The Embarassed GP

The incident

The narrator tells us:

“I was going to see my GP for some general health questions, which were not at all related to my cerebral palsy. I wanted to consult my GP about some other kind of treatment. As far as I remember, it was about massage, whatever.

Anyway, I´m sitting in the GP´s waiting room, which was completely full of patients at the time. I would guess about 10-12 other people. I knew in advance that my usual GP was not available, but in this errand it was quite ok for me. I knew – or at least I expected – that the vicarious doctor would be totally able to assist me in the matter.

After some waiting time, the vicarious GP enters the waiting room, calling out my name. I get up immediately from the chair, exclaiming: here I am. My walker is beside me, and when I get up, of course, I have to grab the walker in order to move to the GP´s consulting room.

In the very moment I get up and the GP sees my walker, she looks at me with a very strange gaze that seems to be surprised, embarrassed and slightly dismayed at the same time. She steps back and stutters in a staccato voice: “well, well, yes well, yes ok, well then, You better come with me…” All her body language shows that for some reason my disability is making her very uncomfortable, perplexed and completely taken by surprise.

After this scene, I followed the vicarious GP into the doctor´s consulting room. But I was so confused and full of embarrassment as well as mixed – predominantly negative emotions – that I could hardly submit my errand. I only wanted to get out and away. Consequently, our conversation was very awkward. It seemed tense and a bit artificial. It was hard for both of us to talk naturally and relaxed after the intermezzo we had experienced in the waiting room. Thus the consultation was brief and at no time pleasant and not at all familiar.

Later on I was thinking: what a relief that I only needed medical assistance in a minor health issue this very day. What luck that I wasn’t asking for medical support for a more serious matter that very day. The GP´s reaction totally broke down my trust and confidence as a patient – and even in the situation – my self-confidence. That may have been fatal in another matter of more serious treatment needs.

Even though I have experienced many strange and offensive reactions on my disability during the years, I never experienced anything like this. I was really shocked that a professional doctor could act like this. Maybe she didn’t take her time to read my file – although this would be her duty as vicarious GP. Anyway, this could never be an excuse…”

1. Identities of the actors in the situation

The narrator is a female university student at the age of 26. The narrator´s studies are within communication and social science in one of the universities in the Capital Area. She is going to finish her studies in the autumn 2016. The narrator lives in the City of Copenhagen. The narrator is physically disabled, with the disease Cerebral Palsy, thus using a walker. Apart from her studies, she is active as a board member and chairman in the board of a major youth organisation for young people with disabilities. Thus, the narrator is also giving advice to other young people when they experience various kinds of assaults and even discrimination due to their disabilities. The narrator is very conscious of and analytical in all questions and topics related to discrimination in general, and especially discrimination related to disability.

However, in this incident, she is positioned as a patient seeking an advice herself. She is going to consult her GP because of a general health issue, which is not particularly related to her physical disability.

Apart from the narrator, the incident involves the following actors:

A female GP of Asian descent, probably in the early forties or maybe the mid-forties. She speaks Danish without accent (common for migrants and even second-generation immigrants after many years). Thus, it seems reasonable to assume that she was born in Denmark or arrived in Denmark at a very early age, maybe as an adopted child. She is working as a substitute/temporary for the permanent GP, while he is on vacation. As a temporary, the GP would not have personal knowledge of the patient/narrator in advance – apart from her access to all the information in the patient’s file.

10-12 other people/patients in the waiting room, waiting for their own medical consultation.

2. Context of the situation

The incident takes place in the GP´s waiting room and partly in the GP´s consulting room at the narrator´s GP. The narrator is consulting her GP because of a general health issue, which is not particularly related to her physical disability. This particular day, it turns out that the permanent GP is on vacation, and therefore another GP is taking care of the patients as a temporary/substitute.

3. Emotional reaction

The narrator´s emotional reaction would be:

In the very moment she feels very embarrassed and confused by the GP´s reaction.

She also feels rejected and somehow even excluded.

She really feels exhibited and exposed to all other patients in the waiting room. Likewise affected by the GP´s strange reaction, most of them are looking up and apparently confused by the situation. Thus, the situation actually affects the narrator´s usual self-confidence in the downward direction.

She feels completely caught off guard. Even though she is prepared to meet various reactions on disability, this is a new experience that she never expected from a professional. In this light, her astonishment and embarrassment is gradually replaced by anger and indignation.

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

The incident collides with several of the narrator’s attitudes, principles and values:

The value of equal treatment and equal opportunities

The narrator is deeply involved in events, activities and debates to combat discrimination, prejudice and lack of equal opportunities. Having Cerebral Palsy, she is the chairman and board member of a major youth organisation for young people with disabilities. Thus, she is generally strictly aware of situations and incidents where either she herself or other people are treated in a discriminatory and exclusionary way because of disability or due to other illegal discrimination areas (like ethnicity, race, colour, gender, age etc).

