A Reflection – Am I a D**khead?

Doctors are Dickheads

I am a Doctor

Therefore, I am a Dickhead

Well, that was the logical outcome of the #doctorsaredickheads thread that caught a lot of attention recently.

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It was variously described as either the equivalent of a #MeToo moment for patients or as a dumpster fire of a thread to be left to burn itself out. Within hours there was the usual ‘pile on’ from all quarters and the polarisation of opinions that the internet seems to specialise in, resulting in some very unpleasant exchanges between parties. It wasn’t pretty.

Matt Morgan and Peter Brindley have published a BMJ blog on the topic which talks about the unhelpfulness of the language used and the reasons why doctors might make mistakes that result in them being labelled dickheads. Whilst I don’t disagree with much of what they say, I do think that there is an angle to this which is not really explored by them and which has occupied my mind for the last week or so:

Am I actually a dickhead?

It would be easy for me to take this whole Twitter episode and just pick out all the bits that I think are ‘wrong’ – the offensive language; the poor understanding of how difficult medicine is; the lack of any subtly in discussion (on Twitter, who’d have thought!); the sweeping generalisations; how tricky some diagnoses can actually be to make; the calls for more doctors to kill themselves (yep, that happened) – and in doing so allow myself to safely move on and decide there is nothing useful for me to learn. However, following a challenging comment from a Twitter colleague, I felt decidedly uncomfortable about taking this approach and so instead I took some time to reflect upon what this ‘event’ might actually mean for me. Where I ended up was not reassuring.

I started by taking some time to read through the earliest parts of the #doctorsaredickheads thread and to watch the video that essentially started all this. The ‘doctors are dickheads’ comment comes at the end of ten minutes of Stevie Boebi’s story about how long it took for her two diagnoses to be made. Here is what she says…

“Oh, oh, I also want to say, doctors are dickheads. Trust your instinct… and if you have the energy, remind them that they work for you.” (11’20”)

Now the ‘work for you’ comment obviously has specific reference to a system with private healthcare but even for me, working in the publicly funded NHS, I think this is relevant because I don’t think it is primarily about money. I think this comment is not necessarily just about who pays me, it is about who I am ‘working for’ at a more vocational level, a Hippocratic level if you like… I should work for the patient. As I then went on to read the Tweets that picked up this phrase, the complaints were not necessarily about diagnoses being missed (in fact in early exchanges that is specifically defended) they were about patients feeling that they were not listened to, that they were ignored or that they were made to feel like they were liars and were inventing or exaggerating their symptoms. Worryingly this seemed to be most prevalent amongst female patients, patients with chronic diseases or disabilities and those from minority ethnic groups. Despite the fact that we as clinicians are supposed to be ‘working for’ our patients, it appeared that we were inverting that dynamic and instead only listening to what we wanted to, believing only what we could understand and investigating only what we agreed to. By the very nature of our professional position, of our training and social status we have gained an element of privilege, of power that we can then go on to abuse… most doctors unintentionally but sadly, judging by these patient stories, others quite deliberately.

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Whilst I appreciate that this last statement might be a little controversial, please bear with me: as a white, male doctor I’ve got uncomfortable experience of having my inherent privileges called out! Hopefully, I do not deliberately take advantage of my colour, gender or professional position BUT I have slowly had to come to acknowledge that that doesn’t mean that I am not taking advantage of them. I have to thank FemInEM for helping me see the passive advantages I have within medicine as a male and realise that if I am not actively working to rebalance this inequality then I’m actually a part of the problem. The same must hold true for my colour and my role within our healthcare culture: if I’m not actively trying to undo the inequality, I’m passively taking advantage.

So, what if the same is also true for my relationship with patients? Am I unaware of the privilege I hold, the power with which I can direct a consultation with just a well trained facial expression, a dismissive shrug or the brushing away of an unwelcome, unexplainable symptom? I would like to think I don’t do those things deliberately but if I’m really honest I’m pretty sure I have done them all. And if I am only pretty sure with those specific examples, what about all the other consultations where patients maybe haven’t felt able to say what they wanted just because I’m the doctor? The second part of the quotation above, ‘…if you have the energy…’ certainly implies this is happening. It suggests that whilst patients are trying to make themselves heard, they are fighting a wearisome battle with little success. It seems to me, if I’m not actively empowering the patient, reaching out to them and making them feel like their voice is important, then I am probably taking advantage of my privileged position passively.

Can you imagine the frustration that must build up when you don’t feel listened to, particularly if it goes on, month after month, year after year? Heck, I had a breakdown because I felt like that! When the people who are supposed to put you first, are supposed to listen to you, are supposed to care for you don’t, and instead they abuse their position of power, it would be enough to make you scream. cry-1675277_1920Much has been said about the unhelpful use of the phrase ‘dickhead’ and I appreciate why, indeed it was my first reaction to the thread and was what drew the challenge mentioned earlier. Much of my reflection has stemmed from here and my attempt to try and understand why this particular phrase was used and caught hold so quickly. The main objection appears to be that it is a phrase that is rude, blaming and not conducive to learning from open and meaningful discussions around power dynamics in doctor patient relationships, but this rather presupposes that those conversations were already happening. This cry of ‘doctorsaredickheads’ comes from a place that I probably wasn’t listening to properly and from the number of Tweets with the hashtag in question, I don’t think I was alone. Would I have preferred less aggressive, less offensive language to be used in drawing my attention to the problem, yes, but as the person whose position is being challenged, I don’t think I get a say in how offended I’m prepared to be, I just have to sit up and listen when the time comes. So that’s what I am trying to do.

Which I suppose brings me back to my original question, or rather Twitter’s original question. Am I a dickhead? Much as I don’t like the answer, it would appear, at least in terms of the original statement, that I probably am… but at least now, thanks to #doctorsaredickheads, I can try to do something about it.

 

Simon

Note: I’d like to thank Mitochondrial Eve for the challenge and for reading this for me before publication.

 

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