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10 February 2013
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Shizaru and Francis: The fourth monkey assumes its rightful proverbial place

Before I go any further, a reassurance: I mention the Francis report in this blog, but won't insult your intelligence by giving you the reference for it at the end. If you do need the reference, please stop reading this now, Google it, and spend your time reading him not me. My words aren't important; his are. 

When you have absorbed even a twentieth of its contents, come back to the blog, for I want to make, on the basis of the report, a claim now in support of Shizaru, who has much to tell us about healthcare and was right all along.

Shizaru? Who? Ah - you might not know him...or her. Remember the proverb of the Three Wise Monkeys? Mizaru, Kikazaru and Iwazaru are their names, and we all know a version of their meaning. And if you contextualise your own meaning into Francis, you may well find some resonance with clinical practice. I'm not meaning to rabble-rouse, but if you are honest with yourself - really honest - have you strode through professional life thus far and truly not encountered an overwhelming tension not speak of things which you have seen and now cannot un-see, or hear and now cannot un-hear? Is there anything arguably more difficult to emotionally negotiate in life than that?

The proverb is rooted in a Japanese Golden Rule, but the twist we often take on it is an unhelpful one - turn a blind eye to tricky situations; don't get involved; you might end up being corrupted, too. Distance yourself from questionable behaviours: you might end up behaving questionably, too. Keep quiet. Keep away. Let them get on with it. So please, speak no evil. 

But what about Shizaru? Well, Shizaru is the seldom-quoted fourth monkey of the ancient proverb, yet the reasons for his...or her...absence in modern recensions are unclear. Quite simply, Shizaru embodies the simple principles of doing no evil. And Francis makes it quite clear that, however tacit, well-meaning, befuddled or confused the 'doing' was in Stafford Hospital - and the other institutions who have nervously exhaled in half-relief, half-anxiety in not themselves being subjected to that degree of scrutiny - the 'doing' was, which ever way one might wish to couch it, rather evil in certain quarters and at certain times.

And I think that is why the proverb usually only has the three monkeys. Because we are all, as human beings, quite adept at not seeing, hearing or, indeed, speaking, any particularly evil things. It's too difficult. We might compromise ourselves and our job. It worries us. But Shizaru had it hardest of all, because he...or she...never does anything evil in the first place. And Francis reminds us that not all of us are the Shizaru type. That is, in healthcare, almost too much to bear, so the fourth monkey quietly slips into the shadows. Time, I think, to re-cast the proverbial wise monkeys as a quartet not a trio, and try our best, each and every one of us, to not do anything evil in the first place. It'll be easier for all of us if we do, because there will be nothing unsettling not to see or hear: our ears will ring with the glad news of proper patient care, not burn with the news of reports that should never have needed to be written.


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About the author

Darren Kilroy's picture

Darren Kilroy

Darren Kilroy FCEM M.Ed. Ph.D. is a Consultant in Emergency Medicine in Cheshire, and Director for Network Leadership and Development in Unscheduled Care. He is also Hon. Senior Lecturer in Emergency Care at Manchester Metropolitan University, and Clinical Lead for Unscheduled Care at NHS Stockport. His main areas of interest are the challenges of clinical and managerial engagement around emergent clinical commissioning models, and the role of clinical leadership within transformational change.



5 years 10 months ago

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