On medical ‘we’

During a consultation the other day, the doctor said “We referred to you X”. I intensely dislike when medics use ‘we’.  So today, I want to write about the first-person pronoun in plural. Some say, it’s the most manipulative word of  all.

The interaction I had with the doctor went something like that:

  • We had referred you to X.
  • No, Dr A did.
  • Yes, Dr A, and we asked you to do Z.
  • You keep using the pronoun ‘we’, who is ‘we’? I’ve never seen you before.

Here I saw the doctor rolling the eyes, mouthing something, and finally, I heard a slightly raised voice:

‘We’ means everybody in the practice.

To which I said:

You mean the receptionists as well? Did the receptionists refer me as well?

A complete communication breakdown. If looks could kill, I would be dead; poisoned, quartered, vaporised by a Romulan disruptor. In all fairness, I made things worse because as the doctor was not hiding their rising irritation, I was not hiding my rising merriment. I don’t want to imagine what was written in my notes.

But, the matter of ‘we’ is serious and I have mentioned it before, both referring to the kind of ‘we’ used by the doctor above and to the ‘we’ in which the patient is co-opted into a group with the medic. Here I want to write about the former case. The use of ‘we’ is one of the most common practices of speaking I observe when I see a doctor, regardless wither it’s a GP or a specialist doctor. Indeed, this observation was confirmed by a medical educator in a discussion under my tweet on ‘we’.

So, let’s get the basics: what does ‘we’ mean. ‘We’ is a pronoun that (according to the Internet) is:

used by a speaker to refer to himself or herself and one or more other people considered together.

In other words, when I say ‘we’, I say that I stand with some other people. This is, indeed, why ‘we’ is considered to be very manipulative. I remember one of Tony Blair’s speeches in the Parliament. He was using ‘we’ all the time, but what was fascinating was that when you stopped to analyse it, the identity of ‘we’ was also shifting all the time. But it did allow him not to speak for himself only, always constructing himself as part of a group, always allied with others. And so, when you say ‘we referred you’, it means that you did it with others.

Let’s start with a clarification, though. There is no ‘we’ that referred me for another medical service. It was one doctor, in conversation with me. Yet, somehow, after this event the referral becomes something that was done by ‘us’, regardless of who is speaking. In other words, both doctors who had nothing to do with the referral and the doctor who actually did the referral speak of a ‘we’ that did it. To be honest, I’m not certain which is stranger, people who claim it or people who disown it.

And here we come to the options the pronoun ‘we’ affords. It offers two, fairly obvious I guess, advantages. First, by using ‘we’, the speaking doctor dilutes responsibility. It’s no longer her/his decision, referral, suggestion or prescription (oh yes, ‘we prescribed’), let alone mistake. Whatever has been done, has been done by ‘us’, this unspecified group of people, a crowd. Can I be responsible for it? I don’t think so.

A digression here. Justyna Ziółkowska and I are finishing a paper on clinical notes in psychiatric care. What’s fascinating is that all references to clinicians are indirect. In other words, clinicians never note that they did something – only that something was done. I think this practice is quite similar in function to the diluting ‘we’.

Now, as much as this argument makes some sense, you cannot ignore the fact that patients (at least some of them) are likely to remember who prescribed their medication. And I think they are unlikely to somehow accept that instead of the doctor they are speaking to, the prescription was given by a group of people. So, there must be another reason for medics’ use of the pronoun. And this aspect of using ‘we’ is to do with power. A decision which is mine alone is, of course, subject to doubt, challenge, and scepticism. But a decision which ‘we’ take is on much firmer ground. It already has a second (and who knows how many more) opinion! It’s not Dr John or Dr Mary who decide on their own. Oh, no, it’s medicine that decides.

Overstated? I don’t think so, I’m afraid. Just like me for years, I think patients tend not to notice that doctors speak of ‘we’ rather than of ‘I’. And all those instances of ‘we’ are just there, white noise, as JT observed on Twitter, that adds to the importance and wonder of the medics we talk to. You know, I’ll press it some more, it turns out that we, the unimportants, do not just talk a doctor, we talk to medicine which speaks through the medic (if some of you see a thinly veiled reference to Catholic confession, you’re right). Can you get more powerful? Can you?

Well, it seems you can. For there is still the answer I heard from the doctor – ‘we’ means the practice. ‘We’ also means solidarity. The locum doctor was taking on the identity of ‘us’, standing by the doctor who ordered the referral, even though the referral had nothing to do with them. In fact, and that’s the most bizarre part of it, the doctor is not even part of the practice! Why do it? I suggest that it’s solidarity, closing of the ranks. What one doctor does, I, another doctor, stand by it, I’m part of it. We’re in it together. It’s not only about medicine, it’s also about us doctors, we have each other’s back.

And so, here is my explanation why I dislike when doctors use ‘we’. It’s wrong. It conceals, dilutes responsibility, it reeks of power. Stop using it. Speak for yourself, doctor.


But…..I think an explanation is needed here. Yes, I know I was not cooperative, I know I wasn’t a model patient. This is because I hated this visit at the surgery. I had been phoned the day before and asked to come in. The receptionist told me that the hospital gym sent a report and a doctor would review it with me. Reluctantly I agreed (they would have pursued me). I came in, sat down in front of a locum doctor who asked: what can I do for you? I must admit I always hoped that a doctor who had never seen me would take a minute or two to look up the notes. Clearly that’s a distant aspiration.

I responded: Well, I was asked to come in, so it’s ‘what can I do for you’? Unfazed the doctor looked at the computer screen and said, yes, of course, it’s your July cholesterol test (I mean, really?!?!, July cholesterol??). And that really angered me. I understand that mistakes can be made, I understand that a receptionist can be ‘phone-happy’, but what I cannot understand is that a doctor cannot simply ask: OK, tell me what you were told. No, the doctor simply decided to bluff their way through. And I find it unacceptable. I also wonder how many patients, less gobby, would have simply agreed and just allowed the doctor to get away with the bluff.

Alas, it didn’t end there. After the cholesterol bid didn’t work, the clinic-X bid didn’t work. I did want to ask ‘how many goes would you like to have, for…sake’, but I didn’t, somewhat regrettably. I was getting seriously irritated (strangely, also amused at the same time, I must admit) and I was still not asked to tell the doctor anything! I was only asked to confirm what the doctor was saying (hence the conversation I quoted at the beginning of this post).  No, instead of asking, wait for it, the doctor left me in the surgery for 15 minutes trying to find our who phoned me and why. Interestingly, I was sitting at the doctor’s desk with the computer which was not only switched on, but also unlocked. A mouse click away. No, I wasn’t tempted to look, but I did have 15 minutes in which to browse!!

The doctor came back, the quest for information was not successful. No, I was still not offered any opportunity to talk (to be honest, I would have refused anyway). I left the surgery with nothing, but to the palpable relief of the doctor. Thank goodness there was the pronoun ‘we’ to think about!


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