Eye-Opener

Daniel Lee ~

1. Bipolar disorder
2. History of postpartum psychosis
3. No custody of her children
4. In treatment for cocaine abuse
5. Regular smoker

I digest each of these facts on the computer screen in rapid succession, progressively cementing the picture of Renee Pryce, a twenty-eight-year-old woman in her final months of pregnancy.

I’m a first-year resident in a large urban county hospital. In the course of my training, I’ve learned that some people (mostly older doctors) find the electronic medical record (EMR) burdensome and inefficient.

As a millennial, I’ve found the EMR very helpful. It’s fast and comprehensive: I can absorb a full medical history in two minutes and develop a picture of a patient before ever setting eyes on him or her.

With this patient, I need only the five facts above to know that she’ll be, to put it euphemistically, difficult. Her photo in the corner of her chart–an unkempt woman with a half-angry expression–tops it off.

In my six months here, I’ve seen hundreds of patients with similar problem lists. They blend together into a composite person in my mind’s eye. I begin to imagine our interview.

I’ll enter the room and pleasantly say, “Hello, Ms. Pryce, I’m Dr. Lee.” She’ll shoot me an annoyed look.

Ignoring that, I’ll ask, “What’s brought you to the hospital today?”

She’ll pause, look at her phone, then offer a vague two- or three-word explanation.

Two girlfriends who’ve come with her will start talking: “I know what she has–something’s wrong with her liver, probably stones or something. My sister’s friend had that same thing when she was pregnant. They had to do surgery to get them out. She needs to have those stones out, I’m telling you–”

“You’re crazy,” girlfriend number two interrupts. “She doesn’t have stones, she’s got morning sickness. She needs some strong pain medicine. That fixed me up when I was pregnant.”

“Well, first let me get more of the story from Ms. Pryce,” I’ll answer, my patience already wearing thin.

She’ll give me a few more specifics, then get irritated–“You’re the doctor, why don’t you figure it out?”–before returning to pressing her long, manicured fingers into her smartphone.

I’ll start to examine her, palpating her abdomen, feeling her legs for swelling and listening to her heart and lungs while asking more questions. The whole time, she’ll be staring at her phone.

She’ll smell like weed. “Yeah, I’m still smoking cigarettes,” she’ll say–but she’s not drinking alcohol: “That’s bad for the baby.” She’ll say that she got kicked out of treatment for relapsing on cocaine.

She won’t want to see a psychiatrist or take any medications for her bipolar disorder: “What makes you think I need a shrink? And who told you I have bipolar, anyways?”

Still staring at her phone, she’ll say, “It hurts a lot everywhere you’re touching.”

I’ll make one more attempt to find out what’s wrong: “What’s your main concern today?”

“I’m in pain,” she’ll answer. “I need something strong for it.” She’ll refuse my suggestion of Tylenol: “I’m allergic.” Same with trying an abdominal binder: “I tried it in my last pregnancy, and it doesn’t do anything.”

“Why don’t we order a few simple tests and see where that takes us?” I’ll suggest.

There will be no response. I’ll leave quickly.

Returning to the present, I trudge reluctantly towards Ms. Pryce’s room. I’ve already suffered through the encounter in my head; now I’m being punished twice. I take a deep breath, grab some cleaning foam, put a smile on my face, knock twice and step around the curtain into the room.

“Hi, Renee, I’m Dr. Lee, one of the resident doctors taking care of you. Nice to meet you.”

She sits up in bed, looks me in the eye and reaches out to shake my hand.

“Thank you, it’s very nice to meet you,” she says.

I’m taken aback by her politeness, but even more so by her calm, controlled voice. She’s wearing a college sweater. There’s no one else in the room. There’s no cell phone.

“What’s bringing you in today?”

She swings her legs over the side of the bed and sits there, hands folded in her lap.

“I’ve been having a lot of vomiting and diarrhea, and I don’t have an appetite.”

“Can you tell me more about that?”

She offers a succinct summary of her pertinent symptoms. She’s on medication for her bipolar disorder. She’s seen the obstetric psychiatrist and knows the date of her follow-up appointment. All of her prenatal care is up to date. She hasn’t smoked since becoming pregnant, and she’s taking prenatal vitamins. She’s in treatment for cocaine and has been sober for a year. She needs a letter to take back to her treatment center, stating that she was seen in the hospital.

