Fighting for more than PPE: Essential Workers Deserve to Relax without Judgment

By Dr. Mary Lee Cunill, Health and Interpersonal Communication Scholar

In a time when we are recognizing health care professionals as essential workers and fighting for their right to cover up with PPE, why are we not fighting for their right to relax and recharge?

Sticks and stones may break my bones, but words will never hurt me.

While pursuing my doctorate, I learned this is not true. And I don’t mean this in a figurative way. I mean it in a literal way. Language matters. Scholars understand that we use language to create, categorize, and organize the world around us. Then, society uses language to transmit this understanding into the world. Language creates our reality.

When we use a word, we are reaffirming its meaning and recreating that category in the world. We reify it with every use. Recently, while doctors were busy fighting on the front line of COVID-19, some researchers were writing about their “lifestyles.” Today I want to tackle the words “inappropriate” or “unprofessional” as reified in an article entitled Prevalence of unprofessional social media content among young vascular surgeons published July 2020 in The Society for Clinical Vascular Surgery journal.

The language chosen by these researchers creates a binary of appropriate vs inappropriate and professional vs unprofessional. Of course, all doctors want to be in the preferred category: appropriate and professional. This binary demonstrates how research and society inform each other, but it isn't correct: Saving lives does not prevent essential workers from having lives.

Most medical professionals already gave between 5 and 10 years of their lives to medical school so they could serve society. We as society should consider this, and their requirement to provide services without bias based on the Hippocratic oath, and withhold judgment of how they spend their time off.

Sadly, the researchers aren’t wrong in that we have implicit biases about how we view groups of individuals. Implicit bias, especially toward human bodies (sizeism, colorism, ageism, sexism) absolutely exists. The issue is, instead of challenging the idea that swimsuits are “inappropriate”, the researchers used the article to firm up this connection, using language to operationalize “swimsuit” + “provocative photo” = “unprofessional”. I am interested in how they measured "provocative."

To reify this in a scientific article confirms the bias. There are other issues with the research, such as claiming that “neutral” Facebook, twitter, and Instagram accounts were created to search for the images. We know that there is no such thing as a neutral account due to the over 100 algorithms used at any given time. To imply that there is the ability to have no bias in internet searches is counter to fact.

As humans, especially researchers and scientists, a main social responsibility we have is to create tools to measure objective facts. For instance, I study human communication, and we do what is called “operationalizing” behavior in order to measure it. For instance, we may measure the term “intimacy” by counting the number of times a couple touches each other in conversation and what parts of the body they touch. However, we would have to control for cultural aspects, length of relationships, type of relationship, and more. Sound research delves into all past research on a subject, learns from it and critiques it through current standards, and then designs a “code book” of what a certain behavior looks like to the observable eye. From there, peer reviewers critique their approach to ensure validity.

For instance, in the intimacy studies above, we may discover that each couple has a base line of how many times they touch in an interaction on average. And, through observation, we know that when couples self-report increases in intimacy, there is a correlation to increases in touch. This we can measure, though we cannot state causality. We can only say they are correlated; as touch goes up, so does intimacy, but not necessarily in that order. Understanding this helps us know what additional arenas need to be researched and controlled for in order for us to be able to draw a cause for intimacy.

I share all of this because we must be aware of and utilizing these tools when researching to ensure that the material published doesn’t hold personal or cultural bias. If it does hold bias and pass the peer review process, the publication of the article literally creates this biased reality by marketing is as truth.

In this article, the researchers were measuring “professionalism.” They opted to define this term as excluding normal adult behaviors, such as legally drinking alcohol and wearing a swimsuit. Just because two things are found in the same place at the same time, does not mean they are tied together. Consider how we see umbrellas and rain present in the same space together, but we wouldn't say umbrellas cause rain. This reinforces the double-bind dilemma for women, or conflicting demands that require women demonstrate contradictory behaviors that set them up for harsh judgment no matter which behavior is adopted.

What research are we doing to understand why these two things keep happening together? When they consistently appear to show up together, this is often a schema that exists in your brain instead of a fact. For example, the umbrella sits in your car all the time, but you only focus on it when you see rain. Our implicit biases are a result of these schemas that narrow our focus and create relationships where there aren’t any causal ties and must be actively unlearned. As a matter of fact, history, and particularly the use of visual representation (or lack there of), has been used to create these schemas in our brain.

Just look at the portrayals of the characters in Grey’s Anatomy. How much of the show was focused on their talent as surgeons and how much time was focused on their love interests? I don’t know, but it might make a fun study!

And I am not knocking Grey’s Anatomy. As a matter of fact, I am a huge Shonda Rhimes fan! I am just saying that we have to be critical about reality and storytelling. To demonstrate how professionalism and life can coexist, here is what actual doctors shared based on their lived experience.

Check out #medbikini on Instagram to look beyond the images and the words and see the human. Note their occupations and contributions to society. See the deeper aspects of who they are. You might even message them or interview them to get to know them better. This is what qualitative research does. It goes more in depth and hears the lived experiences of people that are sometimes grouped as a number in a count. This isn’t to devalue numbers. They certainly matter—look at the COVID-19 counts that are climbing. However, we must go beyond the number to the specific case to truly understand the in depth aspects that contribute to the counts.

By using their voice and speaking truth, these doctors were able to hold the researchers accountable and have the article removed from publication. This means that, through the use of critical thinking and speaking truth, society is able to rewrite the definition of “unprofessional,” excluding normal adult behaviors such as swimming and having a drink in ones free time. The legal adult activities one engages in during their free time do not effect the ability of one to professionally do their job.

Well done, ladies. This is how we change words. This is how we change society. Choose your language thoughtfully.

Note: Through the efforts of female doctors (and many others) leveraging their voice to start the #medbikini movement, The Journal of Vascular Surgery has since retracted the paper from its August issue.

A special thank you to Dr. Wang, Dr. Bilbeisi, Dr. Taleia, Amber-NP, Dr. Bri and the ladies at realresidentsofig for sharing their images on this blog and using their voice for change.