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Assimilationism

Assimilationism is the act of encouraging minority cultural groups to be similar to larger cultural groups.”

This word is one I’ve only learned in the past year or so, but I’m glad I did because I realised that it is something that I experience in a few different ways. I’m going to describe a couple here.

1. Heteroassimilationism

This is usually expressed in the idea that Queer people would have such an easier time of things if they just behaved like all the “normal” people. The idea that Pride would be a lot easier for people to “deal with” if it wasn’t full of people dressed and acting outrageously. Or when LGBT campaigns put forward the idea that the mainstream should accept us because “hey, we’re just like you!” – we want to get married, have kids, serve in the army, all the things you straight people want!”

Of course having equal access to marriage, adoption/fertility treatment + military service is important, but this kind of campaigning erases the experiences of Queer people who have no interest whatsoever in being “just like a straight person”.

2. Assimilationism in medical culture

Medicine is *extremely* hierarchical. A professional hierarchy is of course necessary to some extent – for newly graduated doctors to have the same level of responsibility as those who have been in the job 20 years would be dangerous and stressful for everyone. But the social hierarchy that we have really grates on me.

Doctors don’t just have a hierarchy within our teams, but some specialities in medicine have a culture of superiority over others. There are stereotypes for most specialities – anaesthetists just sit around all day, orthopaedic surgeons are knuckle-dragging morons, all surgeons lack empathy, etc. I think that patient safety and care quality would also be helped if we stopped trying to say that people working in other specialities are idiots! Do I sound like a hopeless hippy when I wonder why we all can’t respect each others’ expertise, the medical training we all have in common, and do our best to get along?

I’m really glad to find that recent reviews of the NHS have suggested that a less hierarchical workplace would be good for patient safety – the idea being that since junior doctors rotate round into different teams every few months, we bring a fresh perspective to the established practices in a workplace. We are uniquely placed to spread good ideas across different workplaces and notice when a team’s standards of care have drifted. I have a natural inclination to challenge lazy thinking, poor practice, stereotyping etc. I am still working on my skills at doing this without rubbing people up the wrong way – sometimes when I’ve asked someone questions about why they did something the way they did (consultants included) it has gone well, but other times it hasn’t and I’m trying my best to learn from my experiences. Having some of my views backed up by a prestigious review of health care in the UK strengthens my conviction that I don’t have to be assimilated into the medical social hierarchy to be a good doctor.

Of course, the heteronormative assimilation I experience in mainstream society is also present in medicine. My experience of this isn’t helped by the fact that I feel my queerness and my disability make me vulnerable socially, and so at work I tend to be more reserved and less vocal about my personal life than my more “normal” colleagues get to be. I think takes me longer to feel “safe” in a “mainstream” social group than it does with people who I know understand certain things about me, like what polyamory is, the fact that people have pronoun preferences, what pansexual means etc.

Since starting entering the medical profession I’ve begun to explore the boundaries of what is considered a “professional” or an “unprofessional” appearance for a doctor – standards which I believe are based in the medical profession’s origins as a profession run by rich white men. In my first job a nurse complained to my supervisor that she felt that my ear cartilage piercings were unprofessional. To his credit my supervisor told me that it was my body and what I put in it was nobody’s business but mine, but that I might want to think about how my piercings affected how people saw me. Happily I was able to tell him I hope that my appearance helps people to see that I’m the kind of person I am AND a doctor at the same time, which will hopefully challenge people’s stereotypes of what kinds of people get to be doctors. After a few months my supervisor let me know that I’d changed his mind, and that he admired me for sticking to my guns.

I’ve also tried having unnaturally coloured hair at work (I’m not the only hospital worker I’ve seen with pink hair, just the only doctor) which has similarly gone quite well and I’ve received compliments from some medical colleagues which has been great. I’ve also started using the phrase “one of my boyfriends” when the topic comes up, which has been quite interesting – some people don’t react in the slightest which does make me wonder if their brain has censored out my words, like a Derren Brown mind trick. Each further step I take helps me to feel more secure in being myself at work, which is considerably more comfortable than feeling that I have to be closeted all the time.

Hopefully though the effects of the decisions I make on how to present myself at work, won’t just have the effect of making it a more comfortable place for me to be, but will help other people to feel that they can be themselves – both hospital workers and patients. I believe that a diverse population is best served by a diverse population of healthcare workers. And I also believe in “being the change you wish to see”. This stuff is important to me, which is why I do it, and why I write about it. I’m really interested to hear about other people’s experiences of challenging workplace cultures, where the desire to do so comes from, your successes and times when things went less well. Leave your comments below!

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Resisting the Hidden Curriculum

I first heard the term “hidden curriculum” mentioned in my first year of clinical training at medical school. The majority of first year medical students are extremely excited to finally be at medical school, after years of planning and work, exams and interiews. They are keen to meet patients and idealistic about what the life of a doctor is like.

