January 31st 2017

The Misplacement of Manners

“Isabel wouldn’t have done that.”
“Wouldn’t have done what?”
“Been so critical.  She would have recognised that, whilst that person’s actions appeared extraordinary to you, there may have been very good reasons, of which you were unaware, that meant that they were entirely reasonable”.

I blame myself.  I introduced Mary to Isabel Dalhousie, the heroine of Alexander McCall Smith’s glorious ‘The Sunday Philosophy Club’ series of books last year, since when any outburst of mine about something that I consider as inappropriate behaviour is met with the same response.  It has got to the point when she no longer needs to say the ‘Isabel’ word, she just puts on her Isabel face.

Even her patience has been tried, however, over the past week during which she has been on the receiving end of NHS treatment.  Without going into specific detail, it has been depressing for both of us to experience an absence of courtesy in so many of the staff whom we have met.  Clinical management and treatment have been faultless but it has been difficult to excuse the lack of manners.  Isabel (yes, her again) comes across this in the book, The Comfort of Muddy Sundays, and has her own thoughts about its cause:   

The doctor drummed the fingers of his left hand on the edge of the table, a strange gesture which suggested, Isabel thought, an impatient temperament.  Perhaps he had been obliged to listen too long to those whom he did not consider his intellectual equal, exhausted patients with long-running complaints, unable to put their views succinctly.  Some doctors could become like that, she thought, just as some lawyers could; prolonged exposure to flawed humanity could create a sense of superiority if one was not careful – and perhaps he was not.

I have some insight into the fact that I am at that grumpy stage of middle-age when everything was better ‘in the good old days’ and I try hard to take this into account whenever something upsets me but I have found the last week very difficult.  Good manners are an essential part of medical practice and the realisation that they have undoubtedly declined since I first started in medicine has been depressing.  I will leave it to Isabel to sum up their importance: 

Jamie had good manners.  Paul Hogg had good manners.  Her mechanic, the proprietor of the small backstreet garage where she took her rarely used car for servicing, had perfect manners.  Toby, by contrast, had bad manners; not on the surface, where he thought, quite wrongly, that it counted, but underneath, in his attitude to others.  Good manners depended on paying moral attention to others; it required one to treat them with complete moral seriousness, to understand their feelings and their needs.  Some people, the selfish, had no inclination to do this, and it always showed.  They were impatient with those whom they thought did not count: the old, the inarticulate, the disadvantaged.  The person with good manners, however, would always listen to such people and treat them with respect.

How utterly shortsighted we had been to listen to those who thought that manners were a bourgeois affectation, an irrelevance, which need no longer be valued.  A moral disaster had ensued, because manners were the basic building block of civil society.  They were the method of transmitting the message of moral consideration. In this way an entire generation had lost a vital piece of the moral jigsaw, and now we saw the results: a society in which nobody would help, nobody would feel for others; a society in which aggressive language and insensitivity were the norm.