Friday, September 16, 2011

A storm brews across the pond

Remembering, as Shaw said, that we are "two peoples separated by a common language," I am nonetheless left aghast by some of the comments from British medical folks in response to a recent post by Anne Marie Cunningham on her blog, entitled "Social media, black humour, and professionals."  Anne Marie is a GP and Clinical Lecturer in Cardiff University, Wales, UK, with a specific interest in improving the quality of medical education.

I'll excerpt the pertinent phrases from this post:

I came across a discussion between several male doctors on Twitter. The doctors were using slang, which I have not come across before, to refer to the wards in which they might have been working. The terms used were "labia ward" and "birthing sheds" to refer to the delivery suite where women give birth, and "cabbage patch" to refer to the intensive care ward where many patients are unconscious.

I was shocked at this and angry and did query the doctors about some of the other things they said, but I felt I couldn't challenge them directly at that time about this language. One of the doctors referred to midwifes as "madwives" . . . 

I did feel the need to check with others how they felt about this exchange so I sent them a link to the collated tweets by private message. I wanted to find out if my own shock and revulsion was  typical and also to gain some advice on what to do about this

My account of this episode, so far,  has been very personal. But I also want to place this story in a wider context within the medical education literature on professionalism and black humour.  Is the use of derogatory humour or slang by medical professionals inappropriate? Berk thinks that: "Simply put, derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves. Such humour is indefensible, whether the target is within hearing range or not; it cannot be justified as a socially acceptable release valve or as a coping mechanism for stress and exhaustion."

I want to raise this topic here -- in this public space -- so that I can think about how I respond to it in the future when I "overhear" it. The next time I may choose to ignore it. Despite Wear's suggestion that incidents like this  provide "teachable moments", and should be challenged, the spaces of social media are much more exposed than a hospital corridor. 

The comments on the blog reflected a variety of points of view, generally said in a thoughtful manner, but then the conversation spread over to Facebook, to this page.  It was here that things picked up and revealed, in my mind, a mindset among some that was extremely upsetting.  In addition to the personal attacks on the author, they indicate some underlying attitudes that make me squirm.  Here are some samples.  Sorry, expletives are not deleted:

The quasi-academic language and touchy-feely social social science bullshit aside, this woman makes very few points, valid or otherwise. Much like these pages, if you're offended, fuck off and don't follow them on Twitter, and cabbage patch to refer to ITU is probably one of the kinder phrases I've heard...

Agree, she sounds like the most naive child like GP ever- most of us do have sense of humour I promise. Those that don't obviously do shit like "research social media"...

For those who have never heard/used this "dark" humour to which the article refers, every profession/trade/workplace make jokes about the work they do. Work is work, not all of it can be enjoyed, it is very normal to make light of things. This is especially true of the high stress environments mentioned in the article.

This sort of humourless blog is the reason that medical students are overfilled with touchy feely bullshit. The time spent doing this detracts from learning skills which might actually be useful on the shop floor such as clinical skills.

It may be my view and my view alone but the people who complain about such exchanges, on the whole, tend to be the most insincere, narcissistic and odious little fuckers around with almost NO genuine empathy for the patient and the sole desire to make themselves look like the good guy rather than to serve anyone else.

Oh and one more thing- my job is to provide the best clinical care I can to EVERY SINGLE patient that I meet. Not to act like a mewing prat. I'd rather be treated by someone who is a dick and gets it right than someone who is lovely but fucks it up. As one consultant once said "my house officers know everything there is to know about bereavement... except how to prevent it." Unless I'm parading a patient through the hospital corridors whilst they're mid shit on a commode I think most acts of indescretion are neither here nor there as long as I'm not deliberately killing people and, you know, trying to make them better and stuff... 

Fortunately, we also see several examples of mature insight and thoughtful behavior:

I take offence being referred to as "insincere, narcissistic odious little fucker." If you read your MPS/MDS bulletins you will discover it people with your attitude to medical practice who are more likely to be sued for clinical troubles because you are too cocky to ever think you might be wrong.

Isn't the issue more to do with the use of public social media rather than the sense of humour? Medical acronyms exist both cos they're funny and to conceal information a layperson might take offence to, like flk or ttfo. I don't think the terms here would have offended anyone but the point is that Twitter isn't private and can be "overheard" by people who could take offence. Use acronyms or use closed social media. The whole world doesn't need to see what's essentially a conversation between a particular group with its own frames of reference.  

From a patient's viewpoint terms like “labia ward” are indeed derogatory and should be avoided on open social media platforms.

Some of you need to really take a long look at the dehumanising nature of your jobs and try to rise above it. Anne Marie Cunningham makes some valuable observations in her blog. As a former surgery SpR, lymphoma survivor, cabbage patch survivor on 2 occasions some of you make comments that make me very concerned for your emotional well being. Social media makes the world a smaller place. Sometimes you should refrain from writing down your thoughts in public places like to FB and Twitter. If nothing else, making derogatory remarks about people you are supposed to care about may in time blunt your ability to make compassionate and "patient-centred" decisions. Please guard against this.

