Unpleasant hashtag

There is a row on medical Twitter at the moment. It’s been caused by tweets under the hashtag #DoctorsAreDickheads. I want to write about this row, because, perhaps unsurprisingly, the row is about communication rights. Who can say what and what it means – a problem for a linguist.

Before I start, I want to stress that, as ever, I present only a few thoughts, they’re mine only and they do not pretend to be comprehensive. Second, I will be quoting a few tweets, but I don’t want to give links to them – the quotes are aimed to raise an issue rather than point to individuals.

1. So, let me start with what I think is the main charge against the tweets under the hashtag. The tweets are abusive. As one doctor put it:

What an unpleasant hashtag. Since when did abusive generalisations about entire groups help anything?

And another added:

I’m sorry – I can’t begin to understand how this came about or who could have thought it was a good idea. Abuse never works out well for the abused or the abuser.

And so, I would like to consider whether the hashtag is indeed abusive. When I started wondering about it, I quickly concluded that the task would be difficult. This is because there are no linguistic markers of abuse. Even swearwords and other phrases used in insulting people, given the right context, don’t have to be used as such. How do you know then that the tweets are abusive? Is it enough if you feel that my tweets are abusive? Or do you need access to my intention to abuse? I’d argue that the former condition is too broad, the latter is perhaps too strict. So, what do we do?

Well, I would like to offer a suggestion. I would like to argue that abuse occurs when you say something unpleasant, hurtful, offensive about the person. So, let’s take a tweet which I found particularly poignant:

Going to the GP feels like going on trial – in the waiting room, I’m mentally rehearsing everything I need to say, psyching myself up to stand firm when I’m dismissed and make sure I get heard, & taking deep breaths to calm my racing heart & tight stomach

This tweet is only about its author. Surely then, you cannot think of it as abuse, can it? The tweeter is merely relating her feelings. How this is abuse is beyond my ken.

There are others like that:

I got left on a triage floor for hours. A guy with a groin pull got wheeled in before me. I’d had undiagnosed EDS all my life, in chronic pain for two decades at that point. It took a politician to turn up at ER for me to be admitted to ER.

I will never get the image out of my head of male doctors laughing at my symptoms.

I was sent to an inpatient psychiatric facility because I was told that my chronic pain and POTS symptoms were due to an “undiagnosed mental illness”

These tweets continue to focus on their authors (though more nuance is needed here, of course). Yes, doctors and their actions are implied, yet, the tweeters explicitly talk about themselves. Surely, to stress the point, talking about oneself is not abusive of someone else.

But let’s take another couple of tweets:

I wanted birth control and Dr wouldn’t prescribe without a pap. I was 21 with no prior sexual activity. She gave me one Xanax and had two nurses hold me down.

Well since X asked 1. PE, DVT (& never looked into 10+ headache) after IVIG “Stop wasting our time. It’s nothing” when I asked if it could be blood clots as they wheeled me out of VGH ER for 2nd time w no tests done. 3rd time dx’d

Went to the Dr at age 14 for chronic disabling fatigue and pain. He said I was probably just in love. Was so mortified I stagnated in my room, pushed myself and denied my own reality and did damage to my body in the process. 11 years later was dx with EDS.

A TMD specialist (A GUY WHO WORKED WITH JAWS) basically told me that TMD isn’t a thing, didn’t even look at my jaw, said that if I talked and ate less my pain would go away. I was near crying and my mom was fuming. Oh should I mention that it was my birthday?

Had an emergency C-section. Doctor called me stupid when I asked if the baby would survive — as he sliced me open. After surgery, he told me he’d found a likely cancerous cyst on my ovary. He laughed as he told me I might not live to raise my newborn child.

These tweets have clear references to doctors, their authors are anonymous, so are they abusive? I really can’t see how. I have no idea they are accurate representations of what happened, but surely, we can agree that the accounts are constructed as factual.

Moreover, these are little stories of pain, of disappointment, of grief. These are screams of suffering and I reject the notion that suffering is abusive. In fact, I think that such a charge is absurd! And there are many tweets like that – as I read through them, I found it very hard to substantiate the claim that the ‘hashtag is abusive’. So, that charge must come from somewhere else.

