Twitter has been flooded over the last week with pictures of female physicians in bikinis. This is a push back from a particularly misogynistic piece of “research” published in the Journal of Vascular Surgery* (“Prevalence of unprofessional social media content among young vascular surgeons”). This IRB-approved peer-reviewed study attempted to quantify the amount of “unprofessional” behaviour on Facebook, Twitter and Instagram exhibited by a group of recent vascular surgery fellows and residents. Three of the authors created fake social media accounts and looked at bikinis, posing with alcohol and sociopolitical posts (among other things) on social media as evidence of unprofessionalism. Unsurprisingly one Twitter commentator posted “I think the authors confused “professional” with “patriarchal”.

The massive backlash illustrated the way the word “professionalism” is often used as a loaded term to define a very narrow set of behaviours that have stemmed from the cultural norms of medicine. Norms which enforce the predominantly white, male, cis (you could keep going) status quo and norms that are subsequently enforced by other healthcare occupational groups. As Grey commented the professional is interpreted as “not just a man but, to a large extent, a white heterosexual middle-class man” (p. 584). These are the “neutral” workers – the rest of us are the exception, and thus need to be managed in the workplace with (e.g.) equity and diversity policies that include gender, race, sexual orientation etc. You won’t be surprised when I slip in a mention of institutional discrimination here.

The professional is one who “keeps his emotions in check and his personal matters out of the office” (p. 68). This likewise ties into “traditional” male values like control and rationality. But what constitutes a “personal matter”? The fact that we are parents? Have a mental illness? A physical disability? This is the same erasure that happens when Black radiographers are told their hair is unprofessional, LGBTQ nurses are told that their identities are unprofessional – it’s illegal to discriminate but acceptable to request that we downplay or hide our identities at work**. For that matter, what constitutes an office now when we’re doing Zoom calls in pyjamas and work-life balance seems like a distant joke?

There is growing awareness of the way that “professionalism” is often used punitively against those already disempowered within healthcare. The heart of the original definition of professionalism is working for the public good. Let’s hope #MedBikini inspires a closer look at what we mean when we use the word “professionalism” in the future.

* Which has since been retracted and the journal and authors have issued apologies

** For more on this see Yoshino’s research on “covering” at work

I love Canada. It’s my adopted home. I’ve happily lived and worked here for over 30 years and I have two Canadian kids. Today, though, I am struggling. I am thinking about my son P who is just turning 19.

When my ex-wife and I adopted P he was a lively 18 month-old. When he was six he received a diagnosis of Fetal Alcohol Syndrome (FAS) which was both a relief (it explained his extreme behaviour) and a bombshell. Our subsequent experiences as parent advocates and support-group attendees prepared us for a tough road ahead for him. P is not unique. FAS affects more than 300,000 Canadians (probably an under estimation as many go undiagnosed). It is a lifelong cognitive and functional disability due to maternal alcohol use. People with FAS have brain damage, which results in difficulties with language, communication, memory, attention and executive functioning. Many kids with FAS struggle at school because of secondary disabilities like behavioural issues and poor academic performance, they often get suspended and drop out early. When they get older alcohol and drug problems are common, as well as chronic unemployment, homelessness and trouble with the law.

P’s Métis heritage was described in his “birth history” binder but became a focus as he entered the foster system at 13. He rightly has access to support that includes specialised social work and developing cultural connections; he’s recently become interested in connecting to his birth family. He’s also inherited this devastating condition that disproportionately affects Indigenous communities. We don’t know what P’s birth mother dealt with, or her mother, but we do know that there are intergenerational effects that are linked to, or are a result of, the Canadian residential school system that removed and isolated Indigenous children from the influence of their homes, families, traditions and cultures. We also know that Indigenous women today experience numerous barriers and gaps in service that prevent them from accessing prenatal and addiction treatment services. This is the colonial legacy of Canada’s 153-year history, a fact that’s not dealt with in the red-and-white festivities that celebrate Canada’s birthday every July 1^st.

