Compassion like smiles can’t be faked

One management ethos is ‘make up an arbitrary targets, and follow them at a molecular level’.


Targets are intrinsically rewarding for managers who want to be seen to be doing something.

A million dementia friends doesn’t necessarily mean an improved understanding of dementia.

There’s no point denying compassion, meticulously cultivated in medicine, nursing and social care training, is pivotal.

It is also crucially important in basic humanity, whether you believe in society or not.

Compassion and leadership are areas of motherhood and apple pie.

But the idea of ‘compassion on demand’ has put shivers up people.

All political parties have been especially bad at this approach to the caring professions, some more than others perhaps.

Liberalising the market has seen its own unintended consequences.

What is clear is that regulation is needed to safeguard vulnerable individuals.

Take for example what has happened in the National Health Service.

There is no doubt that some targets are useful – e.g. cancer waiting times – but some targets appear to have been there for the benefit of the managers, local and national politics, rather than quality of health care.

It might be true that many people are simply not as happy as they should be.

A study reported in the Daily Mail, from some time ago, throws some light on this, using the European Quality of Life Index. Britain is the worst place in Europe to live despite offering the biggest salaries, a study revealed today. Researchers weighed up official data for ten European countries, including France, Spain, Germany, Italy, Sweden and Poland. High incomes in the UK are cancelled out by long working hours, poor annual leave, rising food and fuel bills and a lack of sunshine.

Take, for example, “the simple smile”.

A smile is a facial expression formed by flexing the muscles near both ends of the mouth.

Among humans, it is customarily an expression denoting pleasure, happiness, or amusement, but can also be an involuntary expression of anxiety, in which case it is known as a grimace.

Cross-cultural studies have shown that smiling is a means of communicating emotions throughout the world, but there are large difference between different cultures.

Although many different types of smiles have been identified and studied, researchers have devoted particular attention to an anatomical distinction first recognised by French neurologist Guillaume Duchenne. While conducting research on the physiology of facial expressions in the mid-nineteenth century, Duchenne identified two distinct types of smiles.

A Duchenne smile involves contraction of both the zygomatic major muscle (which raises the corners of the mouth) and the orbicularis oculi muscle (which raises the cheeks and forms crow’s feet around the eyes).

A non-Duchenne smile involves only the zygomatic major muscle.

Many researchers believe that Duchenne smiles indicate genuine spontaneous emotions since most people cannot voluntarily contract the outer portion of the orbicularis oculi muscle.

So, in the same way you can’t physiologically fake a smile, you can’t fake happiness.

You can’t as such ‘fake targets’ but you can certainly game them.

It might not be obvious to people from non-clinical backgrounds that an understaffed health service will find it tough to deliver care to their standards.

Whether clinical regulators care in reality about an under-resourced NHS truly functions is up to them.

How they deal with whistleblowers speaking out safely about the NHS is up to them.

We do know that NHS managers like ‘shiny products’.

But what is clear is that selling compassion is therefore as unconvincing as faking a smile.

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