Her speech is measured, thoughtful, pleasant. Eyes clear, intelligent, kind. Her posture straightens when I examine her. She’s clean, well-groomed, plain.

As we talk, I am struck with respect for this woman. She has weathered the storms of life in a way that has, paradoxically, strengthened her. I don’t feel a need to ask her how she did it, or to revisit the past. To do so, I feel, would somehow take away from her dignity. In seeing and recognizing her transformation, I feel uplifted.

I finish our conversation.

“This sounds like gastroenteritis, or the stomach flu,” I say. “I think we should try some nausea medication and get a urine sample to rule out an infection.”

“That sounds fine. Thank you very much. I just wanted to make sure it wasn’t something else.”

Her test results take a long time. When they finally come back, I go to see how Renee is doing.

“I’m sorry the test took so long,” I say. “The results are normal, with no signs of infection or low nutrition.”

“Oh, no problem,” she says, smiling. “That medicine worked really well. I feel much better, and I ate some crackers. Do you think you could prescribe me some of that medication?”

I put in the script, then give her the discharge instructions and the letter to take to treatment.

I come away from our interview feeling bewildered by the disconnect between what I was expecting and what I encountered. Ruefully, I reflect that Renee’s medical record told me as much about my cynicism and biases as it did about her medical history.

I’m surprised that, after only six months of residency, I’ve begun to assume things about my patients’ character based on their diagnoses. These stereotypes presume that they are incapable of changing their lives for the better; ironically, that’s one of the things that physicians are called to encourage patients to do. If I were a patient, I would want my doctor to see me in a nonjudgmental way. No matter how many mistakes I’ve made or how many times I failed in life, I would still want the chance at a clean slate.

Renee reminded me that illness, including mental illness, has no bearing on a person’s character. People are dynamic–they suffer, they regress, they hope, they grow and transform.

And while bringing me face to face with my own shortcomings, she’s also reminded me that no one is ever hopeless–and that everyone, myself included, could use a little bit of grace.

 

About the author:

 

Daniel Lee is a second-year emergency-medicine resident at Hennepin County Medical Center, in Minneapolis. He wrote his first Pulse story while in medical school. “Writing has always been a way to process my thoughts–a practice I’ve found crucial in understanding the complex, often messy situations that arise in medicine. This experience with my amazing patient was a wake-up moment amid a challenging first year in residency. Medical training leaves little time for reflection, thus I felt compelled to memorialize this event in writing.”

Story editor:

 

Diane Guernsey

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Comments

53 thoughts on “Eye-Opener”

  1. As students, we would like to know everything before the fact so that it is easier on ourselves. We have to remind ourselves that no matter what we hear or read that every patient interaction may be different. A patient may be having a bad day and we may get caught off guard if we expect a “good” patient to not have an attitude that day. Regardless of what the experience is, it is our part to be nonjudgemental because we would like the same treatment if the roles were reversed. I am a big believer of how certain experiences or moments of a person’s life doesn’t define who they are. We as providers, need to ensure we do not have any biases when treating a patient. We just need to go in and provide the best care we can, regardless of the situation.

  2. I feel like this story goes along with the phrase “don’t judge a book by its cover”. Her past medical history painted a certain picture of the patient in the practitioner’s head, but once getting to know the patient, the practitioner realized there was more to her than her records. An electronic medical record is a great way to familiarize yourself with a patient and provide important questions to ask them, whether it be how certain conditions are being managed or if they are taking particular medications consistently. It is a great start, but should not be the concrete surrounding the image of the patient. That is why it is so important for practitioners to not judge their patients and instead encourage or support them to make positive changes.

  3. I found this story to be very uplifting. I liked how the resident realized her bias and cynicism. I can understand how the resident felt in the beginning of the story, as it is a common and human mistake to make quick judgments about people based on only snippets of information. After this experience, I think that in the future, the resident will be less likely to pre-judge her patients. And even if the patient ends up acting like how she described in the beginning, I think she will still address them with compassion and an open mind, remembering that “people are dynamic” and capable of growth and that as a physician, it is her job to help them grow. I liked reading this article and I plan to apply its lessons to my academic and medical career.

