Docsplaining
I want to tell you about an experience I had, because it helped me understanding mansplaining a bit better. It’s an episode I call “docsplaining.”
To understand what happened, you need a little background. I am a partner with two other people in a nonprofit organization dedicated to wellness, nutrition, and a new approach to weight loss. While I hold the title of CEO, that just reflects a role I’ve taken to help the organization — I’m not actually in charge. The two other principals are the brains of the operation.
One of our two leaders is a man I’ll call Doc, a brilliant and charismatic M.D. who holds a prestigious teaching position in a major medical school. He’s a friendly and collaborative guy with a contagious enthusiasm and he gets impossible things to happen with persistence and smarts. He is not an arrogant person.
The other is a dietitian I’ll call K. She’s got an encyclopedic knowledge of nutrition and has developed a lot of the content of our program based her work with many patients struggling with obesity over the years. K deserves a huge amount of credit for our success so far. She asserts herself as needed but, like all non-M.D.s working in medical settings, has grown used to dealing with doctors assuming they’ll be in leading roles by default.
I’ve contributed to this organization with technical and data analysis skills and writing ability — and by having some time to do things that the organization needs that the others can’t get to. For example, I wrote the grant proposal that got us our first major funding, with a lot of collaboration and help from my partners. I’m in one other crucial role: since I’ve been through the program myself, I bring the participant’s perspective. I know something about how people struggling with weight think and feel.
In the episode I’ll describe there was also a fourth person in the room: a bright third-year medical student who’s been helping us out, a woman whom I’ll call S. Since this is a story about power, age, gender, and job roles, you should know that I’m in my 50s, Doc is in his 40s, K is in her 30s, and S is in her 20s.
Docsplaining
Here’s the scene: Doc, K, S, and I are in a conference room. We’re reviewing the comprehensive materials that K has assembled, documenting all of the content for 15 weeks of small-group sessions in our program. Her materials are designed to make it effective to train other medical professionals to lead similar groups. In addition to describing what she and Doc say when running the sessions, her materials include the questions they use to generate conversations among the patients. K also has the smart of idea of including participants’ frequently asked questions, which she has asked the rest of us to contribute to. Both she and Doc have suggested a few, but as the only one in the room that’s actually taken the program as a participant, I feel a particular responsibility to represent what I and other patients frequently ask.
In the session on food choices, I suggest we include this simple question: “Is fat bad?” I know this is how participants think. We’ve all been bombarded with talk about fat from the media, from our doctors, and from thousands of ads for low-fat products.
Doc immediately picks up on this. “You mean, ‘What’s all this I hear about saturated and unsaturated fats — what kinds of fats are bad?’ ” he says.
I cannot be certain that I have quoted him accurately, because at the moment he says this, all the blood rushes to my head and I become speechless.
Doc has now told me what question I, a participant, really meant to ask.
I look at K and S. They don’t say much, because I’m sure they experience something like this a dozen times a day.
I understand the impulse behind Doc’s comment. Doc has run hundreds of these groups. He has listened to hundreds of patients. And he knows that the question of fat and nutrition is complicated and deserves a fuller explanation.
But I am an actual participant. A doctor has just told me that the question I asked is actually not the question I should have asked. Doc knows more about nutrition than I do, but I know more the feelings of a person struggling with obesity than he does, because I am one. And “Is fat bad?” is exactly what’s on many of our minds.
For that moment, the equal partnership that the three of us have dissipates and he is a doctor and I am a patient and he is telling me how I am suppose to think. I feel undermined and powerless and I begin spluttering because I don’t know quite how to respond respectfully to this. I don’t splutter, normally, because I’m used to being in charge, but now I’ve been docsplained.
Because we all have pretty good communication after more than three years of working together — and because K is the master of combining everyone’s perspective — I know this will get resolved in the materials. And with all the conflicts and challenges we’ve dealt with, it’s not a big deal. But it did teach me something.
What I learned from this
From decades as an analyst and SVP at a research company, I became used to being in a position of authority. I’ve done my share of mansplaining.
