to (unsubstantiated) harassment of staff, but putting them in the same sentence as a non-sequitur mentioning the alleged harassment should do the trick.  Put on a sad face and talk about how disappointed fellow-inmates, sorry, patients, were to be excluded from the funeral.  Ignore the fact that the patients were welcome, but that your organisation did not make the arrangements that would have allowed patients to attend without the (understandably) unwelcome Unit staff.  Say that you were willing to kiss and make up, and parade your hurt at being rebuffed.  If you’re still not coming out on top, escalate to level ‘bullying’.  Don’t take no for an answer.  Even if your Chairman tells you to stop, don’t give up.

6) If that still doesn’t get rid of the awkward, ungrateful buggers, don’t give them another opportunity.  Stock up on cartridges of black ink so that you can redact entire pages and documents to a uniform ‘starless midnight’ hue. Don’t forget to give the heads-up to other organisations that you circulated those documents to, so that they toe your freedom-of-information restrictions line.  What’s that?  You didn’t, so they didn’t?  Oops.  You may have to resort to the nuclear option – barefaced lying.  Oh dear.  You already did, and the unredacted documents have shown you up?  Hmmn.  Double oops with brass (neck) knobs on.  May be time to go quiet.  Stay under the radar.  Naturally, you will keep on surveilling any public-domain information about them, while stoutly denying you are doing any such thing.  Why would the fair use provisions of the Data Protection Act apply to you?

7) If you find yourself in a situation – such as, ooh, lemmesee, a coroner’s court – where you can’t keep schtum, get lawyered up.  Seriously lawyered up.  There can be no such thing as too many lawyers for you.  You won’t have to fork out for it – the taxpayer, bless them, will cover it for you.  You know it makes sense – those insects facing you are not entitled to any legal support, which is like, totally fair.  After all, they are taxpayers themselves, so why would they want to go against the legal representation to which they are already contributing?  Then try some of your tactics above on the coroner.  It doesn’t matter if you contradict yourself in court.  Remember, the important thing is to conceal that you don’t have a leg to stand on.  Tell the coroner what he should think and how to go about his business.  He will surely appreciate having the benefit of your omniscience and won’t dare to back his professional judgment and tell you to sling your hook.  Of course he won’t.

How’s that working out for you?

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