  4. This article really shows how people have such biases towards others with mental illnesses without realizing it. I think this article was a great example of how people can put scenarios in their head and go into patient conversations with the wrong type of attitude. This article really shows that not all people are the same in regards to mental illness or just personalities and hardships in general. I think it is super important for medical care providers to try and be as neutral as possible when talking to patients in order to make them feel comfortable and want to talk to you about otherwise difficult topics.

  5. This article saddens me for all of the patients who are judged for things clinicians read in their medical charts prior to meeting them. Their medical history, mental illnesses, race, gender, and so much more allow clinicians to unconsciously make decisions about patients before ever getting to know them. I also think it is important to recognize that even though there will be some “difficult patients”, they still deserve the same level of respect and dedication to treatment as any other patient. People go through rough patches in life and may have mental health disorders which make it even more difficult. Even if all patients don’t show it, they will be grateful for our patience and humility when providing them with medical care.

  6. I think this article outlined perfectly that we should never judge a patient based on their past medical history, or what is written in their chart. It is important to an extent; however, we must not make assumptions prior to meeting the patient. The patient’s past does not define who they are and with changes in life comes growth and maturity. What one clinician experiences is not what the next will, so we must keep an open mind when entering each patient room. If we are receptive to them and accepting of their illness or past, they are more likely to be cooperative and pleasant towards us.

  7. There is a lot of importance in seeing a patient’s past medical history- but it sometimes can give a false first-impression that is not intentional. Especially with mental disorders such as bipolar disorder; we as a society haven’t completely gotten rid of the “taboo” responses and the stereotypes associated with it. We see ourselves grow as individuals constantly and overcoming barriers every day. We need to see our patients this way as well- they’re also fighting battles every day like ourselves and constantly needing to overcome those battles. We must also instill confidence in patients because although this woman had a support group, sometimes you need to be the support for the patient for the time that you are seeing them and advocate for them.

  8. This article demonstrates that you cannot judge a person based on their story. There are many challenges in life and some things aren’t always in control of the patient. Reading the medical record beforehand is a good way to get a short history but it is not the only thing you should read and you should never base judgment on your patient ever, but especially from a few sentences in their chart. Behavioral medicine illnesses are not something to judge someone over, because they cannot control their illness. Addicts you see also sometimes do want to change their habits and shouldn’t be lumped into a broad category.

  9. I really enjoyed this article, as it is something we are taught in CT sessions, as well as our clinical experience classes. This resident put on his blinders and made assumptions about the patient before even seeing her, this could have clouded his judgement to treat her when she had a medical illness that needed to be treated. It is important to look at the patient’s history, however, it is not fair to them to be judged before they are even seen by the provider. Everyone has hard times in their life, and some may turn to drugs or alcohol for coping mechanisms; this does not necessarily make that person a bad person, they just had a coping mechanism that isn’t widely accepted by society, as some stress eat they may stress drink, and as we know obesity is much more widely accepted than alcoholism, for example. It is important as future providers that we enter the examination room with an open mind and no prejudices as it could vastly affect the treatment of the patient. It is our duty to provide the best treatment possible to any patient, no matter their history or current state.

  10. I think this article really outlined the uniqueness of every patient and every patient encounter. How it is important to enter every situation with an open mind and clear of negative thoughts of how things may go. It is like we are taught not to judge a book by its cover but we forget that we should not judge a patient by the chart information. Realistically, you have no idea what you are walking into and the patient as a human being, it is important that providers understand this and take every patient with a fresh mind and no predispositions.

  11. This article demonstrates how a clinician should not make judgements about patients before walking into the examination room. With having clinical experience, it can sometimes be hard not to generalize and make assumptions before conducting the exam. However, it is unfair of the clinician to do this to patients because sometimes papers do not accurately represent the whole story. The patient is unable to make a first impression themselves because the EMR has already done that for them. Clinicians can become closed minded, and in effect, the patient is then not given the proper care. Every clinician should walk into the room without preformed biases for a patient because every patient is different and they should be treated as such.

