Professionalism – turning dolphins into whales

Professionalism – turning dolphins into whales by northerndoctor

Posted on Sunday, June 20, 2010 at

Professionalism is an explicit outcome in most medical curricula yet remains a nebulous concept. Some medical students recently asked for my opinion on body piercing and tattoos. Would having a tongue piercing or a tattoo constitute an unprofessional act?

The many systems being developed to assess and measure professionalism can feel oppressive. Paradoxically, patients thrive on the traits of a doctor they come to know over many years. My hairdresser can give me a detailed rundown of the personal flaws of the doctors at her practice. Their eccentricities are well documented and they may well struggle to ‘pass’ a modern test of professionalism but a stable primary care system allows patients to drift toward the GP that matches their own foibles. It’s worrying that early exposure to some consultation models and the systematic medical history homogenises students. It would hardly be surprising if they felt coerced, pressurised to conform and nervous of expressing their own individualism. We all have to find a way of feeling comfortable in our own skin when we practice medicine.

And what is the prevalence of body piercing? Rather helpfully, there was a study in the BMJ in June 2008 which set out the prevalence of non-ear lobe piercing.

Adults aged 16-24 had a prevalence of 27.4% (95% CI 24.8 to 30.0) for any kind of piercing. The most common were navel (14.8%), tongue (6.5%) and nose (6.1%). A proportion of over 1 in 4 with a piercing suggests to me that it is normal behaviour for some young people.

Of course, there is a downside to tattoos that goes beyond the potential to cause a fit of the vapours in venerable consultants. Blood-borne viruses aside there is little to guarantee that the subtle, philosophical motif that elegantly symbolises your personal credo will be so appropriate in ten years time. How about fifty years hence when you are drawing your pension? They are a highly visible sign of the ageing process and the clear lines of youth are remorselessly smeared out into the blurry edges of old age.

One of the answers to professionalism, at least in primary care, may be to concentrate less on the individual and to spend more time ensuring continuity in the system. Fragmentation of care may ultimately make people less tolerant of normal human eccentricities in their doctors.

My final word of caution would be for the female students: before you get a dolphin tattooed on your abdomen, spare a moment to consider the effects of the gravid uterus on your body art. As one young pregnant woman bewailed: “Look at my tattoo; it’s not a dolphin, it’s a bleeding whale!”

Bone, A., Ncube, F., Nichols, T., & Noah, N. (2008). Body piercing in England: a survey of piercing at sites other than earlobe BMJ, 336 (7658), 1426-1428 DOI: 10.1136/bmj.39580.497176.25

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