But I think I learned something important from this interaction. The doctor-patient relationship is one where the doctor is the authority figure. In our little nonprofit, while my title is CEO, I certainly remain aware that the intellectual powerhouses are Doc and K. I’m also the only fat person and the only one who is not a medical professional.
I know Doc didn’t say what he said to shut me down or express authority. He’s used to explaining medical things to both patients and medical students, and his teaching instincts kicked in. It wasn’t hostile in the least, and I know he respects my contributions to the organization.
But at that moment, when a doctor was telling me what I, a patient, was really feeling, I felt undermined and small. It was as if my experience and knowledge didn’t matter.
It took me back emotionally to the moment at which I, a graduate student, made a wisecrack in a small graduate math class at MIT. The professor loomed up over us and said imperiously, “I make the jokes.” He was a Ph.D., not an M.D., but somehow docsplaining is still docsplaining. What happened back then actually made a difference in my decision not become a mathematician.
These things happened to me a few times. I know for women, they happen all the time. I’m trying to figure out how it would feel to have this emotion multiple times a day. I can’t. But at least now I know how it feels when it happens.
If a woman (or a patient) is talking, listen. Understand what they’re saying. Even if you have a better idea — even if you mean well — pause, and listen. It’s the least you can do.
If you really want the people to remain anonymous, you need to rewrite this.
The principals involved know this. They told me they’d prefer I didn’t use their names in the post, but that’s as far as it goes.
I don’t really get your point. The question he asks I believe is your exact question. It just reeds more attractively giving away that there are different sorts of fats to prepare the reader for the most universal answer to most questions: it depends.
Everybody knows certain fats in excess is bad, or not? Sorry for the hardtalk but given the forum I think acceptabele. So the interesring answer is in the nuance.
Signed: an overweight person that loves binging sessions on bad fats.
The point is not whether the question is better. The is telling a patient what they actually meant to say.
The interaction is consultative. The person with the knowledge is not there to judge the quality of the question. He or she is there to answer the question and then expand on the question to open up the discussion further.
Josh, your story is very good and meaningful, and I like the reference to docsplaining. I would extend your reference to “people-splaining” since I have observed this for across genders, in both directions.
As you identified, I believe it comes from a position of knowledge and power, and sometimes (I could even say often) a good natured attempt to express the complexity of the answer. Of course the simple answer may not be complete, but it does shift the power to person asking the question.
As a senior manager, I work with managers and employees. If you do write about the people-splaining behaviors, it would be a useful and informative tool to help people work through it as both givers and receivers.
I think this was a great piece. It is applicable across the board, I think, when working with people who are not of “your profession”. It is better to listen, answer the question, and THEN perhap go into more detail as required. Validate the question and then expand.
Thank you very much. Your insights into man- and docsplaining are right on and pervasive.
Lovely illustration. Your question was a “search term” question, a perfect blog post title. No one would ever google: “What’s all this I hear about saturated and unsaturated fats — what kinds of fats are bad?” Maybe they’d never get the information, then. Your “jargon detector” Spidey sense got all tingly.
I just finished listening to several hours of an interview between two professional men. I found myself irritated by the interviewer. He habitually interrupted his subject, even in the middle of a detailed story, to give his own summary in his own words, for no reason, as though the speaker had been speaking a foreign language. My example lacks the power differential in your story, but points out that perhaps it is often just a bad habit. Perhaps it’s love of one’s own voice, or a need to translate information into words the person owns — a way to store info into their own mind. Perhaps it’s a need for them to reassure themselves of their own validity.
Your story illustrates power differential in several types of relationships: male/female, MD/non-MD professional, MD/patient, older/younger. Think of discrimination against people of color, disability, agism, poverty, you name it… Also, how the US has traditionally approached aid to Africa, for example — by telling “the needy” what’s best for them, rather than asking what they need or what fits with their culture. Think of patriarchy and authoritarianism…
I call BS! But before I do, I uncover the lede.
