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HUNTING PINK ELEPHANTS

By Blair Smith
Contact the author via Chris Johnstone by e-mail at christopher.johnstone@ntlworld.com

Broadcasters Bill McFarlan and Alan Douglas run a media training company, "The Broadcasting Business", one of whose courses I recently attended. I came away from this day with two novel concepts firmly implanted in my mind:

1. Stick a camera and/or microphone in front of me and I metamorphose into a gelatinous, inarticulate ignoramus; and

2. Pink elephants.

Now, while the former needs no further explanation, and possibly comes as no surprise to those who know me, the latter is worth exploring. The idea is that, if I tell you not to think about Pink Elephants, these mythological pachyderms are suddenly the only things trumpeting in your consciousness. In communication terms, a Pink Elephant is therefore an unnecessary negative - one which makes your listeners think exactly the opposite, or at least which conveys a very different meaning to that which you intended, by painting a picture that did not previously exist.1 They tend to let listeners know what you actually mean but are trying to hide. So, when Richard Nixon famously told reporters, "There can be no whitewash at the Whitehouse", this raised the first suspicion that his system might be somewhat less than transparent, and stimulated the very investigation that led to his downfall.

Since being introduced to the Pink Elephant, I have noticed several members of the species marching boldly across the airways. For example:

1. Tony Blair was "not just postponing the House of Commons vote on electoral reform because of dissent among labour MPs and the possibility of a further, damaging defeat".

2. David Murray (Chairman of Rangers): "I have no plans to sack Alex McLeish [the manager], and have definitely not been discussing who might succeed him."

3. David Davies, currently Conservative Party leadership candidate: "If you want a boring, low-risk, politically correct leader who's afraid of a challenge, then don't vote for me."

4. My personal favourite - Annabel Goldie, on the day she took over leadership of the Scottish Conservative Party: "The Party is not just a rickety old cart, and I'm not just the nag who's turned up to lead it." What an image this Pink Elephant confers, perhaps the very one that expresses our thoughts precisely.

These four Pink Elephants seem to be harbingers of a fate that will, in some cases, have been sealed by the time you read this. Of course, they were caught in the traps set by the interviewing journalists, who consider them fair game. Pink Elephant hunting is a favoured sport among the profession. I have, though, also begun to observe Pink Elephants in the surgery, and find that they are indigenous in this habitat. Some of them accompany our patients:

"Doctor, I hope you don't think I'm wasting your time.…"

"I'm not saying you're wrong, Doctor, but Dr. X said…."

"I never come to the doctor."

Other Pink Elephants spring from ourselves:

"Whatever you do, don't scratch it!"

"It's a viral infection and you don't need antibiotics."

"I don't think it's cancer but I'm referring you to the breast clinic."

In the case notes of the back pain patient:

"No neurological deficit detected" [ie neuro exam not actually done].

In most case notes:

"did not attend (DNA)" [why not "defaulted", or "wasted everyone's time (WET)"].

Whole herds of Pink Elephants populate administrative aspects of the NHS:

"The QoF is not just about bureaucracy and statistics…"

"You won't have to wait too long for your appointment with the neurologist."

"Serving on this committee will not take too much of your spare time."

"I won't keep you too long at this meeting."

"This is a not-for-profit organization."

Sometimes they come in pairs, or even threes: "He has not DNAd for over a year, and should not be denied a follow-up appointment". Sometimes they tempt fate: "I've not thought about Mrs Heartsink for a month". Sometimes they are blatantly inappropriate: "Hard work and long hours never did me any harm". Sometimes they are cruel but kind: "Peter Murchie is not the ugliest doctor in Aberdeen".

All of which animal magic is very well, and we can modify our communication skills by its observation. Messrs McFarlan and Douglas presented the Pink Elephant as a pest to be culled from our conversation and writing, and generally this is true. However, I contend that they are occasionally welcome visitors, if not essential. If, after examination, I say to my worried patient, "The cause of your headache is not serious," this is not because I've deliberately harnessed a Pink Elephant, sowing the seeds of cancer phobia (though this sentence is itself a perfect example of the species). Rather, it is because I have judged that the possibility of serious pathology is at the front of my patient's mind, top of his list of concerns. Therefore he is more interested and keen to hear me tell him what his illness is not, than what it is, or may be. Similarly, when I write in the case notes of the child in whom I have just diagnosed a simple URTI, "No neck stiffness, no rash," my intention is to tell future hypothetical reviewers of the notes that I specifically sought and excluded these signs of serious illness.

The former of these two examples shows how Pink Elephants can assist patient care, while the latter shows how they can help to defend medical practitioners. So, while we often do need to hunt down and eliminate Pink Elephants from our environment, it is worthwhile keeping and taming a few, for judicious and well-judged professional appearances.

Have nothing but a good time this Christmas, don't over-indulge, and don't think about work!

Reference

McFarlan B. Drop the Pink Elephant. Chichester: Capstone, 2003.

Other hoolet online articles by Blair Smith can be found at:
hoolet edition 49 - Ethics and Repression in the Bloo Toon
hoolet edition 48 - May The Best Team Win
hoolet edition 47 - Hunting Pink Elephants
hoolet edition 46 - Predictive Texting
hoolet edition 45 - Role Models
hoolet edition 44 - Time To Go Killorglin'
hoolet edition 43 - Salt and Shake
hoolet edition 42 - Stepping up the Pace of Life
hoolet edition 41 - Smoking out the Irish Question
hoolet edition 40 - Not Cricket
hoolet edition 39 - Anniversaries and Predictions
hoolet edition 38 - Is There Life on Mars?
hoolet edition 36 - Onwards and Upwards
hoolet edition 35 - Goal of the Season‘s Greetings
hoolet edition 34 - Chickens and Eggs
hoolet edition 33 - On Shifting Goalposts
hoolet edition 32 - Period Zero
hoolet edition 30 - Annual Appraisal
hoolet edition 29 - Working Towards Scotland's Healthier Children For Us All 2020 and A Framework for Maternity Services in Scotland
hoolet edition 28 - In Memoriam Admiral Byng. A cautionary Tale

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.