    1. I think this article really outlined the uniqueness of every patient and every patient encounter. How it is important to enter every situation with an open mind and clear of negative thoughts of how things may go. I think that this is a twist on the “treat the patient not the lab slip” but don’t judge a patient by the chart information. Realistically, you have no idea what you are walking into and the patient as a human being, it is important that providers understand this and take every patient with a fresh mind and no predispositions.

  12. This reflection should be something all medical students and providers read prior to beginning their professional phase of schooling or job. Many physicians read their pt’s medical history before entering the examine room. Although this is meant to allow the physician a “head start” on questions and DDx, it can cause the situation seen above. We as medical professionals are not meant or there to judge pts but to help them. When we put pts in a “bubble” based on their similar cc or PMHx, their plan of care is already diminished; just because a set of people have the same beliefs/thoughts does not mean they are the same. Each person is unique and should be treated as such.

  13. This article above shows us how easy our bias can take over. Although it is important to read over charts before meeting with the patient, we need to make sure that all of our internal bias are removed. We should go into the exam room without bias and be read to hear what our patient has to say. I know this can be difficult to do, therefore it can and may take practice. We want to provide our patients with the best care possible and in order to do so, we must practice treating them without bias.

  14. Katelyn O'Connor

    After reading this article, I realized that I may also stereotype a patient based off of what they have, and this bias may even influence the patients ultimate treatment. I might assume they may be noncompliant, or simply go in with a poor attitude. Or on the other hand, see that they’re perfectly healthy with no significant past medical history and not take symptoms as seriously as they should. Overall this article taught me to focus more on the interview itself and less about the patient’s medical records; every patient is different, and are their own person and should be treated as such.

  15. Madalyn Harbaugh

    I really liked this article and feel it was a good read prior to beginning the behavioral medicine unit. Many times those with mental illness, especially substance abuse, are automatically judged based on their diagnoses, which is not fair. I liked that the doctor pointed out that his original assumption was wrong of him, because I feel many providers have probably experienced this same mistake themselves. I think it is important to remember that one bad encounter with a patient that may have had a certain disorder does not mean that all patients with that disorder will behave the same way. I also thought it was important that the author noted that as providers we should provide non-judgmental care to our patients as you never know what a person has gone through causing them to end up where they are today.

  16. This article definitely stressed the importance of not judging a book by it’s cover, or in this case, judging a patient by their PMHx. It can be easy to assume everything about a person based on what they’ve been through but the truth is that everyone is different and unique. It is important as future clinicians that we stay open-minded and not let our biases or assumptions prevent us from giving our patients the respect and care that they deserve.

    1. This article really highlights the importance of seeing every patient with an open mind. In this specific example, the provider already conceived an idea of how the patient interaction was going to go just based on what the provider read about the patient. However, once the provider met the patient in real life, the encounter was far from what the provider was expecting. I think this article really shows that even though you might have the facts or medical history on a patient, you truly do not know how the patient is going to bring those facts to life until you meet them.

  17. This article shows the importance of actually meeting a patient before assuming how they may act based on their chart. Making assumptions can negatively impact the care that a patient may recieve. I feel that providers may assume that things in the medical history are current issues and forget that they could be in the patient’s past. When it comes to caring for a patient, they need to be treated as an almost blank slate before assumptions on their personality can be made.

  18. Olivia Catalone

    This article provided a lot of insight into how easy it can be to make assumptions or judgments about a patient based on their history or past. I remember during shadowing experiences prior to didactic year, providers would make comments about patients who walked into the ED/Urgent Care based on their appearance or their history only to find out that some of them had conditions that were terminal or chronic or they couldn’t afford treatment. It is our job to go into each interaction with an open mind and to be non-judgemental and compassionate to all our patients. 

  19. It is easy or medical providers to form a bias against a patient through their past medical history. It is important to form your own clinical opinion and judgment of a patient yourself instead of forming it based off of their past or other providers. The provider in the article based his experience off of experiences he has had in the past before even giving the patient a chance. Many patient’s seek medical attention on the basis that they are receiving judge-free care.

