Blog by Luna Dolezal and Arthur Rose
On Saturday the 7th of March, Australia’s state of Victoria’s health minister Jenny Mikakos declared that she was “flabbergasted” that a Melbourne GP had continued to see patients while he had “flu-like symptoms”. The doctor in question, Dr Chris Higgins, had returned from a trip to the US with a runny nose. He treated 70 patients before testing himself for Covid-19 “for the sake of completeness,” as he noted in a Facebook post. After he tested positive, he ceased working and notified all his patients. Nevertheless, in Mikakos’s view his decision to go to work with any symptoms was negligent and should perhaps be referred to the Australian Health Practitioner Regulation Agency. However, Higgins did not meet the criteria for testing when he returned to Australia, and his symptoms had been very mild. As he noted in his message to Mikakos, defending his behaviour: “I hesitated to do a swab because I did not fulfil your criteria for testing but did one anyway on Thursday evening … not imagining for one moment it would turn out to be positive.” While Mikakos did not name Dr Higgins directly, she named his clinic and gave enough identifying information that it took no time for the media to discover his identity, thereby breaching his patient confidentiality. The immediate reputation damage from the media attention that followed, compromised his practice and livelihood.
Jenny Mikakos’s attempts to publicly name and shame Dr Chris Higgins is by no means an isolated phenomenon. In fact, the story parallels a similar case in the UK in September 2019, when Jacob Rees-Mogg, Leader of the House of Commons, attempted to shame Dr David Nicholls, a critic of the UK government’s no deal Brexit policy, through a comparison with the anti-vaxxer Andrew Wakefield. As in the Mikakos-Higgins case, Rees-Mogg’s attempt to shame Nicholls backfired, as doctors rallied behind Nicholls. Both cases teach us a valuable lesson that is not unique to the Covid-19 situation. As frontline representatives of healthcare, doctors are particularly vulnerable to shame and shaming. Issues which directly affect a doctor’s ability to deliver healthcare effectively, including long working hours, staff shortages, bed shortages, waiting lists and limited treatment options, can be perceived as shortcomings in the individual’s performance, rather than part of wider systemic problems. In addition, our cultural expectations regarding doctors (fuelled by mainstream media representations of doctors and clinical encounters on TV programmes such Channel 4’s Embarrassing Bodies in the UK) are that doctors are infallible and superhuman; they must make flawless diagnosis and treatment decisions, leaving no room for doubt, error or imperfection. In addition, they must not be physically or emotionally vulnerable: they should not get sick, need to sleep on a shift, have mental health problems, or other personal needs while treating others. The overwhelming negative public response to cases where doctors have made mistakes, or are perceived to have made mistakes, suggests that this expectation of infallibility and invulnerability exacerbates feelings of violated trust. We are outraged when doctors fail us by being human.
The culture of shaming doctors, as toxic as it is within the workplace, becomes particularly noxious when it becomes unbounded by its dissemination through various media. Mikakos’s comments provoked users to shame Dr Higgins with comments such as: “Personally I’m ‘flabbergasted’ at Dr Chris Higgins arrogance. HE should be the one that needs to apologise! Seeing 70 clinic patients and then visiting a Nursing home, shame on him”. But it was Mikakos who was principally subjected to online shaming from the Australian medical community. Numerous posts were made on social media by prominent Australian medics defending Higgins and in turn shaming Mikakos for undermining confidence in the Australia’s doctors. More than 11,000 people signed a petition calling for Mikakos to officially apologize, while #IStandWithChrisHiggins and #Flabbergaslighting trended on social media.
Online shaming is pernicious. Not only can it lead to irreparable reputation damage, it also frequently has deleterious effects on one’s mental health and self-perception. As the philosopher Bonnie Mann has noted, the ‘scene of shame’ has changed dramatically in online arenas. Online shame is unbounded by geography or temporality, dislodged from any particular social community. As such, online shaming has the capacity to follow an individual everywhere and indefinitely. When Mikokos was pressured to apologise to Higgins, after being subjected to her own public shaming for her “disappointing” comments, many observers approved of this “good” use of shame. Shame, in this sense, became a useful tool for speaking truth to power. However, it is worth noting that we could not predict how the shaming of either Higgins or of Mikakos might have played out. The problem with shaming, whether in medicine or in politics, is that its effects are unpredictable. Shaming can sometimes lead to prosocial behaviour and positive change, but it is more often associated with negative consequences, such as defensiveness, aggression, depression and anxiety and, in extreme cases, even lead to suicide. This incident highlights the culture of “fear and shame” that circulates in healthcare for medical professionals (e.g., see the NHS Staff and Learners Mental Well Being Commission Report, Feb 2019), while also pointing to the broader shaming culture that has become commonplace in politics and the public sphere. Both are problematic.
The Mikakos-Higgins case, like that of Rees-Mogg and Nicholls before it, teaches us valuable lessons that hold for situations beyond the current crisis. If anything, the recent surge in support for healthcare professionals makes it increasingly unlikely that politicians will attempt such overt shaming for the near future. In this regard, the Mikakos-Higgins case, though less than a month old, already feels rather dated. At the same time, the rise of shaming terms like COVIDIOT (a person who selfishly hoards food or who ignores public health warnings) shows that the crisis is not defusing shaming practices or the shame they cause. Rather, it is transferring the shame usually reserved to healthcare professionals, or those subjects supposed to know better, to individuals within the general populace. As public expectations about each individual’s knowledge of Covid-19 begins to rise, we can only expect such shaming practices to increase, and to strike victims who do not necessarily have the epistemic or institutional armour to deal with it.
Luna Dolezal is a Senior Lecturer in Philosophy and Medical Humanities at the University of Exeter; Arthur Rose is a Vice Chancellor’s Fellow in English at the University of Bristol.