“There are some unusual spots on my feet that I want to have examined,” says the fifty-something woman with a friendly smile.
She is wearing an al amira, a two-piece veil consisting of a close-fitting cap and an accompanying tube-like scarf. The rest of her body is covered by her loose-fitting abaya, despite Philadelphia’s sweltering July heat. I have learned that these garments are traditionally worn by Muslim women as an expression of modesty when they’re in the presence of males not in their immediate family.
“Okay, do you mind if I take a look?” I ask hesitantly. I am a fourth-year medical student in the dermatology clinic, where women sometimes ask me to leave the room during examinations of sensitive areas. I suspect this traditional Muslim woman will make such a request.
“Not at all, take a look,” she exclaims, hiking up her abaya and pulling off her knee-high socks.
I gingerly place my hands on her skin, feeling its texture. I examine the spots, noting their waxy appearance, which suggests these lesions are not serious. I do not examine any other part of her body, as I feel uncomfortable asking her to remove her garments, even though I’d normally do so. In dermatology, looking all over the skin of all patients is considered good practice, to search for possible skin cancers.
A few minutes later, I tell my attending that I did a focused physical and found the spots were benign. We return to the exam room together, and the attending examines the spots and reassures the patient that she has nothing to worry about. None of the lesions on her feet are cause for concern.
She thanks us and departs.
Later that day, I’m sitting at my desk, reviewing my notes, reflecting on the day’s patients. I think about the Muslim woman, about how my assumed notion of what she would want got in the way of my examination. This patient is just like any other patient, no matter what she is or is not wearing, I think. Everyone deserves to choose their own treatment, but I didn’t even ask her if she wanted me to check her skin.
I determine to never let that happen again. I resolve that the next time a woman comes in wearing concealing garments, I will…I must…ask her if she’d be willing to get naked.
Or words to that effect…
D. Micah Milgraum