  20. This article highlights the importance of keeping an open mind when seeing a patient. While an extensive PMHx may seem daunting and you may want to prepare yourself for seeing a patient, it is important you do not stereotype them and keep in mind that every patient is different. For example, there are some statistics about HTN patients being notoriously noncompliant with medications, but you will see some patients who are very strict with their treatment and never miss a dose. It is important to keep an open mind in order to provide the best treatment possible and assess the patient as a whole as well as able to efficiently treat their chief complaint. If you are careless and choose to stereotype, this can cloud your judgment and you could do more harm than good.

  21. This article highlights how judging a patient’s character before having even met him or her, simply based off of the problem list or past medical history, can potentially affect how the patient is treated, resulting in unfair treatment toward the patient. As medical providers, it is extremely important to provide a clean slate to each individual patient, rather than allowing preformulated biases to take over. Each patient has his or her own story and no two patients will be exactly alike. Walking into a room with a bias toward the patient and an assumption of his/her character may cause us to treat the patient differently, especially if we are assuming the worst. Thus, it is important not to allow these biases to dictate one’s thoughts about what a patient is going to be like based on the patient’s medical history and instead walk into each room with a clean slate and open mind.

  22. I think this article does a good job of highlighting the unconscious biases that every person makes without thinking twice. It is difficult to not make these judgements when all you have to go by is the EMR system. The patient history is just words written on a screen that could tell you absolutely nothing about the patient. It is important to maintain an open mind as you never know what might be going on behind the scenes in someone’s life. As a provider, it is essential to maintain a proper quality of care as preconceptions should not play a role in how patients are treated.

  23. This article describes a scenario that most likely happens every day for some clinicians. Unfortunately, with access to EMRs providers are able to find out a lot of information about a patient before they even step foot in the room. This presents the opportunity for the provider to form biased opinions before they even meet the patient. It is important that each patient should be approached with an open mind and they should never be labeled. Labeling patients can be very dangerous because a provider could potentially miss a life-threatening condition because they don’t properly examine and interview the patient. Ultimately, it is important to remember that people can change and should never be labeled off their pasts.

  24. This article highlights the importance of approaching each patient as blank slate without any predisposed judgements based on past encounters or prior medical history on the EMR. The treatment and quality of care for a patient should not be affected by a caregivers judgements or preconceived ideas based on how the patient looks or their past medical history. I think this article does a good job of also highlighting the need to approach each patient as an individual and not like every other pateint they may have seen with similar illnesses.

  25. This summary of a patient encounter is a very clear way of explaining how easy it is to judge a person from a few ideas about their past and come to a conclusion about how they are going to act before even meeting the individual. This is an important patient encounter to read because it teaches the importance of not judging someone before meeting them and allowing them to make their own first impression without the implicit biases that can come with a patient chart. It is important to remember that any biases we may have to someone should in no way influence the care they will receive and they should have the same level of care that we provide to all patients.

  26. This article does a great job at showing how easy it is to judge people based on past encounters. It shows just how real bias can be. It is so important to view each patient as an individual and to not go into their room with any assumptions based on their past history. It is not fair to patients, as it can lead to you treating them differently and they may not receive the treatment they deserve if the provider has already written them off.

  27. This article highlights the fact that internal biases can affect the way we treat people. Medical professionals have to make an effort to ignore those biases and do what is best for the patient. It also brings to light that assumptions shouldn’t be made before you even walk in the room. It is the job of the medical professional to give the best care possible, no matter how the patient presents. Stigmas and internal biases cannot affect how patients are treated.

  28. This article truly depicts the easiness of being judgmental based on previous experiences. However, as future physician assistants it is important to not fall into this trap. Every patient has the right to the best possible medical care they can receive, and that doesn’t include biased opinions based on their chart. I know that I’ve heard a fair share of stories of patients being judged by their doctors, and it is unacceptable. This is why I am proud to be a physician assistant student because our motto is to treat every patient with care and compassionate.

  29. This article demonstrates how our biases can impact the opinions we have of our patients and people we’ve never met. The assumptions Mr. Lee made about his patient with bipolar disorder were completely inaccurate. If Ms. Pryce in fact had relapsed recently and continued to smoke while pregnant, how would Mr. Lee’s treatment have been different? To enter an exam room expecting the patient’s complaints to be illegitimate can be damaging to her treatment and health. Her struggle with mental health, substance abuse, and tobacco use led Mr. Lee to assume the worst. Recognizing how we stereotype others is the first step to overcoming our biases and focusing on providing rather than judging our patients. It was wonderful to read that Ms. Pryce was pleasant and stable, but had she not been, is she the one who is truly to blame?

