Of cheese and choice

I am standing by the cheese cabinet in our local supermarket. (This is poetic licence, you understand. I am actually sitting at my PC, but my recent supermarket experience is so vivid that I have no difficulty reliving it.) I am in a state of high anxiety. In front of me are uncountable types of cheese. There is Canadian, Irish, Welsh, New Zealand and English. There is mild, mature, extra-mature, vintage and farmhouse. There is low fat, full fat—presumably ‘high fat’ would be a marketing disaster—and vegetarian. There are special cheeses in expensive waxy paper, or in the kind of customized black rind you see in Dutch markets. There is also ‘value’ cheese with a naff logo that allows you to proclaim your penury or your meanness. These are the varieties of Cheddar alone. Faced with such an obscene superfluity of Cheddars, how can I be certain of selecting the best value, the best taste, or exactly the one my wife will like? Being of a moderately obsessional turn of mind, I try to contain my anxiety by doing a mathematical calculation of how many different options there must be here: nationality times maturity, maturity times fat content, fat content times price band, and so on. The arithmetic soon falters. Firstly, it is clear that the grid may have gaps in it (the Welsh seem to make mature vegetarian Cheddar, but the Irish do not). I also start to have serious doubts as to whether I fully understand the taxonomy of Cheddar: is there such a thing as a mild farmhouse or an extra-mature non-vintage? I even begin to wonder if I shall need to invoke Venn diagrams or algorithms to sort the problem out. Then something else occurs to me. The cheeses are not laid out systematically. Their arrangement is apparently haphazard. Low fat Irish Cheddar jostles alongside Olde Mother Bassington's Superior Special Original Connoisseur Edition from the Cheddar Gorge, but nowhere near any of its creamier compatriots. Expensive cheeses are mixed promiscuously with the cheapos. If you are searching for a mild English vegetarian cheese—and suddenly I remember that is exactly what my wife asked for—you may need to scrutinize the contents of this cabinet for hours. Finally, the penny drops. There is method in this madness. I am being intentionally bamboozled. The proprietors of this supermarket do not want me to make a rational choice. Quite the contrary. The ridiculous volume of information, the gratuitous scale of alternatives, and the brazen attack on my cognitive ability are all calculated to render me incapable of choice. As a result, I will almost certainly end up choosing a cheese impulsively and at random. I will be left, of course, with the feeling that I could have chosen better. Like a teasing lover, the supermarket has promised me all, but will deliver so little that I will surely be coming back for more. Having got a handle on this, I find that my mind starts to wander to another topic: choice in health care. Perhaps this is not surprising. In recent months, the issue of choice for patients has acquired stupendous prominence in British political discourse. We will soon, apparently, be able to choose from as wide a variety of hospitals and consultants as we can with cheeses. Both the main political parties are promising, in different ways, to extend enormously the choices that are open to patients. Both are proclaiming that choice is the route to patient autonomy, to increased consumer influence, and therefore to raised standards. At one level, this is entirely welcome. Twenty years ago, I was able to make a referral as a GP to any specialist in the country, but successive reorganizations of the health service (some of them, oddly enough, in the name of competition) reduced my options drastically. It is nice that I will be able choose again. However, the example of the cheese cabinet may indicate what happens when choice alone is king. What I most longed for when I stood by the cheese counter was for a friend to appear unexpectedly from around the corner to say: ‘Go for the own-brand farmhouse, John. It's fantastic!’ In much the same spirit, our patients often ask us: ‘What would you recommend?’ or ‘What would you do if you were in my shoes?’ These questions might appear like passivity, or as attempts to evoke paternalism, but usually they are not. They are forms of acknowledgement that what raises our fear are the unknown and the overwhelming, and what allays it are trust and human connectedness. There is, in fact, a certain cynicism about placing such an emphasis on choice. In the real world, as opposed to the virtual one that politicians so often seem to inhabit, many of the neediest people cannot actually exercise very much choice in these matters for all sort of reasons: infirmity, urgency, distance from other providers, the complexity of their needs, or the natural wish to be near their families. But even for the small proportion of patients who are wealthy and well enough to travel anywhere for their medical care, choice may not be so very liberating either. Giving them a list of the nearest eight hospitals, together with records on surgical mortality, cross-infection and a vast array of other parameters may only raise their anxiety—for who can ever be sure that they could not have had their gall bladder or cataract removed just a little more slickly, a little more painlessly, somewhere else? Like the bewildering range of produce in the supermarket, vast amounts of information may offer patients a superficial illusion of perfect control and contentment, but in reality it signifies the commodification of care, and the further loss of community.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.