Don’t become the biased physician.
In medical school nowadays, there is a heavy emphasis on perfecting a physician’s demeanor when interacting with patients. Classes on essential patient care focus upon the social constructs of medicine, allowing permeable medical minds to ponder over various patient-care scenarios and determine the perfect method of one’s bedside manner. I used to believe such classes were ludicrous. Why the need to have a class on basic mannerisms such as, “Never argue or raise your voice to patients,” or “Don’t begin to judge patients when they walk in because you don’t know their back story,” was beyond me. Many of these aspects were common sense! I naively believed that to be so deep in the medical career process (example: passing through medical school interviews) one would already possess the innate demeanor that is taught in these medical school classes.
The wards taught me something different.
I began seeing a pattern as a physician’s years in practice progressed. As physicians became more seasoned, some of them began to form assumptions of people based on their outward appearance or personality. Seeing words like “smoker” or “missed appointment” automatically placed that person into a certain category causing the interest in both the patient and their overall health to wane in the physician’s eyes. The more dinged you are via society’s standards, the more dinged you are in the physician’s eyes as well. This quality was not only reserved to physicians, I’ve seen it spread all the way to nurses, who are the front-line advocates of health in a hospital or clinic setting. Let me share an example.
While I was on the labor and delivery unit, there was a female in her late twenties, G2P1, 25 weeks and two days pregnant, admitted for trauma. Her and her husband were enjoying the beautiful weather outside when she saw her 2-year-old child running in the direction of a pond. The fretful mother began to run after him and tripped, resulting in an abrasion to her knees and abdomen. Worried, she came to the ER and was admitted for monitoring to make sure the uterus was able to withstand the force. All through the evening the mother seemed okay. Her vitals were good, she had no contractions, fetal heart rate was in the 130s, she had no pain or bleeding, and ultrasound showed no abnormalities. The mother got a good night’s sleep, and the next morning seemed promising for a discharge.
Around 6 a.m., fetal heart tracings showed a 2-minute dip to 70 beats per minute (BPM), then rose back to 130 BPM. With cautious eyes, everyone was glued to the fetal heart tracings, hoping it was a one-time glitch; it was not. In the next five minutes, the fetal heart rate dropped to 60 BPM and did not rise. The on-call OB was paged, a bedside ultrasound was done, and the mother was taken back for a stat C-section. I have never seen anyone move that fast; from the transport to the OR to the baby’s delivery took 10 minutes. Valiant resuscitation measures were taken and protocols were followed, but the baby had already passed. In the uterus, we found multiple clots and a 50-percent placental abruption that had no symptomatology whatsoever. No eyes were dry and no hearts were unbroken for this mother and her child. Nurses and physicians were doing everything to make sure this mother’s post-op stay was as comfortable as possible.
The next morning, a second female in her late twenties, G3P1, 24 weeks and four days pregnant, was admitted for trauma. She was an IV heroin abuser who was worried after noticing heavy vaginal bleeding. A cervical exam was difficult with the blood loss, ultrasound was inconclusive, and the fetal heart rates were not promising; therefore, the decision was made for a stat C-section, as well. Again, valiant resuscitation measures were taken and protocols were followed, but the baby had already passed. This time, however, the dynamic in the room was different. All eyes were dry. All hearts seemed intact (except for the obstetrician’s and mine). The post-op care seemed systematic with no compassion for this grieving mother; in fact, nurses were reprimanding the judiciary system for not arresting this woman for murder. I was perplexed. Two women with similar situations were being offered the same care with different feelings. Both women had a different team of nurses and physicians who looked after them, so they were not burdened with a double loss. Why the difference?
The stark variability in the standard of care differed for these two women because of the back-story. One was painted as a doting mother who was doing the right thing and lost her child in an accident; the other was painted as an uncaring woman who keeps getting pregnant when the only thing she cares about are drugs. The latter was placed into a category of, “If she doesn’t care for her health, why should we?” I was repulsed. My fresh medical student eyes saw something entirely different. During post-op rounds, I had visited both mothers and found many similarities. Both mothers were deep into grieving, carried a burden of guilt, and were inconsolable. Both mothers had a little child who did not understand the brevity of the situation. Both mothers wished for situations to be different. What outsiders saw as a no-good addict, I saw as someone who was yearning for recovery but was too weak to withstand the obstacles in her life. What others saw as uncaring, I saw as someone who loved with all her heart. As the second mother was also battling withdrawal symptoms, she became labeled as “difficult.” All of these labels painted her as someone who was vastly different from the first mother. While the standard of procedure and treatment plan were mostly similar between these two mothers, the mindsets in which the care was given were on the opposite ends of the temperature scale: warm and cold.
Labels are a dangerous practice in medicine. Wisely used, they can help tailor a treatment plan towards the needs and benefits of that individual person; however, used unwisely, they can unknowingly affect the standard of care that should be offered to every patient, regardless of background. In this field, our thoughts truly affect our actions, and our actions have a deep impact on the care of a person. While the ideas taught in patient care classes may seem like common sense to our fresh minds, the storm of the wards has seemed to weather many minds down the road.
Don’t become the biased physician.