  30. It is unfortunate that previous encounters with a similar patient background had led Dr. Lee to be biased towards new patients without even meeting them. I feel this is mainly due to the overwhelming burden of dealing with so many patients in just 6 months that may have that similar background and ill intentions when visiting the emergency room that it causes him to become jaded and lose sight of his role as a medical provider to be un-biased and non-judgmental while providing care. This patient encounter seemed to be a much needed and refreshing reminder to Dr. Lee of why he does what he does and that a past does not always dictate one’s future. This was an extremely uplifting reflection and a kind reminder to never judge a patient by their history in this case.

  31. This article truely depicts a picture of how one can easily be biased and judgmental when someone fits the stereotype, which is not only true in medical field but in general thats the problem. It’s crucial for everyone but especially for medical providers to never presume when they see the patients because every patient is unique and have their own circumstances of why they came into the office. All patient have the right to be respected and treated as an individual regardless of their apperance, gender, and diagnosis.

  32. While reading this article, at first I found myself in agreement with the authors idea of the patient she was about to meet based on the patient’s medical history. After reading that the woman was nothing like what the doctor had imagined based on her previous experiences I realized I also had a bias as well. I think this article is a much needed reminder that no two people are the same and everyone deserves the right to be judged aside from their history and similarities that it may have with a certain stereotype. People are a lot more dynamic. As future providers I think it is really important to check ourselves in these situations so that we do not become jaded or let biases take over.

  33. As revealed in this article, in medicine it is easy to characterize a patient by there medical history. We are taught never to assume anything about a patient, but once you see the same type of patient 20 or 50 times, one may start to characterize these patients in a certain light. However, as displayed in this article, it’s crucial that, as clinicians, we approach each patient with an open-mind and without prejudice or assumptions. We can never know for sure what a patient will be like or know for sure what has happened in their life that has brought them to this point. As such, we must remain free of bias and continue to treat with an open-mind, care, and compassion.

  34. This article unveils the subconscious prejudices that come with past patient diagnoses. It’s easy to think of how patient encounters are going to go based on their charts. But by doing so, you’re already putting your patient at a disadvantage, for you’re already planning your plan prior to even gathering a proper history. With a past history of drug abuse, the physician can pass early judgement of a possible coinciding tendency of drug seeking, even though that has never proven to be the case. The chart also never mentions the current status of those illnesses, and just allows for physicians to make certain pre-conceptions of their patients before face-to-face interviews. Like how in this encounter, the physician came in expecting to see a “drug seeker” with poor hygiene and an avid drug problem, regardless of her pregnancy. But when he came in, he saw someone opposite to what he was expecting based on what he concocted in his head. This article allows us to reflect on certain preconceptions that we have with certain diagnoses, and how that can impact the care that we would provide them with if we stuck to those thoughts.

  35. This article emphasizes the old saying “Don’t judge a book by its cover.” Every patient deserves to be treated with human dignity and respect despite lifestyle choices or medical conditions. Forming pre-misconceptions about patients before meeting them can actually worsen the quality of care they may receive. This article taught me a lot about that patients can dramatically transform with the proper medical treatment despite their past. Overall, very powerful!

  36. Eliminating bias not only in the medical field, but also in general can be difficult considering some treatments and symptomatology present in very similar ways. The author of this passage demonstrated she had already formed a picture in her head of what her patient was going to be like prior to entering the room because she had seen numerous other patients with similar characteristics. She prematurely judged her patient based off of little information. The author of the article stated she felt “bewildered” by how the patient communicated with her. Never had she had a patient with the same set of symptoms and other background information who treated her with such respect. This goes to prove that a book should never be judged by its cover. Forming opinions about patients before seeing them is not a beneficial way to effectively practice. However, sometimes it may be difficult not to have an opinion when so many other patients have acted in the same negative way. I think this article demonstrates the importance of having an open mind with a judgment-free attitude. Demonstrating these two skills effectively allow for a well-rounded medical provider.

