#Banthebash

BASH: badmouthing, attitudes and stigmatisation
in healthcare as experienced by medical students –
the paper can be found here.

We’ve all made an offhand comment where our feelings about certain specialities become clear. I personally am wary of radiologists and surgeons, but it doesn’t mean I tar them all with the same brush- as in life, there will be horrible ones and great ones, hard working ones and lazy ones. The paper states that generalisations such as ‘useless GP’s’ and ‘lazy dermatologists’ are heard in medical schools and that doesn’t surprise me. A lot of these attitudes and statements will come from students who have experienced a speciality not to their liking- but just like any concept in medicine, we can’t stuff a whole speciality into one box.

We shouldn’t be bashing the patients, the speciality or the doctors who work within that speciality. It’s rude to suggest that all people are the same just because they come under one heading- whether that’s patients or doctors, there’s still going to be a massive spectrum of personality types, illnesses and behaviours that cannot be captured in a stereotype.

Psychiatry and GP get the most bashing. My family aren’t medical and do have mental health issues but still see the stigma attached to psychiatry- ‘why’d you want to work with psychos all the time?’ and ‘Isn’t that for doctors who are a little bit strange already?’ have come up at the dinner table. I like to think I’ve set them straight on that, but if my family, the general public (my family has no medical connections at all, they’re all ex-Naval) see that, how can we expect medical students not to? And with comments that evocative, how can we expect it not to influence career choices?

As the paper states, there is a generalised acceptance of badmouthing, viewing it as banter, harmless fun and not meant to be taken seriously. This is of course true- everyone makes offhand remarks, everyone wants to view their speciality as the best and will make jokes about the others. It’s a way of bonding, a coping mechanism, and yes, in most cases, just harmless fun. But is it still harmless if it’s contributing to people changing job? If it’s deterring people from areas that need more doctors, from areas those students actually love?

Those more hard hearted than me would argue that it’s just meant in jest, it doesn’t mean anything, don’t be so sensitive, and if you wanted to move into that speciality then you’d do the research for yourself and if you really wanted to do it, a bit of banter wouldn’t deter you. But when all you’ve ever heard about something is negativity, why would you even bother to do the research? I am lucky in that I spend a lot of time on twitter where I exclusively follow people that love their jobs (I am grumpy enough without hearing from other people hating things.) But if you’re not seeing that, what you are seeing can be very demoralising. If you have a tentative hope of being a psychiatrist and you’re then only hearing that psychiatry is boring. you’ll lose respect, psychiatry is boring, it’s too easy, you never cure anyone and the treatments don’t work, then what is going to prompt you to nurture that spark until you realise that actually, psychiatry is pretty great? (Statements about psychiatry quoted from quotes from Dr Alex Langford, @PsychiatrySHO)

It’s not just that. You might be able to look past the negative comments to see that the speciality is actually amazing, but then wonder if it’s worth going into something you love just to be belittled so often by other doctors. Someone else would say to toughen up, other people’s opinions shouldn’t matter anyway- but inevitably they do, and you need to be able to trust that others trust your judgement, and good relationships need to be maintained between departments not only for the workers, but to ensure good and cohesive care for patients. If a guy who disrespects your speciality is given your patient, you need to know he’ll trust the decisions you’ve already made, regardless. That is only hindered by the view that some specialities are beneath others.

It may be naive to wish that everyone could get along without bad mouthing each other, that doctors should support their juniors into the specialities that they want instead of persuading them to theirs or dissuading them from others. This attitude of badmouthing is very much the prevalent attitude though- there is not the support necessary. I’d rather have someone support me into doing what I want to do and be happy and thus more productive, than bullied into a career I don’t want and thus be less caring. I don’t want my teaching in surgery to be less than best because the surgeon has decided I’m not worth it (I want to be a paediatrician at this current point).

If we’re pressing stigma on doctors, are we then also pressing it on patients? By saying Dermatology is a Derma-holiday, are we implying that all derm patients are easy to treat, not worth treating or that dermatology is simple? If the general public were aware of these attitudes, would they treat their doctor and their doctor’s opinion differently?  By saying GP’s are lazy, are we opening them up to patients treating them badly because they don’t believe the GP is doing everything they can for them? By implying that surgeons just want to cut and anaesthetists put people to sleep with their personalities, could we be making patients believe their care is substandard because their doctor, whoever they may be, doesn’t care about them as a person?

So yes, I am supporting Ban The Bash. It seems to be primarily to reduce psychiatry bashing, but we need it for all specialities.

That’s not to say every speciality is perfect and we don’t all need to be constantly seeking to improve- but putting each other down for the sake of banter shouldn’t be a thing. We should be working on genuine issues, not improving the face of specialities due to chat between students and doctors.

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