I am acutely aware that P’s story is his own and it is still being told. It’s not his only story, he is smart, loves to rap and has a wicked sense of humour. As his mother, with his other mother, we live with the knowledge that he is unsafe, open to abuse and often puts himself in risky situations. One social worker told me that “we can only try and keep him alive until he grows up a bit”. I also know I am privileged. We were given support (although not enough as FAS is chronically underfunded), and as White women we were listened to. We had money to pay for extra help and the ability to move across the country to access better schooling. Indigenous mothers in our support groups had terrible stories of abusive treatment from healthcare workers and other support people. They endured racism, blame and mistreatment from those who were paid to help.

I’d usually stick a flag on Twitter or Facebook to celebrate Canada Day. But today I’ll just think about P and the thousands of other Indigenous people with FAS and skip the celebrations.

Indulge me, I promise to get back to (semi) academic topics soon. I wrote this in the throes of wedding planning, researching an LGBTQ2S+ legislation timeline for a course I’m developing and in the middle of LGBT history month. All of these things have made me realize how life has changed over the last 30 years in a much more personal way…

 

I’m getting married next year. I’ve been married before. My ex and I had a commitment ceremony (way) before same-sex marriage became legal in Canada. We’d bought a house, and we were starting the process of making a gay family (which is a lot more complicated than the heterosexual way). It took me a few years of us being together to realize that, although we couldn’t get married, I did want some kind of ceremonial commitment, a way to mark our passage from urban gay-village dwellers to suburban, baby-planning mortgage-havers. Although we were out to our families, it was a strained “don’t ask, don’t tell” kind of out. None of our parents wanted to come, and my only sibling likewise wasn’t interested as it wasn’t a “real” wedding. I convinced myself that this was fine, we had our chosen family there and they were the ones that counted, but that was only half true. I missed the build-up, the planning, the normal rituals of heterosexual coupling. Our lesbian officiant helped us create a kind of half-Wiccan, half-culturally appropriated semi-Indigenous ceremony that seemed fine in the mid-90s but would be wildly inappropriate today. We had a friend drive over to Buffalo and fill up the car with wine. Other friends provided the music, did the flowers and brought home made pavlova.

It was a fabulous day, and very meaningful, I loved it. But I couldn’t shake the feeling while we were planning that it wasn’t the same, it wasn’t fair. I didn’t want the big white dress, but I would have liked the option to scoff at the patriarchal idea of my dad giving me away (and I would probably have done it anyway). I’d followed the “marriage is an anarchic, repressive, heteronormative institution that gays should shun” argument and I could see the point. I also felt (and feel) strongly that queer people often have to build their family with alternative forms of intimate relationships. This is a strength of my tribe! It reminds me of the advice in Hamlet about keeping good friends, how you should “grapple them to thy soul with hoops of steel”. When you’re up against a society that tells you that you are less than, friends that understand are worth grappling. I knew all that but wanted to get married anyway.

On June 20^th, 2005, Canada became the fourth country in the world to legalize same-sex marriage. My ex and I tied the (official) knot at City Hall that same year. We’d already done the commitment ceremony so we kept it simple. We went with two gay friends who also got married (there were lots of jokes from the clerks about making sure they married the right couples). I  bought a purple dress from Le Chateau, put up my hair and cried my way through the familiar words. I remember a rush of joy and amazement that we were participating in something so taken for granted by non-gay people, a process that is so fundamentally optimistic. An ancient observance full of love and hope. It was incredible. We went out for dinner afterwards, a new set of photos appeared on the mantlepiece and we had a new anniversary date to remember.

This time I am older. Society has changed, but I still don’t want the white dress. My beloved and I are wedding planning for next year in the UK and no one cares that we are two women. There are still dedicated websites for “gay friendly” locations, but most places stick a same-sex couple on their website just to flag that they are cool with it. The biggest beef I have is that everyone seems to get married in a barn these days. With hops on the rafters and fairy lights. And when did I miss the memo that I should have a minimum of 100 “evening” friends? Who wants to schlep all over Kent to drink in a barn on a Saturday night with a mini cone of fish and chips (standard “evening” wedding fare)? But despite the vagaries (and expenses) of the wedding industry, the process feels…normal. And wonderful. Most importantly, our families are excited and involved. Finally. I don’t feel like I am apologizing, minimizing, rationalizing why it should be less than, different from or not as good as any other marriage. It’s just the same. Almost thirty years after the first time, it’s just the same. It’s marriage, not gay marriage. And that’s a lot to celebrate.

Photo by Annette Dawm from Pexels