  37. I love this piece. My book: Heart Murmurs; What Patients Teach their Doctors has a whole chapter on assumptions. One of my stories is right up there with yours. I have come to love it when I am shown how assumptions are wrong.
    Thank you

  38. Dorothy Blake

    Thank you for writing the article. It reminds us all as health care givers and as humans to keep our preconceptions on a leash.

  39. I really appreciate this discussion. I’m writing a memoir about my son’s childhood brain tumor, which went undiagnosed for 3 years. As we went from specialist to specialist, I knew I had to sell each doctor on ME as a mom, so they would listen to my concerns. I didn’t do a great job. Can anyone tell me how much communication/dialogue/doctor-patient relationship is taught in medical school?

  40. JOSEPH fennelly

    This is an excellent article. We in medicine take a course in art. The object is a 4-dimensional work of art: body mind psyche and spirit. We learn to love that art be close reading , close listening, close seeing. Only then can we discover the patient as person. Thus the physician enriched her physician as person.

  41. Alice Fornari

    I am a medical educator always looking for amazing stories to use in our curriculum and this is one of them!! So many learning moments for the resident to share with our learners. I thank the author for this level of teaching and reflective capacity. A true gift to medical educator. Pay it forward and use in curriculum please. Honor PULSE and all it does for us weekly. Alice Fornari

      1. Alice Fornari

        There is literature describing a role as a medical educator. There are four Common categories Of teaching excellence, educational focused leadership scholarship, curriculum development, assessment and evaluation knowledge and skills. Leadership includes mentorship.

  42. Sara Ann Conkling

    This is a frightening story, which underscores the courage and honesty it took to write it. Thank you. As a patient with a pheochromocytoma that is is being evaluated at the present moment, I’ve connected with a support group of patients online, the majority of whom were diagnosed with serious mental illness – usually along with factitious disorder – before their large, catecholamine-secreting tumor was removed. The judgemental misdiagnoses affected not only the proper treatment of their pheochromocytoma, but all of their subsequent medical care. As a patient with genetic anomalies and more than one zebra in my personal medical zoo, I am sobered to the biases, and the incompetence of so many providers when it comes to treating someone with a rare disorder (or three or four, in my case). And when I find the relatively rare physician who cares enough to admit what they don’t know (and then find out what they don’t know so they can be of real help), I notice and I am very grateful.

  43. Pris Campbell

    What’s frightening is that too many doctors make assumptions based on lists of diagnoses in charts. I hope this doctor learned something lasting from this encounter. I appreciate his honesty about his initial bias.

  44. Laurin Bellg, MD

    As a physician, I understand how easy it is to succumb to our own generalizations, often without even realizing it. We want to believe in the best of humanity, but our personal experiences often inform us erroniously and, sadly, affect our behavior. It’s an unfortunate human habit, no matter our circumstances. I recently had my own experience of misplaced preconceptions with a well-coiffed patient who, based on years of treating similar patients, I fully expected to present me with a long list of important community connections, money-speak and lawyer threats if “an outcome didn’t meet her expectations”. I was prepared to navigate those circumstances, until she crumpled into tears in front of me, completely terrified by the limited mortality her diagnosis was wielding. Which, in the lovely words of Dr. Lee, succeeded in “bringing me face to face with my own shortcomings” and “reminded me that no one is ever hopeless–and that everyone, myself included, could use a little bit of grace.”

  45. As a minority woman, I am frightened by this article. This physician seems to think that admitting his biases absolves him of his stereotypes, and there are many. Even the way he describes his expectation that the patient has “long nails tapping on the phone”. He has a long way to go to keep his blind-spots from influencing patient care. This is why minority patients are mistrustful of the medical system. I pity the patient who falls outside of his socio-economic class whom he can not identify with.

    1. Rachel Weiner

      Thank you Theresa for naming this. I think this is an important story because it shows how implicit bias is real. But it is negligent in not addressing race directly while indirectly painting a stereotypical image of a black woman (I know this is an assumption and I do not know the race of the patient but by leaving it unnamed I suspect the image most readers came up with is an angry black woman). And the author is able to connect with the patient only when he finds she fits into his definition of acceptable dress and behavior. I feel disappointed in Pulse for publishing this, at least without a deeper analysis of what’s at play.

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