I had three deliveries last week.

A USB stick, for work.
A pair of shoes for a party.
A wheelbarrow full of manure for the garden.

The USB came through the letterbox and landed on the mat, and escaped being eaten by the dog. The shoes arrived when I was out and were somewhat unceremoniously dumped behind the side gate, to be retrieved by me later, the bag somewhat dirty from landing in a pile of rubble in the rubbish area of the garden. The manure was somewhat more well timed as I had to be in to sign for it. The delivery person was friendly, asking if I had roses and was that why I had ordered so much manure. To be honest I had somewhat messed up my conversion from imperial to metric and was now sitting with a huge pile of manure in the middle of my pocket handkerchief garden.

The USB was used straight away, the shoes went back to the shop, not suitable, and the manure, well, it is still sitting there, steaming slightly, waiting for my husband to do something with it.

Why on earth am I writing about manure (and shoes and a USB?)

It is that little word: delivery.

If I could change one mindset in the world of health and education it would be this one. We do not deliver health care, and we do not deliver education. And until we start to appreciate this, we will continue to perpetuate the paternalistic, top down culture we are all trying so hard to overcome.

Please stop using the word deliver, unless it is in the context of babies (or manure.)

Let me explain. Such an easy word to use, it is everywhere in health and education, and yet it takes us out of our collaborative, patient centred, learner centred values and straight back to the Victorian times where the professional was expert and the patient or learner was a tabula rasa (blank slate) on which to be written; a lump of clay to be moulded, then maybe tossed aside once the cracks in the design started to appear.

Every healthcare and education professional I meet and talk to has the most admirable belief that we work with our patients, or our learners, to establish together the best forms of learning and care that we can, together. Joint ownership of care or learning plans, open and relational communication, equality of power, collegiate, considerate, compassionate. I have seen surgeons discussing challenging treatment with patients, allaying their fears, calming them but explaining clearly, on a level with them, the risks and benefits, the aftercare and answering their every question, no matter how apparently trivial. I have heard GPs negotiate a plan with a patient with complex needs that does not solve all of their issues but does find a way for greater patient agency in the management of them. I have felt the care of nurses when they work their magic of being by your side, on your side and completely in the moment with you, as you face your biggest fears.

I have witnessed the most creative courses, workshops and seminars where learners have been taken to the edge of their capability with warm support and intelligent supervision. These learners put their fear of failure to one side and with the help of amazing facilitators, learned to fly in the most emotionally challenging tasks.

And yet, at the end of all of this incredible human practice, came that word: delivery.

Delivery of care. Delivery of a course. Delivery of treatment.

The word delivery indicates that there is a commodity to be delivered – the USB, the shoes, the manure. It says there is a person who brings it and another who receives it. Apart from a friendly question, “where would you like me to put this?” there is no real communication, no opportunity to get to know one another, and no relationship. It is a transaction. I buy something and somebody brings it to me.

But people are not USB sticks, shoes or manure. And yet transactional language in human endeavours reduce us to packages, our work to tasks, and our roles to binary ‘givers’ or ‘takers.’ Health and education both become a commodity to be bought and sold, bestowed or withheld. They are reduced to knowledge and actions with no regard for the finer human elements of how they come together.

Is this really what we do in health and education today?

Maybe once upon a time, but not now.

Today we work with our patients and learners, we adopt a perspective of curiosity, together exploring the issues and together agreeing a plan of action. We no longer tell people we will operate, or send them away with a drug without explanation, or test them on factual recall without understanding. We don’t deliver care or education, we co-construct it. We build it together. Without our patients and learners working with us, we achieve nothing.

So next time you talk about care or education, as if it were a commodity, remember it is so much more than that. It wasn’t shoved through the letter box, or left behind the gate; it did not arrive in a wheelbarrow. It happened because both provider and consumer worked together, to negotiate the best outcome, through curiosity, communication, collaboration and compassion.

We do so much more than deliver. Let’s not forget that.