The birthmark

The incident

I was 27 when I went to the local surgery to get a birthmark cut from my face with local anaesthesia. The doctor was a man at the age of retirement. He first asked me to get completely undressed and to lay down on the operating table. He did not cover me, I was laying there until they started to prepare for the operation. Finally, one of the assistants covered me. As the operation went on, he asked me if I felt pain. I said no. Then he asked if I had ever given birth. I said “yes”.  He remarked in a condescending tone that, in that case,he was sure I had other cuttings too, which were much worse than this one. He then giggled.

When the operation was over, he still slapped my thigh a few times and praised me for being such a well behaved “little girl”. I went through all this without saying a word and without resisting. I barely understood what he was doing and it was extremely humiliating. The doctor was not at all embarrassed.

1. Identities of the actors in the situation

The patient: Young woman (35). At the time of the event she was a university student, not married, but living with her partner. From an upper middle class family. Not religious, although the family environment is. City dweller, born in Budapest.

Medical Doctor: Male, in his late sixties. No information about his background, but considered as upper middle class. No information about his family status. He must have been practicing for more than 25 years.

Both age and gender differentiate the actors, they are only related by their affiliation to a relatively privileged class. That fact could create some familiarity, however it doesn’t, rather the contrary, because the protagonists do not recognize themselves as “same”: the relationship that seems to dominate their communication is the doctor-patient dichotomy, which is inherently unequal, especially in the combination of older male doctor to young female patient.

2. Context of the situation

The incident happened in a private healthcare institution.  This is where procedures and protocols are dictated by formal rules prescribing the accepted conduct of health professionals and patients.  There are also by implicit unwritten informal rules. Both types of rules provide a big margin for the doctor who is relatively free to dictate the norms to be followed. Patients are fighting for appointments with “good” doctors so they are in a relatively dependent situation.  This is not a new phenomenon, it has been like this for the past few decades. Also within the internal culture of hospitals, sexist jokes and behavior did not count precisely as taboos, even within the previous regime. This doctor, relatively old, probably continues with the old system.  This combined with the new prestige of a private doctor, in his private consultation, the medical space of the consultancy room allows for some exceptions from everyday norms of behavior and communication.

3. Emotional reaction

The patient feels humiliated, in a completely unrealistic situation where she is denied any control over her body and the whole process. She is helpless and consumed with shame, both because of her nakedness, and because she cannot find a way to defend herself.


4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

The patient would value a doctor-patient communication based on equity and mutual respect, although she is aware that this is more an ideal than an available practice.

For her nudity involves shame, obliging the person to break some social taboos. Medical space gives a certain rationale for breaking taboos, provided it is justified by the medical procedure. Her idea about the medical procedure in question is that this situation does not have to involve nudity. Consequently, her nudity breaks a taboo without any excuse.

Speaking about genitals involves the same taboo breaking, with the same logic.

She does not expect medical communication being personal, rather objective. For her the behavior of the doctor is both rude and non-professional.

The fact that the doctor is an elderly man and she is a young woman complicates the situation as she identifies sexual jokes as sexist behavior that results in creating a power hierarchy between the author and the object of the joke. This interpretation is based on recurrent experience.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

The patient has a very negative image of the doctor whom she perceives as sexist, voluntarily humiliating her in a rather perverse way. She does not know much about the frame of reference of the doctor but she knows he has been a medical doctor for a long time. His behavior, however shocking, corresponds to her stereotype of older male doctors.  This perception is based on facts, but her interpretation is necessarily subjective.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

There is a chance that sexual jokes with patients for the doctor is part of his own routine, into which he was socialised during long years of practicing in a public hospital in the socialist regime. He might not have had negative responses to that, partly because some patients found it as natural as him, or because (almost) no one ever dared to complain.

He might have a conscious aim to put the patient at ease with small talk during a minor surgical operation. He might perceive himself and his behavior as friendly and human, to break the inhumanity of the medical space.

It is possible that consciously or unconsciously he identifies the conversation as a form of gentle flirting.

Nakedness does not involve the same taboo to him as to the layperson, as he is well accustomed to it. Not covering the patient might be a voluntary action to expose her beauty as a form of relief from the exposure of old and sick bodies, but it might also be a non voluntary act, seen as not part of the important things.

He probably does not perceive the humiliating and hierarchy-creating nature of his communication as this particular hierarchy based on gender, age and professional experience is just natural for him.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

Medical communication is not a concern for a lot of doctors, especially not from the older generation, socialized in the previous regime. This is true for verbal, let alone for non verbal communication. It might be difficult to change old routines, but it is all the more important to introduce this aspect in the initial education of health staff and in the life long learning involving health professionals. Forms of communication are not only the products of individual communication styles but also of professional and institutional culture. Younger, better informed colleagues can do much to transform this culture by intervening if necessary, as was the case in this incident, too.