This has issue has nothing to do with whatever subjectively constitutes "humour" in our personal opinion. It has everything to do with professionalism. No-one expects healthcare professionals to live on a Higher Plane. However, every hopes that the healthcare professionals that they work with will extend them the courtesy of treating them with respect. That includes not talking about them, in any context, at any time, in terms that they would not use if they were in the same room. So: guess which of the participants in this thread I'd like to co-create my healthcare, and share in my healthcare decision making?

Well said. Derogatory comments about people in your care, in a public forum, tell us lots about you , as do the self serving defensive "lalalalala I can't hear you I never do anything wrong" responses with ears covered.    


Anonymous said...

Hmmm. There are a couple separate issues here; the nature of the remarks themselves and the use of them on public social media. I would have to agree these do not belong in the public sphere. (Ask Anthony Weiner).

As to the remarks (and subsequent FB comments) themselves, I think it is impossible to separate their content from the associated gender issues - to wit, who made them and who is reacting to them. I confess, as an older female physician, I feel neither shock nor particular revulsion - rather, that these are typical immature male jerks as seen in every profession, who will either grow out of it or become those docs everyone hates - and who usually wind up eventually being disciplined or changed by peer pressure. Would I have ignored it? No. Is lecturing usually effective with such people? No. Behavior modification is more so.

I am reminded of walking on a street in college with a female friend and being subjected to lewd remarks from construction workers (this was 40 years ago). Suddenly she screamed "F--- you!" at the top of her lungs - after which there was a shocked silence for the rest of our progress to the corner.
Not that I am recommending this approach, but reason is not usually effective with such people.


Anonymous said...

Dr. Cunningham is a courageous physician who should be supported by all who demand that medicine leave the Dark Ages. That colleagues have not ostracized these thugs demonstrates that medicine has little ability to develop scientific or humanitarian standards on its own.

In their world, they may be kings of men. But in 2011, they are ridiculous, and will be out competed by smarter people. This kind of talk sounds like the schoolyard bully who knows he's not going to make it to the next grade. Real scientists don't abuse the source of their knowledge - or livelihood. What proof more do we need that too many doctors have power disproportional to their intelligence?

'As long as I'm not deliberately killing people, and you know, trying to make them better and stuff'? Really? Is this what they teach in medical school?

Anonymous said...

While I feel that some of these terms were derogatory in a way that communicates contempt and distaste without any value added, I can say from a more personal perspective with many years of ICU behind me that the black humor employed by many in critical care is simply a (rather crass, but effective) coping mechanism. Where there is humor, there is pain.

No coincidence that staff and physicians have employed black humor in a setting where our emotional needs are rarely accounted for. I worked in an ICU in one of the best hospitals, period, in the world, and was at the morgue regularly. I had no outlet or support system for being slapped with death besides frequent vacations, then resigning upon full burn-out.

Nina said...

From Facebook:

Unfortunately, this is a tough sell to the younger generation. Many believe social media is akin to a therapist's couch, and that their audience fully concurs with them. Social media is also a place to showcase how funny and clever you are, which also encourages these types of exchanges. On top of that, sarcasm is not always clearly expressed or perceived through the written word, which further complicates communication. Thought provoking exchange.

Allison said...

@Anonymous #2: No, this is not what they teach in medical school.

Howard, MD said...

I must say that I am shocked and dismayed by the language, and the attitude it reflects, by the vulgar healthcare "professionals." I certainly would not want them to provide me with care.

I sometimes wonder whether all this social media stuff is advancing our society or coarsening it.

Kerry said...

Every patient that has been in the "system" for more than a year learns the medical slanguage. It is really quite entertaining to watch the expressions on providers faces when you talk their talk. They usually get real quiet and ask if I am a doc. My favorite reply is no I am just a survivor with a photographic memory.

Claireot said...

I agree that comments made in public need to uphold the standards and values of our professions. I blogged a longer response to @amcunninghams original blog here:

We already have evidence guiding our use of social media as healthcare professionals. My question is, why aren't all of us using it?

Sarah Stewart said...

The issue to me isn't so much social media but the language itself. I think it is disrespectful and I worry how that is reflected in practice. Maybe social media is a good thing because it "outs" these attitudes.

Anonymous said...

As a potential patient of these medical 'professionals', I was appalled to read some of those comments. Restricting them to private forums may only serve to perpetuate the arrogant belief that this is in some way acceptable. There are many professions involving high levels of stress and life or death decisions - fortunately, most of these have grown out of the childish dehumanisation seen in these posts. Hopefully these medics will evolve before they bring collective shame on their colleagues, who are working hard to do a difficult job with respect for their patients.

Anonymous said...

My experience as a patient, as a person is this. Certainly humor is a defense mechanism, we use it to cope in high
stress situations. For example, were we to be on an airplane together, as we taxied toward take-off, I might comment "Ten thousand low-bid parts." We chuckle, and I
am a little less apprehensive as the plane takes off.
This is FAR different from the crude, offensive comments
some are calling fox hole humor. These remarks are indicative of a mindset, and lead to sloppy work and nasty
comments in patient charts.
Your arrogance amuses. If you were good doctors, you would look askance at these sophomoric comments and the worldview they reveal. Only your mother, should you be fortunate enough to have one, is impressed by your three years of "see one, do one, teach one." The rest of us will recognize and respect
decency, integrity and competence.