2. And here is the second, admittedly, a less pronounced issue raised by the opposition to the ‘unpleasant hashtag’. Let me illustrate this with this tweet:

I think this hashtag #DoctorsAreDickheads is outrageous and will upset many hard working #nhs staff who are already working at their limits. We need to protect our staff not make them feel worse about themselves. This is derogatory and not appropriate in any conversation.

The same doctor added:

I am now just enjoying blocking these individuals who really have no right to any kind of response

Gosh! I must admit that I was gobsmacked. Who are the individuals who have ‘no right to any kind of response’? Surely, we, patients, all do!

These tweets are about the process of communication between the patient and the doctor and what’s significant, though unsurprising, is that the doctor assumes the right to tell me, the patient, how I can speak to him, or more generally, to doctors. Indeed, a number of tweets raised the issue that we, patients, should speak politely, appropriately, constructively. Basically, what’s said under the hashtag is inappropriate.

I reject such demands (I have written about what I think about constructive speaking here). I reject the demand that the feedback we, patients, give, must be authorised. That it must be sanctioned by the doctors who will receive it and are the object of it.  If I am ever to be part of a conversation with you doctor, I must be an equal partner, without you setting the conditions for talking. Otherwise our conversations become parleys, negotiations between feuding parties and that makes no sense.

3. And so, we come to the final point. The objection to the ‘unpleasant hashtag’ comes from its direct challenge to medical power. I cannot count the times I wanted to tell the doctor I was seeing what I thought about them, sometimes in harsh and very direct terms which cannot be repeated in a polite academic blog. I didn’t because I assumed that such a direct challenge to the medic’s power could only be detrimental to my interests.

I always wonder about the extent the doctor, as s/he sits comfortably on their chair, realises how safe s/he is. And I bet, doctor, you know that I cannot say the things I want to say. You can, after all, crush me with your power as I can become a ‘difficult patient’, let alone be sent to a zero-tolerance clinic. You know I can’t speak, and you know you’re safe. Sometimes I feel extremely helpless.

And all of a sudden something happened. The #doctorsaredickheads hashtag is a venue at which I finally can. And others can. I can say whatever I want and I can even call you a dickhead. The hashtag is a direct challenge to your power and you can do precious little about. Perhaps for the first time, doctor, you feel as helpless as I do, as you tell me that I look for an illness or that you can reject what I say, because the real evidence is in your computer.

So, finally, what about the name of the hashtag? No, I would not have chosen it. I don’t particularly want to call you a dickhead – I’m a fairly articulate professor I can do damage without call you names. But I understand why someone felt the need to coin it in such a way. This is because I understand the need to challenge your power doctor, directly. To hit where it hurts you and to claim the right to hurt. The one you have known so well.

 

4 Comments
  1. I respectfully disagree, but I’m sorry to hear about your bad experiences.

    Aggressive and unfair compaigns against all doctors, only further pit doctor and patient “against” one another when the relationship should be collaborative. Working toward a collaborative relationship isn’t just doctors’ responsibility, but patients’ too. Patients should not be treated rudely by their doctor, but it goes both ways. Being called a “dickhead” by someone you’ve never met because of your profession is offensive, it’s personal. You wouldn’t catch me making excuses for doctors who used a “patients are morons” hash tag.

    I’m really not sure what you mean by “medicine taking note”. There will be doctors who because of their own attitude or personality are never going to hear the message that they should respect and work together with patients. Some who even enjoy humiliating or upsetting their patients (and sometimes colleagues). Naming these doctors dickheads may offer some kind of satisfaction but sadly isn’t going to change them. If we’re talking about diminishing the influence of those kinds of attitudes and personalities on medical culture as a whole, then I profoundly disagree that this particular hash tag campaign is some kind of special breakthrough, or a positive thing at all. Medical power / paternalism has been recognised for some time and rightly continues to be challenged and eroded. An entirely different demographic of doctors are now making their way through the system. They are human beings with feelings, they are learning, and they need encouragement and direction. The failure to discriminate between good and bad, by calling all doctors “dickheads” isn’t just not helpful, it’s harmful. Will the “doctors are dickheads” campaign pull these individuals towards or away from patient advocacy?

