This is not easy as it turns out. Part of the issue is distinguishing between lying and bullshit.
The key features of bullshit are that:
- Bullshitting is intentional – if you believe you’re being honest you’re not bullshitting, you’re either right or mistaken. The intent behind bullshit is to get away with something or to serve benefit in a particular situation. In the example above it was to make it look like I knew what was going on!
- Bullshit is unconnected with a concern for the truth. The bullshitter doesn’t care whether they are right or wrong (unlike the liar who is trying to convince an alternative truth), they are merely saying something. The only criteria for the content is that it achieves the purpose at hand. The bullshit is more about the person saying it than the content therefore. I didn’t believe that whether we’d been giving the drug or not was important; we could easily start it straight away after all.
- The bullshit is not necessarily false – the bullshitter might be right, but being right isn’t the intention rather it is to be believed.
- A subcategory of bullshit is ‘pretentious bullshit’. This is bullshit when the desired outcome is to impress by suggesting greater merit in the bullshitter than is warranted!
It’s probably also worth highlighting a related term – that of ‘bull tasks’. These are are those which are thought to be unconnected with the primary activity being engaged in (i.e. tasks which someone may feel are pointless and don’t contribute to the desired outcome). Every hospital has one or two of those!
Importantly if a task is perceived as bull, it doesn’t mean it is but maybe more effort should be put into getting across the true value.
What’s the harm of bullshit in critical care?
The main issue with bullshit is that it shows contempt for the truth, and the consequence of false bullshit is the same as lying.
We occasionally see this when patients are presented or referred. If a fact isn’t known, a vague ‘non-answer’ is given simply to make the question go away. The history then becomes less reliable, accurate and complete with all the consequences that come with that.
From the educational standpoint it also reduces learning. If for every question there’s someone willing to bullshit an answer, what’s to make you go and find out the truth? And if you’re passing on that bullshit then you’re honest but mistaken, but still perpetuating potentially false information.
Culturally it’s also not where we want to be. Do we really want to be in a speciality where it’s more important to say something other than “I don’t know”?
Why do we bullshit?
Critical care is a far reaching and fast moving specialty. There’s that statistic about having to read a journal every 3 seconds to keep up to date, yet we often expect ourselves to know more than we can (whether we expect it of other people too is interesting). When we don’t know something we have 3 options – say nothing (which is just rude), say “I don’t know” which isn’t good for our ego, or bullshit. With the amount of unknowns we are faced with on a daily basis, maybe some bullshit is inevitable.
Is there something about critical care or the people who work within it that makes them less likely to say ‘I don’t know’ or to use pretentious bullshit? As educators do we give the impression that we’d prefer to be ‘bullshitted’ than to not get an answer? As trainees is bullshitting seen as a useful coping strategy, and is the ability to master bullshitting ever seen as a positive attribute?
Recently Michael Gove declared that Britain had had enough of experts, and Frankfurter himself highlights that in today’s society everyone is expected to have an opinion on everything. Research is now subject to public peer review by the FOAM as well as the research communities (putting aside ongoing debates about the rigour of journal peer review). Social media FOAM is a popularity reliant medium, so there’s a risk that to maintain ‘market share’ a degree of bullshit might creep in (yes I can see the irony).
A tweet or blog can also under-represent the amount of work or thought that has gone into it or the credibility of the source (not always though). The danger is that social media may increase the feeling that ‘everyone else knows far more than me’, leading to more bullshit as a coping strategy to keep up.
Finally, some conferences are now using entertaining speakers as their USP, but how do these speakers remain entertaining? There’s only so much ‘talking like TED’ that will get you through, so there’s a potential to creep into big, bold statements that may or may not be entirely true. They will be attention catching and entertaining, but they might also be bullshit.*
So over to you…..
- Do you think bullshit can sometimes be useful?
- Is a consultant is simply a registrar who is more credible when they bullshit?
- Can you spot the planted bit of bullshit in this article?
- Would a world without bullshit be a less interesting one?
I look forward to reading your comments; next month we’ll return to something more academic!
*Before people get upset, I’m not saying FOAM and conferences are rife with bullshit but simply pointing out that it’s a ‘high risk’ area and we should keep an eye out.