The value of equality, equal opportunities and anti-discrimination implies in this case that people with physical disabilities should have equal opportunities to take part in society on equal terms with other people – and have a right to be treated equally and with equal respect as other people.

In this incident, the narrator experiences that her basic value of equality and respect for other people regardless of their background, resources and skills, is violated. Indeed, this is not a first time experience for the narrator. But the shock occurs specifically because she expects these values to be a basic part of the professional attitude in the healthcare system with the primary task to deal with patients with all kinds of physical and mental challenges.

The value of safe and equal access to professional care and treatment

Even though the narrator is generally aware of lack of equality and discrimination in society and everyday life – she still has a strong expectation of a fair distribution of benefits and requirements as the basic value of the welfare state. She expects that she is equally as entitled as other citizens to ask for a decent medical care and treatment whenever she needs it. She expects to meet a professional and objective approach in the healthcare system, whether her GP consultation is about her disability or other health issues.

In this incident, her general expectations are frustrated when she learns that the GP is unable to comply with these professional requirements. The shock occurs because the response to her physical disability comes from a doctor who is supposed to have a professional insight into physical disabilities and all other kinds for physical disorders.

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 narrator´s image of the temporary GP can be assembled in the word: lack of professionalism on various levels:

Firstly, the GP is sloppy – she didn’t read the narrator´s file properly. That may have had serious consequences in matters of proper medical treatment etc.

Secondly, the GP is indiscreet – by her reaction she is exposing the narrator to all other patients in the waiting room. By creating awareness about the narrator, the GP exposes the narrator´s otherness as a disabled person.

Thirdly, the GP is close to discriminatory and exclusive behaviour – she seems unable to relate naturally and inclusive to patients with physical disabilities.

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

The cultural approach:

From an intercultural perspective, this incident seems quite subtle. On one hand, the temporary GP appears to be raised and integrated in a Danish tradition, be it in the existing professional healthcare culture as well as a wider culture of inclusiveness and respect for citizens with visible disabilities.

Thus, it remains puzzling, whether the GP´s reaction comes from cultural attitudes and feelings towards physical disability. It is well known that people in some cultures tend to “hide” relatives with disabilities to the world – actually in order to protect them. But it seems inexplicable that the GP with her Danish cultural background has similar cultural preferences.

The diversity approach:

However, there may be a reason to interpret the situation as an expression of the GP´s lack of understanding of – or insight into – a wide diversity concept. Thus, the GP´s disorientation in the situation may be a reflection of her personal and private embarrassment to people with physical disabilities. In the situation, the GP transmits her lack of personal experience to the professional contact with a patient with a walker and a visible physical disability, in this case the narrator.

Thus, the GP´s remarkable reaction may suggest that she – despite her profession – is unfamiliar with diversity in practice. She seems to have a preconception about people and patients with physical disabilities: you have to treat them in a special way, because they are, in fact, different. Perhaps you also have to talk to them in a special way, do they perceive things in the same way as normal people, do they suffer from declining mental faculties etc.

Such considerations may in a split second have gone through the GP´s head. She doesn’t want to act in a discriminatory way, but she may feel helpless, due to the lack of insight in a diversity discourse and, as part of this, a disability discourse. In summary, from the diversity perspective, the GP may react from lack of insight and thereby from a stereotyping, which may also be viewed as a specific variation of culturalisation.

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

A double shock

This incident represents, in fact a kind of double shock:

On the one hand, the shock is triggered by the lack of equal treatment and unpleasant exposure of the narrator´s disabilities and otherness. This seems all the stronger because disability is not at all relevant to the narrator´s consultation.

On the other hand, the shock is triggered by the lack of professionalism as well as the lack of professional empathy and perspective which makes the narrator uncomfortable, insecure and vulnerable as a patient. By her attitude, the GP brings the narrator out of her comfort and safety zone as a human being and as a patient. Probably, the GP´s reaction is an expression of her own insecurity and disorientation. However, this only reinforces the image of her lack of professionalism in the situation.

This would leave the narrator with the principle question: how can you trust a healthcare system where the professionals are unable to comply with basic professional principles and values in terms of professional medical attitudes and in terms of general human rights and equality requirements.

In summary:

It is obviously that no matter what may underly the GP´s behaviour, in the situation she doesn’t meet the professional requirements for medical practice in a diverse society, where the concept of diversity  is closely related to the concepts of equality and discrimination. Thus, the concept of diversity embraces a range of illegal discrimination areas, including disability.

The situation is also an illustrative example that we cannot limit our intercultural conceptual framework for intercultural misunderstandings to ethnicity. Culture in this context is a broader term that rather goes hand in hand with discrimination against people who are different from the so called normativity of the majority population.

Consequently, intercultural training must include and articulate the broad concept of diversity, referring to a wide range of exclusion mechanisms.