Patients are not stereotypes

Perhaps one of our greatest assets and strongest detriments in medicine is our ability to look at a patient and make a quick, thorough assessment of his or her condition and state of distress. Certainly, a good clinician is able to triage and provide greater quality of care in the emergency room if he or she can use the intangibles of a patient’s presentation to provide them better quality of care.

However, more often than not this skill set carries over into judgment of a patient’s character or personage to a level that actually disrupts our ability to provide patient centered care.

She has been in here ten times this month, she must be pill seeking.

Look at how disheveled that family is, what are those parents thinking.

He is morbidly obese — there is no chance he will listen to any health maintenance advice I give him.

I know this family, nothing that I say will convince them to adhere to their treatment plan.

Nothing has struck me more during my brief, 12-month foray into the medical field than the limitations that are placed upon us by these snap judgments. Indeed, I have caught myself making these decisions and assumptions repeatedly.

I can recall the eccentric patient who seemed to have difficulty in speaking yet was a high commander and special operations member in the military. The patient receiving palliative care who seemed so weak and fragile while lying on the bed, yet he came from an incredibly successful boxing career. The reticent young girl who seemed ready to disregard any and all physician advice, but who in reality was terrified by the implications of her menstrual cycle disruption.

I am barely a quarter of a way into my medical education, and I already am so struck by the detriment that quick judgments could have on my ability to be an excellent clinician in the future. How easy is it to forget that patients are not stereotypes, that people are certainly more than the sum of their parts, that patients fit into boxes just as frequently as diseases obey the “rules.”

All of these observations have convinced me of the fact that empathy is more than saying I’m sorry for your loss at the right time.

Empathy is more than trying to understand a patient and walk a mile in their shoes. Empathy is in many ways, a practice of exclusion. Empathy is the solemn refusal to let the quick assessments that have guided so many of us in our careers thus far determine how we treat a patient. Empathy is walking into each and every patient’s room with a commitment to see them as nothing more than a person with hopes, dreams, and aspirations that likely mirror many of ours. Empathy is giving our patients the benefit of the doubt, trusting them to understand their own pain, and then asking them to trust us enough to heal it.

It’s a relationship of mutual trust and understanding. A relationship that begins with each of us who practice medicine in any way walking into the room, smiling, and reminding ourselves that the person sitting in front of us is, quite simply, just that: a unique person.

Kathleen McFadden is a medical student.

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  • John C. Key MD

    The stereotypes usually ARE correct but it is a foolish physician who falls into the trap of following the stereotype. People really are individuals and must be given a chance. The morbidly obese can be motivated to change their lifestyle, and the addict can be removed from his pills. As a formerly uncontrolled Type 2 diabetic, I am glad there were a couple of endocrinologists out there that didn’t give up on me.

  • Scott R.E. Thompson

    Great article. In my time as a medical student, I remember having some of the same thoughts. It is vital that healthcare professionals don’t fall into the trap of labeling or stereotyping people despite how easy it may be.

  • SteveCaley

    I’m going to snip something I wrote and drop it here; I think it’s helpful, even if it’s a retread.

    I believe that there is no diagnostic instrument, test or imaging that can compete with a GOOD physician with an OPEN mind and enough TIME with the patient. THIS is why our forms-based, check-block, paperwork mill is BAD. It keeps doctors from doing what they do.
    I saw a consult on my fourth year Neurology rotation at Boston City. Patient alleged to have a seizure. 21 year old black female. I stopped a few feet short of the hospital room, as there was a hand firmly grasping my ankle. Attached to a person who fit the description of the patient. She was moaning. She said she needed morphine for her pain. Having nothing more urgent to do, I helped her in the room to do the consultation. She knew she needed morphine. This was the worst belly pain of her life. Not quite knowing what else to do, I examined her belly. All sorts of normal stuff was easily felt; nothing was tender in the least. I talked to her some more; she was writhing about in pain. (People with peritoneal and joint pain lie perfectly still, as movement makes them worse.) I asked her all sorts of things; this pain had been coming on for two or three days; never had anything like this before. She’d been on a diet; sometimes she felt bad when she was trying to lose weight, but nothing like this.
    No nausea/vomiting, no chance of pregnancy. I asked her if she used heroin; she admitted to it now and again, and she sure would like some now. I asked her if she drank alcohol. She tried it once. It made her sick.
    Nothing else on the examination was notable, except for 4+ knee reflexes that were so extreme they looked like complete baloney. I told here that the Neurology team would visit within an hour or two; we did.
    It turns out, morphine was exactly right for what ailed her, and a lot of other things too. I told the Attending Neurologist that she may be having a first onset of Acute Intermittent Porphyria; that she was. He tapped her knees; he made EVERYONE tap her knees – and then he called the Intensive Care Unit.
    People with AIP have a nasty habit of dying all of a sudden, but she didn’t. They lose the ability to breathe; a rude way to go.
    More often than not, 21-year-old African American females who have a history of heroin abuse, who crawl out into the hall and grab your ankle seeking morphine for abdominal pain that is absolutely undetectable on examination, well, I suppose they might be drug-seeking.
    Being a good doctor means seeing the rose – SEEING the rose. Letting it unfold. 21-year-old females with new onset seizures, with severe abdominal pain from anorexia, and alcohol; and hyperreflexia; may damn well have AIP.
    Today’s medicine means making the five-minute diagnosis on consultation. She was probably drug seeking, based on his history and examination. But probably means nothing, if you take your patients one at a time. I still think I am a VERY cool cat for making that diagnosis; no wonder the resident gave me a “low pass.”
    And I’m grateful to that patient. She taught me more than any attending ever did..
    Everything you ever learned in medicine can bring you to that 99% But you are the one who makes the decision to call it 100%. What if I had missed AIP in this patient – would I be a bad doctor? NAW. But if I went right to the 100% when I felt the hand around my ankle, I would have been, perhaps. You get experience over time, recognize things faster; but nothing can substitute for Seeing The Rose.

  • Ava Marie Wensko George

    Very well said.