Much a tattoo about nothing – a doctor’s perspective

ben's tatto

Someone I know and love has recently had another tattoo etched (or is it drawn?) over their left shoulder, the most recent of at least 16 tattoos that I know about, about their person. Perhaps, it is a symptom of growing older but there seems to be more and more people in more walks of life with tattoos. I have a number of unanswered questions about tattoos:

  • Why exactly do people get tattoos?
  • Just how many people get tattoos these days?
  • Do just young people get tattoos?
  • Are there associations with tattoos that we make as doctors?
  • Are these associations in fact a form of prejudice against those who choose to decorate their body permanently with ink figures, symbols and pictures?

Although the cultural significance to young people in the UK today of tattoos may be a subject for sociologists to ponder I find it interesting to consider the relationship of the tattoo with medicine. The prevalence of tattoos is perhaps something for our public health colleagues to consider but I do wonder if my perception of it is accurate?

In order to try to answer my questions I carried out a brief search of the NCBI database [1] for articles including the words “prevalence” and “tattoo”, or “perception” and “tattoo” or with the MESH term “Tattooing/psychology”  as applied to humans and in the English language. This non-exhaustive, but handy search revealed approximately 50 publications since I graduated as a doctor 7 years ago and began taking notice of tattoos.

Of these only 3 were carried out in the UK. One was a touching anecdote about a patient who tattooed the name of his rare medical condition onto his body [2], another was about the effect of tattoos on body image and self-perception of the recipient [3]. The same author had carried out research which closest answers one of my questions 4 years earlier when a study of 160 undergraduates resulted in the provocatively titled article “Unattractive, promiscuous and heavy drinkers: perceptions of women with tattoos” [4].

Since I have graduated it seems that tattoos are no longer confined to rock stars, sailors, soldiers and drug addicts. Even watching football highlights over the last few years has made me realise that more and more people younger than me are getting tattoos, and more elaborate and extensive tattoos at that.

It seems a shame that the only recent piece of research in the UK draws on the opinion of university students and comes up with such a negative connotation of tattoos [3]. I wonder if this feeling pervades amongst the medical profession? Do we use phrases such as “tramp stamp” – a derogatory term for a tattoo in the lumbar region that seems popular, especially amongst women? Do we associate tattoos, perhaps wrongly with increased risks of blood borne viruses, where the majority of the research seems to focus?

If one is to rely on the evidence base about tattoos, you could be led to believe that doctors perception of those with tattoos are those with risky behaviour, certain occupations, with hepatitis B/C or some other weird and rare disease contracted from Chinese ink [5]. Our older patients fall into the categories of criminal or regretful.

My search didn’t really answer my questions, but made me examine myself. It made me examine what I thought of people with tattoos, questioning whether my observations of ink-stained flesh slip into judgements and whether there is anything I could do to change this, if that were the case. I also realised that there is a massive gap in knowledge about tattoos. If tattoos are a risk factor for both physical and psychological illness, then perhaps we should at least have a handle on who is getting tattoos, where they’re getting them, why they are getting them and how it affects us as doctors when we see and treat them.

bens tattoo2


  1. Pubmed. [accessed 8 June 2012]
  2. Whittaker RG, Turnbull DM, 2009. A diagnostic tattoo. Clin Genet. 75(1):37-8.
  3. Swami V, 2011. Marked for life? A prospective study of tattoos on appearance anxiety and dissatisfaction, perceptions of uniqueness, and self-esteem. Body Image. 8(3):237-44.
  4. Swami V and Fyrnham A, 2007. Unattractive, promiscuous and heavy drinkers: perceptions of women with tattoos. Body Image 4(4):343-52.
  5. Hamsch C, Hartschuh W, Enk A, Flux K, 2011. A Chinese tattoo paint as a vector of atypical mycobacteria outbreak in 7 patients in Germany. Acta Derm Vernereol. 91(1):63-64.

More on encouragement

What is the point, you could ask, of doing anything positive, or altruistic? Is there any point in doing something out of the ordinary and free of charge if there is no reward of any sort. As creatures we are wired up for reward, for dopamine-mediated impulses that feed a desire for pleasure and satisfaction. Is that what drives talented people, and doctors in particular to write, unsolicited and financially unrewarded, for medical journals, blogs and in social media?

Do we crave the reward of retweets, likes, favourites, replies, comments, views and re-blogs? Do we need these, things or do we convince ourselves that we are performing a cathartic act that is of no consequence to anyone but ourselves?

For example, what’s the point in getting five publications in an international journal which is delivered to 45,000 clinicians, for the encouragement and appreciation of just 3 emails/responses. That’s potentially 200,000 readings for just 3 people to think it is worth typing a thank you. My, for it is I, dissatisfaction with this could be due to a number of things:

  • I am too needy and too expectant of praise

  • Doctors don’t actually read this journal

  • The vast (understatement) majority of doctors don’t like what I write

  • There is not a culture of encouragement amongst doctors

To some degree I expect that all of the above are correct. I’m going to be honest. I need feedback, I need encouragement, I need to know that I am heard, I need to be appreciated. I am a rather needy person. Amateur (and professional) psychologists would have a field day. When I write, I am saying, “Come look at this thing that I have made with my brain and hands, I cradled it for a while and now I have brushed off the dust and blown away the rough edges and fashioned it into something understandable and appreciable. So go ahead and appreciate. Look what I have done for you…” Perhaps that’s why I give sneak previews of my new articles to people I know will like them. Perhaps I need therapy.

In this time-pressured world it is possible that medical journals stay in their wrappers, from cradle to grave, or find a new home in a magazine rack or coffee table before making their way to the recycling before being opened. Nothing much I can do about that I guess.

If people don’t like what is accepted by the journal then perhaps the editors need to change their policy on accepting pieces. Or perhaps I just need to write better to appeal to more doctors, or more inflammatory to provoke a response, any response to just to be sure that I exist in the world of words.

What I am hoping is that my lack of encouragement is merely a symptom of a society that is worried of appearing too much like our American cousins. I’m hoping that there is a realisation that in order for doctors to carry on doing good things, and I’m not just talking about poems and publications, but looking after their patients in the face of adversity, blame, financial pressure and unrealistic expectation, that we need to be encouraged by one another. We need to be told that we are doing something good and that we are appreciated.

Realising that I needed encouragement made me reflect on how much I failed to encourage the colleagues and community around me. So, for the last few weeks I have tried to make sure that I give feedback to doctors who are publishing stunning blogs and articles in medical journals, giving credit where credit is due. I’m hoping to be the change the culture, one small email or tweet at a time. Feel free to join in.