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An Editor’s Invitation: Making Assumptions

As a physician, I make assumptions all the time.
When a child or teenager presents to me with chest pain, I assume that the pain is not being caused by heart disease–the thing that they or their parent are most worried about.
Yes, I do my due diligence to confirm that assumption. But that snap judgment occurs as quickly as the words “chest pain” are out of a youngster’s mouth.

We all make assumptions, and sometimes they’re helpful. In this instance, my assumption helps me focus attention on other causes of chest pain–muscle strain, joint creakiness, gastritis, stress–that are more likely to apply.
The assumptions we’re not aware of are more troubling.
I was once leading an inpatient team caring for a young African American man recovering from a sickle-cell crisis–steadily improving on appropriate pain medications. I stopped by his bed one day, found him looking at a screen, and we took to chatting.
It turned out he was a dancer. Not only that, but he’d appeared in a music video with a famous recording artist. He pulled it up and, sure enough, there he was, dressed to the nines, making impressive moves.
I was astonished and delighted–and not a little pleased with myself. I made a point of sharing my discovery with the team, none of whom knew anything about our patient’s artistic accomplishments. I hoped that the residents would take note of what they’d missed.
But then I realized, with some shame, what this discovery had revealed about me. Part of the reason I was so startled and excited by the dance video was that I’d previously assumed that this sickle-cell patient didn’t have a life. In my mind, he was a two-dimensional figure defined by his illness. The dance video made him three-dimensional and gave him more legitimacy.
Why did it require a dance video to make a patient with sickle-cell disease worthy? What, exactly, did this episode say about my own assumptions and prejudices?
It was a rueful reminder that my own humanistic impulses are not without their limitations.
And what assumptions, I wonder, do patients and colleagues make about me? Do they see beyond my stethoscope, my gender, my skin color?
This month’s More Voices theme is Making Assumptions.

What assumptions have you made about others–or have others made about you–in the course of receiving or providing health care? What impact did those assumptions have on you, or upon the care you received or delivered?

Paul Gross
New Rochelle, NY


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