Are Doctors Dickheads?

​​​Last week, Twitter was abuzz with heated debate. The question? Whether, in fact, doctors are dickheads.
 
The discussion was started by US-based, disabled patients with Ehlers Danloss Syndrome (EDS) who felt patronised and misdiagnosed by the doctors from whom they had initially sought a diagnosis. The hashtag #doctorsaredickheads quickly began to trend, as users shared experiences of medical malpractice and disrespectful treatment from across the world. An indignant and similarly vocal contingent fought back, defending clinicians as providing exceptional care in challenging circumstances.  
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It is certainly no compliment to be called a ‘dickhead’. The OED defines ‘dickhead’ as ‘a stupid, irritating, or ridiculous man’. Others have proposed more colourful equivalents.
 
Many of those in the profession, or the process of becoming doctors, may balk at the idea of the doctor as dickhead. For the overwhelming majority of those either practicing or aspiring to treat patients, being a ‘dickhead’ is anathema to what they hope to do as a doctor.
 
Some patients sprung to their doctors’ defences:
 
https://twitter.com/RussInCheshire/status/1055363838072238080
 
However, many of those tweeting their negative experiences returned to themes that healthcare professionals may recognise. A significant proportion shared experiences of poor communication, difficulty in being diagnosed with chronic conditions such as EDS, polycystic ovary syndrome (PCOS) and fibromyalgia, and the dismissal of the concerns of (particularly) women and disabled people.
 
Many of these responses are deeply upsetting:
 
https://twitter.com/AlexandraJurani/status/1055143115579908096
 
https://twitter.com/ianbfarquhar/status/1055174394660540417
 
Nevertheless, there is awareness in the medical establishment that these issues are not always well- or consistently addressed, and they often form the basis of service improvement proposals.
 
Ultimately, there is a power imbalance inherent in the doctor-patient consultation. The doctor is the bearer of knowledge, resources and power, while patients arrive sick and vulnerable, and put their faith in the doctor’s insight. The ability to become a doctor often intersects with other markers of structural privilege, such as affluence and parental education, potentially widening this power imbalance. In addition, as a CQC report highlighted, many patients worry that by complaining they may be perceived as a ‘trouble maker’ or receive lower quality of care.
 
‘The doctor’ is not only a human delivering treatment, but also a social construct that society dictates is deserving of trust and respect. Foucault examined this relationship in detail, and likened society’s quasi-religious faith in the institution of medicine to save bodies to the clergy’s historical responsibility for saving souls. He described a ‘medical gaze’, in which doctors separated the patient’s body from the patient’s identity in order to analyse and thus diagnose a patient’s ailments. While this plays an important role in pattern recognition and diagnosis, Foucault argued that it is inherently dehumanising, and further disrupts this balance of power.
 
Though medical treatment is provided free of charge at the point of care in the UK, the structure of the NHS means that a patient is often only able to access higher-level resources via their GP. This adds a further dynamic to the doctor-patient relationship, in which doctor is ‘gatekeeper’ of resources.
 
Many doctors navigate the line between the personal and institutional aspects of their profession with care. Trust in institutions allows the building blocks of modern society to continue functioning: schools, banks, the civil service and hospitals require an environment in which honesty is assumed. At a personal level, medicine is not only a challenging profession, but an enormous privilege. Doctors are routinely trusted with the intimacies of patients’ lives, and most are only too aware that the delivery of effective treatment is facilitated by an atmosphere of openness and integrity.
 
At the same time, the advent of the internet has dramatically changed the amount of information (and mis-information) available to patients, and inevitably altered the balance of power. Now, a patient may turn up with a correct or incorrect hypothesis about their own ailment, fully informed about a condition that their doctor has rarely, if ever, encountered. In amongst the foray of #doctorsaredickheads, there were clashes between those that had felt they knew more than their doctors, and others who expressed dismay at the ‘lack of respect’ shown to medical professionals – a clash between emerging and traditional approaches to the role of doctors in the internet age.
 
Nowhere is the intersection of structural power and human compassion more acute than in General Practice, particularly now that it lies at the heart of commissioning in the NHS. General practitioners are simultaneously the gatekeepers of referrals, paperwork and prescriptions, and humans who have chosen a speciality that sees an enormous variety of fellow humans in need. This relationship may also be affected by constraints on time, resources and the growing number of legal reprisals. Nevertheless, this nexus of intimacy and structural power places GPs in a powerful position to advocate on behalf of their patients. Many take personal and professional pride in doing so.
 
Twitter is no stranger to heated debate, and, in the wake of the #metoo scandal, the social media platform has emerged as a crucial virtual space for people to share experiences and gather the momentum needed to translate anger into action.
 
There was a third voice on the platform, in addition to disappointed patients and those defending the profession: that of doctors. Some ventured into #patientsaredickeads; other pleaded #notalldoctors, and #doctorsarehuman. Many apologised on behalf of their profession, and implored other doctors to listen to the tales of dismissal and neglect. I suspect that a further contingent chose not to add their voices to the fray, and yet recognised, in amongst the debate, echoes of situations from their own working environments.   
 
The hashtag itself is provocative and polarising. There is no evidence that it reflects a sea change in opinion of the medical profession or institution of the NHS; a recent survey suggested that 87% of British people are proud of the NHS.  
 
However, the #doctorsaredickheads outcry presents an opportunity for doctors to hear the unvarnished stories of patients across the globe who feel genuinely let down by one or more of their medical professionals. These responses may be anonymous, but are equally unfiltered by a patient’s desire to please or by fear of inferior treatment. This is a chance for students and medical professionals to be reminded of the privilege and power of the profession. If we can use these honest and heartfelt expressions of disappointment by patients for reflection and growth, and to better include and advocate for all patients, we all gain. 

Clarissa Hjalmarsson

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