With the seemingly-relentless talk about Covid-19, doctors could be forgiven for feeling a little worn out. What began in February as intense anxiety about an impending tsunami of severe respiratory illness has evolved into a more general worry about patient care and how to regain some sense of normality in all our lives. Is resilience the key? 

A couple of years ago, a systematic review in the Postgraduate Medical Journal examined 24 studies to determine the factors influencing resilience in doctors.¹ Those factors, according to the authors, were demographics, personality factors, organisational/environmental factors, overcoming previous adversity, interventions to improve resilience, social support and leisure activities. Note the last item – it means ‘fun’.

But are doctors allowed to have fun? Or do the rules of professionalism dictate that some of life’s perfectly-legal pleasures are simply out of bounds?  During lockdown, I happened to watch a repeat of Graham Norton’s eponymous BBC chat show – one with Jennifer Aniston, Reese Witherspoon and Sir Ian McKellan. As usual, Graham finished the show with a visit to the ‘red chair’, which involves a member of the audience sitting in a large wingback red chair and regaling viewers with an amusing anecdote. If Graham becomes bored, senses audience discomfiture or simply wants to save the contestant from themselves, he pulls a lever to flip the chair backwards while the audience cheers. If the anecdote is deemed to have hit the mark, the contestant is allowed to walk off with dignity. Graham typically begins by asking the contestant what they do for a living. The contestant I saw recently said she worked “as a consultant [pause]… in an IT company”. Graham replied, with some relief, “I thought you were going to say you were a medical consultant and I thought you really shouldn’t be doing this”.

Which begs the question, why not? Is this not just a bit of harmless fun? Alas as medical professionals, perhaps we are our own harshest critics. The Journal of Vascular Surgery recently felt it necessary to retract an article that had survived the peer-review process and was published online in July 2020.² In it, the authors sought to evaluate the extent of ‘clearly’ and ‘potentially’ unprofessional content among 235 publicly-identifiable social media (Facebook, Twitter and Instagram) accounts. ‘Unprofessional’ content was found in 26% of the accounts, with 3.4% deemed to be ‘clearly’ unprofessional (‘obvious alcohol intoxication’ or ‘uncensored profanity or offensive comments’). ‘Potentially’ unprofessional content was present in 25% of accounts and included ‘holding/consuming alcohol’, ‘controversial political comments’, ‘censored profanity’, ‘controversial social topics’, ‘controversial religious comments’ and ‘inappropriate/offensive attire’.  

One might argue that having a ‘controversial’ opinion outside of medicine is not only compatible with professionalism but is indeed our right as equal citizens. But it was the subjective author comments on ‘inappropriate attire’ that caused a particular stir. The ensuing online backlash included accusations of misogyny and prompted hundreds of medical professionals to tweet pictures of themselves in swimsuits under the hashtag #MedBikini. An apology from the authors appeared on Twitter before the paper was ultimately retracted. So, perhaps some fun is allowed after all.      

References

1. McKinley N, Karayiannis PN, Convie L, Clarke M, Kirk SJ, Campbell WJ. Resilience in medical doctors: a systematic review. Postgraduate Medical Journal 2019; 95:140-147. doi.org/10.1136/postgradmedj-2018-136135
2. Hardouin S, Cheng TW, Mitchell EL et al. Prevalence of unprofessional social media content among young vascular surgeons. J Vasc Surg 2020 Aug; 72(2):667-671 [Retracted]