The year 2022 began on a rather hopeful note for Singaporean doctors.
Their trials and tribulations have finally surfaced in the national broadsheet. The Straits Times had highlighted the issues junior doctors face, publishing articles such as “It may be time to review junior doctors 30-hour shifts” and “My brain kind of stops functioning: Long working hours leaving young doctors exhausted” in February 2022. These articles came in the heels of smaller independent news companies such as The HomeGround Asia, which had highlighted the matter last year (2021).
While the public’s response was largely sympathetic, the medical circles were divided. Several doctors who had already left public service for the private sector even wrote to the Forum editor of the newspaper, expressing their views.
Some highlighted that members of the public were overzealous in insinuating that it was due to the medical community being “resistant to change”, while others continued to reinforce that “night duty (is) an invaluable part of house officers’ medical training” and hinted that such outcries on the plight that junior doctors faced were puzzling.
Dr Yik Keng Yeong, for one, said in his letter, dated 11 February, that this was a non-issue: “It may sound worse than it really is. During my time as a house officer, even under the duress of stamina-sapping work hours, I don’t remember any of us cracking under pressure.”
In some closed medical Facebook groups, the same sentiments were shared by senior doctors and healthcare administrators, highlighting that their past experiences were worse, and called junior doctors partaking in such discourses “shit-stirrers”.
More explicitly, senior doctors in administrative positions began calling out popular doctor meme pages such as @updatemeprn for being troublemakers who only represent a small minority of disgruntled voices. After all, what can be learned from meme pages when memes themselves have traditionally been the Internet’s medium to provide entertainment to digital natives.
Memes: When art mirrors life
For the uninitiated, the idea of memes was first introduced in 1976 by Richard Dawkin. It was intended to express the idea of an “ideological counterpart to genes: like how a gene (such as for brown eyes) spreads through sexual selection and physical fitness, a meme (such as the idea that the earth orbits the sun) spreads through social selection and ideological fitness” (McCulloh, 2019).
The reference to memes on the Internet evolved to represent multimodal texts that were imitated and then adapted. Each replication followed a template and could have multiple intertextual and indexical meanings.
Contrary to popular belief that creators and consumers of memes are illiterate and silly beings, Canadian linguist and author of the book, “Because Internet: Understanding how language is changing” Gretchen McCulloh highlights that meme creators and consumers needed some deep cultural understanding and technical know-how. More importantly, memes function to provide humour and is a means for creators to express their opinions and views on the Internet.
The meme created by the On-Call Doctor has garnered 525 likes, and 11.1k views. It takes a scene from the popular Korean show, “Squid Game”, and contextualises it to their experience as doctors in the Singaporean system. Its creator borrows a popular hashtag, “#HealthcareHero”, referencing the nation’s attempt to express gratitude for the many sacrifices that healthcare workers made during the pandemic, and even adds on a doodled stethoscope.
The first panel of the meme expresses their sentiments as doctors — the energy and hopefulness they feel arriving to serve, and the second panel exemplifies the utter feeling of hopelessness and defeat when they “see their list”. It doesn’t refer to the names of patients — it refers to the overwhelming number of patients under their care at the start of the day. It entails performing history-taking, doing all necessary checks and admissions before the consultant arrives.
Medical officer David Yung says, “It isn’t just about seeing all the patients on the list, but needing to be thorough and to know each of their stories inside out before the consultant arrives.”
Another example tapped on Singapore’s current affairs. The classic moments between People’s Action Party’s (PAP) Edwin Tong and Workers Party’s (WP) Pritam Singh sparring during the Committee of Privileges (COP) hearing turned into great material for meme creators, and the On-Call Doctor was no exception when it comes to making use of it.
The meme highlights the power asymmetry that junior doctors feel, which they believe is illustrated by the situation during COP. It also rides on the public’s sentiment that Minister for Culture, Community and Youth Edwin Tong’s “accusatory style of questioning and explicit attempts to frame a particular narrative”, was something that junior doctors similarly felt towards “Master M” (i.e. Ministry of Health Holdings). The meme reinforces the message that the “master” is out of touch with the ground.
Such memes, while entertaining, are also considered highly informative. They depict the doctor’s mental state, their inner emotional experiences, and struggles. More importantly, the number of likes and engagement with the posts are highly revealing as they can be good indicators of what resonates with other doctors and healthcare workers, and can paint a pretty good picture of the sentiments felt by most of the juniors.
Why are doctors running meme pages instead of going through official channels?
While administrators and senior doctors wonder why run a seemingly silly page instead of actually talking to people who can make changes, it is perhaps more helpful to examine the predominant beliefs about junior doctors today. If they truly believe that all junior doctors want to do their best and the patients are at the centre of all they do, then the assumption that junior doctors are “lazy”, “entitled” and “shit-stirrers” become mere labels.
In 2021, The HomeGround Asia conducted a survey with junior doctors and it revealed some of the reasons why official channels are not a popular platform for feedback. The article states, “All the doctors who submitted feedback indicate that the responses they received often fell into the following categories: accusations of personal inefficiency; manpower constraints; rerouting the doctors back to their own teams to settle it internally; and being told that it is “part and parcel” of the job.”
