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Much tattoo about nothing

The rise of modern phenomena can be mysterious, and unlike the popularity of cider with ice, the popularity of tattoos cannot be explained by clever marketing. Someone I know well 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. 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. At the surgery and walking down the street it seems that tattoos are no longer the confine of rock stars, sailors, ex-prisoners, soldiers and drug addicts. 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?

I wonder if my perception that there are more and more and more people in more walks of life with tattoos is simply a symptom of growing older. It is my understanding that little research on the psychology and perception of people with tattoos has been published since I graduated as a doctor and began noticing the tattoos of patients. Although the cultural significance in the UK today of tattoos may be a subject for sociologists to investigate I find it interesting to consider the perception of people with tattoos with general practice.

Do the tattoos of patients generate negative, if subconscious, associations amongst the medical profession? Do we as doctors use phrases, in private, 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, an area 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 patients with tattoos are those with risky behaviour, certain occupations, with hepatitis B or C or some weird and rare disease contracted from infected ink. Our older patients tend to fall into the categories of criminal or regretful.

Pondering tattoos has made me consider what I think of people with them, questioning whether my observations of ink-stained flesh subtly slip into judgements and whether there is anything I could or should do to change this, if that were the case. I have also realised that there is a massive gap in our collective knowledge about tattoos. If tattoos are indeed 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.

Dr Samir Dawlatly is secretary of the RCGP’s adolescent health group and a GP in Birmingham.