    When was the last time you found an offensive generalisation made against you appealing, made you think “oh that’s something I ought to listen to”?

    Insults don’t encourage critical self-reflection or a change in perspective. They hurt, and promote anger, division and defensiveness. Playground insults also fundamentally undermine the point being made by the person using them. They make the person using them (and their perspective) look bad. Would you trust a doctor if they addressed the sentiment “patients are morons” directly to you? Would you be more or less likely to engage with their point of view?

    Demanding that doctors show patients more respect, by disrespecting those same doctors with a playground insult, is fundamentally hypocrisy. Having an unreasonably high expectation of doctors’ human characteristics (eg roll over and don’t be upset when strangers call you a dickhead, their emotions are the only ones that matter) whilst at the same time insisting that doctors aren’t superhuman or above anyone else, is confusing and contradictory.

    If you wouldn’t call a doctor you met for the first time in the shops, or at the clinic, or in your baby group a “dickhead” face to face, because you’d had a bad experience with a different doctor, then you shouldn’t call them that online.

    1. Dariusz Galasinski

      Yes, we disagree.

      1. Can such campaigns pit patients and doctors against one another? Possibly. My problem is that without them I’m not certain patients get anywhere. I also don’t think tweets under ‘that’ hashtag were aggressive. Those I read weren’t.

      2. Yes, medicine should take note. It can mean a number of things, for example, using those tweets in education. I think that instead of bemoaning the hurt egos, medicine as a profession should reflect on why such campaigns are organised. It’s really not because all these people are stupid and full of malevolence.

      3. I think those doctors who are good will know how their patients relate to them. I do believe that most will not be touched by the hashtag.

      4. I really cannot see that disrespect in the tweets. As for the hashtag label, it is unfortunate, but I also think it should be seen in the context of Twitter and as an emotional outburst, and not a claim to universality of the statement it carries. And as I read those heartbreaking tweets, if saying #doctorsaredickheads gives the authors some succour, so be it. It is not a great price to pay for the doctors.

      5. Would I call my doctor a dickhead? No, mostly because the word is not in my active vocabulary. I did call a doctor stupid to their face (admittedly it’s not the same) and I wish I had gone further.

  2. Doctors aren’t “safe”. 2 of my colleagues have committed suicide within the last year. One, my friend, was following an complaint. The complaint was unfair, ridiculous even. Yet she was still subjected to a horrible and dehumanising process with no support, no certainty. It wasn’t the only reason for her death, she was depressed, but it was a trigger.

    Doctors are human beings. They don’t deserve to be called dickheads, they don’t deserve to be abused – certainly not for the mistakes or failings of other people whom they don’t even know (but happen to also be doctors).

    If you relish the thought of another person, be they a doctor, maybe a conscientious, kind and caring doctor like my friend, or anyone – feeling small and helpless because you have felt that way, then there is something wrong with your humanity. You don’t have a “right to hurt” and I can’t imagine why you would want one.

    1. Dariusz Galasinski

      Thank you for your comment.

      I don’t reslish any such thing, I also appreciate that doctors are human beings. I also would like to point out that patients are not responsible for complaints systems (about which I have written here, rooting for the doctors). Having said this, I would like to say that also patients are huamn beings and not groups of symptoms which can be ignored at the doctor’s pleasure. ANd I’ve been partonised enough by medics to understand why patients are angry.

      More generally, having seen discussions about doctor-patient relationship for some time now, it’s the first instance when medics actually respond without platitudes and empty declarations of holistic everything. You have thousands of tweets which tell you how desperately bad healthcare can get. And for the first time, it seems, the challenge to medical power under ‘the’ hashtag touched the nerve. And I would suggest (not so humbly) that medicine should take note why it takes such crude measures to get its response.

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