So if official channels were not working, why meme pages do then?
The birth and following of UMP
It was on New Year’s Eve in 2020 that @updatemeprn was created. The On-Call Doctor, more colloquially known as UMP, says that it was a day of mixed emotions: They were happy to get the day off – the first after a long time. They were also dreading work the next day because of the long list of patients and lack of manpower.
UMP says, “I was finishing up my [redacted] posting, and was feeling so crappy because I could not take any Annual Leave. I needed an outlet to channel that frustration and turn the depressing experiences into something more fun. It was supposed to be like my diary, and I didn’t expect it to gain so much traction.”
The choice of the name “updatemeprn” was an ironic twist and a subtle nod to the unrelenting number of phone calls medical officers had to take while serving patients. According to UMP, “Update me pro re nata (as needed in Latin) or as in the short form for doctors when handling patient referrals.” The Instagram handle, relies on fellow doctors’ ability to sense the irony — UMP really only wants to be called “only as needed”.
On using Taylor Swift’s signature look in her music video, Blank Space, UMP says, “I’m a big fan of Taylor Swift and the desperate look with the running mascara and the slight craziness in the eyes was exactly how I felt.” Apparently, UMP was not the only one who felt this affinity. “A lot of people messaged me to tell me that they also resonated with Swift’s look — the desperation, the exhaustion, the tears — that characterised our experience as junior doctors,” UMP says.
More so, UMP’s mission with the Instagram account was inspired by Swift’s Blank Space. Instead of dwelling on the negatives, UMP wanted to take all the criticisms and negative experiences and “turn them into something creative, fun, and quite uplifting”.
On how they managed to update the Instagram page so frequently, UMP says, “I have a bank of memes I created. I post and create during pockets of free time — while waiting for the consultant to arrive and in the twilight moments before I sleep. I use Instagram stories to create as it is really fast, and I guess I am not short of inspiration when I experience so much in the hospital.”
When meme page turned into advocacy
Interestingly, UMP’s page gained so much traction – the current number of followers stands at 7,521 followers – that it has become a fertile ground to organise efforts to help the community of junior doctors.
UMP has also become a pseudo-rights activist, educating fellow officers on call pays, notices on phishing emails, and even organising a helpful Excel sheet every six months to facilitate swapping of medical postings for all medical officers.
On top of these efforts, UMP has become a place for organic community building. UMP even takes on the role of part-time counsellor for fellow healthcare workers who readily share their negative experiences. It even offers advice to aspiring medical students. And a key part of why such community building works is due to the Internet’s unique offering: anonymity.
UMP says, “I think that it can be hard to tell others about your experiences when they know you.”
While anonymity can be a double-edged sword, it provides more benefits in the medical context. Some may question the credibility of the experiences and information shared on anonymous accounts but in the professional circles where the jargon and quirks of the job are so unique and require a reader to have gone through the same training and experience to understand it, credibility is hardly an issue.
As the unspoken rule of such anonymous meme accounts is often that of a two-way respect for anonymity, it has created a safe space for other doctors to share their experiences. UMP says, “some would also ask me to organise polls or to share their own experiences in my Instagram stories, and in response, many would respond in kind, sharing their experiences and helping others feel less alone in their experiences”.
Dr. Kuhanesh Jarnardanan, one of UMP’s followers, says. “I’m not a fan of memes in general but I do applaud the boldness to advocate for the difficulties junior doctors face on the ground. It highlights the collective need for more open and transparent discussion among all stakeholders.”
UMP is not the only popular meme page. In fact, the millennial healthcare workers have formed a community of healthcare-focused Instagram accounts ranging from @medgags, @thehonesthealthcareworker, @sgnightingales for nurses, @pyrexic_memes for other doctors and @memedsku for current medical students. Together, they work almost like a hive mind, gathering and informing others of unfair practices, and sharing stories to advocate for better support systems for all healthcare workers.
Things healthcare administrators learn from memes
Apart from getting some daily dose of laughter, these meme pages provide key data for administrators as an excellent roadmap to fix some of these issues, such as which are the low-lying fruits that can immediately help healthcare workers to feel more taken care of.
A quick run through meme pages shows one: anti-phishing emails. While it is key to training doctors to be more careful with data security, especially since they deal with sensitive information, perhaps the content of these anti-phishing emails could be revised.
Apparently what drove the scalpel deeper into the side was some of these anti-phishing emails contained promises of Starbucks Gift e-vouchers and vacation offers — what healthcare workers have been robbed of.
Next, it also provides qualitative data on how strategic communication can be planned with doctors. Dr Mythili Pandi, a family physician at The Integrative Medical Centre who follows UMP’s account and other doctor meme pages, says, “I like to feel what’s happening on the ground. These meme pages help me glean information about how stressful it is, and the general psychology of the doctors.”
“While much of their experience isn’t that different from my experience as a medical officer, there is not the added stress of Covid-19. However, it doesn’t mean that [the treatment of junior doctors] is right. Doctors need to be entitled to their rest. Only when they are properly rested can you expect to get good medical management,” she says.