Any chance we could lose the cardigan jokes?
I wore a cardigan in work, a red one (speech & language therapist). I worked with people who wore green cardigans (occupational therapists) and navy cardigans (physiotherapists and nurses) and all kinds of cardigan-free clothing (doctors, medical social workers etc). There did not seem to be any correlation between whether people wore cardigans or not and the ability to critically review the science/be a decent clinician/assess whether treatment was effective/ listen to patients/treat patients with respect/think independently.
Male and female health professionals and non-professionals in a wide variety of clothing deliver ineffective care to people with ME/CFS every day. In the future, effective care will be delivered by male and female health professionals in a wide variety of clothing.
I am sorry if the cardigan references touch a nerve. It is all my fault, I admit.
However, although I may reduce references to cardigans here if that is what people prefer, I am probably not going to drop the reference altogether because I think it may be useful.
So I need to justify that and am happy to be shot down.
I worked in rheumatology alongside women in blue and green cardigans of the sort you mention. Our speech therapists wore mufti but I can imagine that red was their colour. The few men in the therapy professions did not wear cardigans.
Right from the start as a trainee I saw these cardigans as symbols of a male doctor-run hierarchy. Doctors could wear what they liked but were able to wear a macho white coat on top. I went on the wards without my white coat at Bart's as a registrar and a coat was immediately ordered by the consultant from sister. For a doctor not to wear his badge of authority was unthinkable. I would be only too happy to make white coat jokes. Over the years people came to realise that my original reason for not wearing the coat was right. It is better to wear fitting clothes you put in the laundry bin every night than a coat you might wear for a fortnight that sweeps past every infected object in a ward of cancer patients with no immune defences.
But in fact the cardigan joke does not refer to uniforms. It comes from a more subtle social pattern, I think. Clinical psychologists, like psychiatrists and GPs (interestingly) never wore uniform. The blue cardigan I envisaged was based on young clinical psychologists who we had in the department in the 1990s, who mostly lasted about six months. They wore mufti but always a slightly cuddly dressed down mufti (no suits) that indicated inferiority to doctors but a 'caring' role for patients. Their cardigans were fluffy and a bit more expensive and usually pale blue or maybe charcoal. Cardigans were worn at work then because a lot of hospitals had poor heating and you had to go outside to get to the ward or lunch. I doubt many people wear them now. But if you were a young doctor you wore a suit. If you were a skivvy nurse you wore starchy uniform. Everything was tuned to 'persona'. As I saw it the cardigan was a sign of a position in a hierarchy that was not top but not bottom and coded for a particular 'human' role.
I have been reading through the document 'The bastards do not want to get better' and I think this highlights what I am trying to get at. The nurses felt uncomfortable with the 'new persona' of being a therapist. As a doctor I have lifted patients, carried bedpans, put up drips, told people they are dying, written prescriptions and God knows what and it never struck me that I might need a 'new persona'. But it seems that to deliver CBT and GET you need to put on some strange mask that makes you a different person. I see the cardigan in medicine as part of that charade.
So my main point is that I am absolutely not suggesting that people who wear cardigans rather than white coats are dim or uncritical or rationalising or disingenuous. The villains of this piece come in all dress codes. And the heroes and heroines may have to wear the same. I am suggesting that the cardigan as symbol of role playing, of charade playing, is at the heart of the problem. The results of PACE are literally the results of this charade playing and the cardigan role seems to me to be pretty much what gets the results.