What the doctor might want to say next time is something like this:
Great question! No, fat is not bad. In fact, one needs fat to live.
That was a great question that I often hear posed as “what about saturated and unsaturated fats — what kinds of fats are bad?” That’s harder to answer, especially when tied to a project like ours dealing with wellness, nutrition, and a new approach to weight loss. The real answer is Medical Professionals don’t fully know. We suspect that unsaturated fat may have benefits, while saturated fat may clog arteries and increase the risk of a heart attack or stroke. So, we tend to skew towards eating more unsaturated fat than saturated fat. But how it will impact your health is hard to know, it’s a complex mix of diet and how your body reacts to diet.
Note, I did not tell the doctor what he meant to say or what he should have said, but (in a subtle, but real distinction) what might be more useful. And I did not slam the doctor (nor the lay patient) and I did not use a horrible piece of jargon like -splaining. So, I gave a constructive reply from which we can learn and I respected the rights of the doctor and patient to say what they want.
I will, however, insist that we never use loaded jargon like -splaining. Or I will call BS again.
Hmm. Docsplaining (or mansplaining) means trivializing the patient’s expertise and no paying attention to the patient’s context.
In this case, you ignored the context, which is that I was not posing a question to the doctor, I was telling the doctor what question a patient would be thinking of in his group sessions. As the patient, I’m the expert on that, not the doctor. The answer about fats doesn’t matter to this example — it’s the question we’re talking about here. But you chose to focus on the doctor’s answer and show off your knowledge of how fats work.
“Splaining” isn’t jargon, it’s slang. I used it to make a point, not to imply a more sophisticated knowledge of a subject — which is the usual problem with jargon. Sorry you missed that point.
But please do come back and comment again, analyzing your answers is quite instructive.
Yeah, I flipped-flopped between jargon and slang, settled on slang, and then used jargon when I wrote the comment. So, the -splaining is slang and as such has no place in BS-free writing. I will be firm on that. The exception will be to explain the slang and why it should not be used. (Jargon can be used in the right context; maybe that is the real difference between the two.)
I did not miss the context at all. I believe that you are representative of patients who would pose the great question about fats (and broader basic questions). I also believe the doctor intended no harm (although harm was had), when he processed the basic question and took it a step further to the next logical level (in his learned mind).
My response included the fats discussion because that was the question you posed and the reply you ignored when you set out the discussion. The focus of my reply is on how the interaction could have gone better for all involved. I gave the specifics, rather than complain about the problem and offer no solution. Now, I allow readers to take the specifics and generalize it. That is the instructive part. Not the fats discussion nor the lack of a solution for when someone leaps ahead and appears to trivialize your input.
I so much want to use the slang “butthurt” for your reaction, but that would be just BS.
“The slang and why it should not be used” ? “Harm was had” ? Passive voice much, Norman?
Slang is fine depending on context. Bullshit, in my formulation, is writing that fails to communicate clearly and accurately and wastes the readers time. Slang doesn’t fit.
Admittedly we use the word bullshit differently. But having written a book and 700 blog posts about it, I think my audience has adopted my definition, at least when their visiting my little corner of the web.
Have a happy Halloween.
I think this is beautiful! And I love your response to the BS-caller comment. Generally, I don’t like comment wars, but I love how you actually provided MORE knowledge and understanding with your reply. Awesomeness.
As an autistic person with a PhD and a vagina, I spend a lot of time thinking about effective communication. I didn’t understand your reaction to the Doc’s comment at first because paraphrasing is one of my primary tools of communication. Hearing their words in my voice or vice versa is how I make sure we’re on the same page and I thought that’s what he was doing.
But I also struggle with SO many people (usually men, gotta admit) trying to tell me that what I said isn’t what I *meant*. When that happens, my blood boils because who but I knows what the F I meant to say?!? So, yeah, when you clarified in the comment that resonated.
Finally, I love that you’re using docsplaining to understand mansplaining! That touches my heart that you would try to reach into my world to understand my life when you didn’t have to.