We were warned that as we progressed through medical school and into the clinical workplace, we would see doctors who were cynical, disengaged from their patients, who didn’t appear to “care” as much any more, and whose practice might be somewhat ethically questionable.We were warned that if we were not careful, we’d end up like them. Some authors go further than that and warn that if we are not resistant to this erosion of ethical values we put ourselves at risk of repeating the atrocities of the Nazi regime. These changes are not what medical school aims to teach, but things that people pick up along the way, learning from the examples set by more senior doctors, and so it gets called the “hidden” curriculum.

As I’ve gone through medical school I have seen friends of mine become more cynical.  Some seem to see patients as a chore. I know of people who seem to think that being a doctor makes you superior to other people, or that being a particular kind of doctor makes you superior to other kinds of doctors as well as everyone else.

Medical culture has lots of insidious norms, some of which I’ve written about before – the idea that you’re a bad doctor if you’re happy to go home at the end of the day, or if you’re not willing to work hours and hours of unpaid overtime. That if your priority in life is to be happy, you can’t have a career as a surgeon. That “patients” are a class of people and are somehow different from us, or that patient is problem to be solved rather than a person asking for help.

That doctors somehow never get ill.

I don’t think any of you will be surprised to learn that throughout my medical career I’ve put considerable effort into trying NOT to become indoctrinated (‘scuse the pun) into medical culture. I’ve tried not to become cynical, and to continue to treat my patients as people, and to be open about my health affecting my ability to work, and to resist when people try to tell me that being a doctor means making all these compromises that I’m not willing to make.

I will be writing more about specific parts of medical culture that I find troubling, but for now I’m going to leave it at that. I would really like to hear of other people’s experiences of workplace culture, and medical culture, any problems you’ve come across, and any solutions or ways of coping that you’ve come up with.

On being a doctor with limited spoons

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I have depression, and this means that for the last couple of years I’ve been operating on limited spoons. This is why I’m working part-time. It means that some days I run out of spoons and have to just spend the evening trying to recover some of my energy. It means that I have to remember to take medicine every day in order to not turn into an angry crying mess. I am very lucky to have a family and friends who support me through my bad patches, and who understand that sometimes I will cancel on them at the last minute, or have difficulty committing to things.

It makes me less giving, and I worry that people see me as being selfish. When I went back to work after having broken my leg, a couple of my consultants fed back that I was “unwilling to stay beyond 5pm” and that they saw that as not being appropriate for a junior doctor. At the time I was completely supernumerary and my depression was flaring up due to having broken my leg, so I don’t think that trying to hang on to my spoons was inappropriate at that point, nor did I feel that it was necessary to disclose my health status to every single person that I worked with to pre-empt them judging me for not working unpaid overtime. But doctors are expected to want to be at work all the time, and for many specialities, the training requires you to work a LOT of unpaid overtime just to get exposure to the kinds of cases that you need to know about in order to develop your skills and knowledge base.

When colleagues ask me what I want to do with my life, I often answer “be happy” rather than specify my career intentions. The range of responses this has provoked is very interesting:

“Oh, you want to be a GP then? Most GPs work part time”

“You’re not going to be a surgeon then.”

“Well, you know you can do flexible training in lots of different specialities so you don’t just have to be a GP”

or, saddest of all

“Aww, I want to be a surgeon :-(”

Most of the people who assumed that wanting to be happy and wanting to be a surgeon were incompatible were surgeons themselves!

Some people live to work, and that is fine. A lot of doctors have that kind of attitude to work, because it used to be that ALL doctors lived to work – there was no other option. If you were a GP in a one-man (and it was one man) practice, then you were on-call *all the time*. If someone got ill in the night and needed you, you had to be there. Fortunately (from my perspective at least) things are not like that any more and while there are arguments against doctors working shifts, the fact is that my job is shift work.

I work to live – having a job enables me to have the resources I need to be able to spend time with the people who are most important to me, doing the things I most enjoy. I took a year out before university, I took a year out from medical school and did a Postgraduate Diploma, and now I’m working part-time. I’m ok with the fact that I’m not climbing the career ladder as fast as is humanly possible, because I know that if I were trying to do that, I would be less happy.

I try to be open at work about the fact that I’m working part time and the reasons for it, and for the most part I think that has been a good thing. I want to be visible to other people who have less spoons so that they know that they are not alone, and I want to be visible as a person with mental health problems in order to try to challenge the stigma that people with mental illness face.

Video: Thoughts from summer holidays: queer spaces in social + professional life

Video: What does “appearing professional” mean for doctors in minority groups?

Click through to the YouTube page for links to more articles.

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