Doctors, patients and dickheads

Dr Vyom Sharma
Oct 20, 2016 · 4 min read

“Kevin, you’re being a dickhead”.

*Sigh* “I know”.

There’s an exchange I didn’t expect to hear.

Don’t get me wrong… I’ve met several Kevins who would fit, and even admit to, that description. I just didn’t expect to hear that exchange in a medical appointment. Such are the privileges of observing a consultation between a GP and patient, as an observing doctor in training.

The GP was the one who said the naughty word, and the dickhead in question was the patient. I say in question, because the verdict wasn’t unanimous. While two out of the three people in that room found in favour of the accusation, I abstained.

If I’m to be perfectly honest, I can’t remember the specifics of the story. Something about Kevin’s new housmate Shazza. Something about a crystal meth lab. Something about a court date.

Clearly, Kevin had messed up. And rather than portray him as merely a victim of his circumstances, with one incisive invective the doctor assigned responsibility. It seemed the only person in the room who found this exchange confronting was me. According to the doctrine I had imbibed, passing judgement wasn’t the doctor’s role.

I had learned that making personal judgements were the chemical constituents for the destruction of the doctor-patient relationship: an explosive destruction if there was disagreement and antagonism, or an implosion if the patient became submissive.

And yet, the result was neither. The air in the room wasn’t antagonism or humiliation. It was empathy and commiseration. Somehow the invective didn’t come off as parental judgement, but brotherly dissuasion.

At the time I couldn’t fathom how the consultation felt positive and warm, not in spite of the crude language, but in some small part because of it. That particular expletive resonated with all three people in the room. It’s a word that can be levelled in jest as much as it can with vitriol. But in that moment, we all knew what the GP meant. Kevin was, by building a meth lab, being a dickhead. And any other wording would have been a betrayal of the truth.

I walked into that consult room a fundamentalist about professional use of language, but I walked out a skeptic.

All that aside, we shouldn’t swear; that’s not my opinion, that’s societal consensus. I’m not just talking about words and phrases used to incite overt hostile/sexist/racist offence. I’m talking (relatively) inert ones that require context to be meaningful — you know, the other words for penis, vagina, sex and faeces. Why the ‘rude’ variants of these original words are considered offensive, is a semiotic mystery. But the variants sure do feel dirty.

And as is the case with most things dirty, we’re told to indulge in them privately, or with likeminded company. It all seems pretty arbitrary though. Much like keeping elbows off the dinner table, there is no intrinsic reason why certain swear words, even very benign ones like ‘crap’ are considered bad. But society draws a line at these words, because it’s one of the arbitrary ways we demonstrate our respect for other people.

However why we avoid cursing as doctors extends far beyond decorum.

Our conversation style aims to encompass both professionalism and empathy. And staying within the overlap of this Venn diagram isn’t always easy. But it’s the best thing. The idea is to listen, offer truthful answers, provide options, and guide the patient towards what they want.

Judging people is not part of the job, which is fair enough as it does more harm than good for patients. As doctors we don’t just avoid swearing because it’s rude. It’s because swearing tends to be a pretty crude judgement of a situation or character.

And yet none of this explains why everyone, including doctors, does in fact, swear. And I do mean everyone. Even the most ardent puritan will, having stubbed their toe on furniture, say ‘sugar’, ‘shoot’, or ‘fudge’. Why these thinly veiled euphemisms? It’s the adult equivalent of telling your grade 5 teacher to ‘puck off’, and pretending you won’t bear the consequences (which I did).

We swear because it’s honest. We swear because, at the time we do it, any other words would diminish the truth of what we are feeling. If you disagree, next time you lock yourself out of the house, I challenge you to utter any milder epithet than a loud “shit”. Say any lesser word, and you will defraud yourself.

While we all avoid swearing in consultations, a few of us will admit to having done it intentionally — perhaps not aimed at a patient, but using it to express ourselves in a certain way. An empathetic physician seeks to understand what the patient feels. A cursing physician expresses what they feel. While that’s not always a good thing, sometimes, maybe it is.

Dr Vyom Sharma

Written by

Medical Doctor / Health Commentator