Wednesday, August 8, 2007

Health Despair-ities

By Teresa Smith, MD

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
-Dr Martin Luther King, Jr

Medical Stereotyping

It was a miraculously quiet day in one of the busiest emergency departments in New York City. We all sat around the doctor’s station chatting, talking about everything and nothing, just praying that the moment of silence in the ED would last a little while longer.

In the group there was myself, an African American intern, an Indian medical student, and a Caucasian nurse and intern. I am not sure how we got on the topic, but the nurse, states, “Well, I was taught that if a patient from Bangladesh comes into the ED with chest pain, he gets admitted immediately,” no matter how much they down play their pain. And, she continued, “I had this patient, a man from Bangladesh, who said he was having just a little chest pain," as he sat in his bed comfortably. “Turns out, he was having a major heart attack.”

I had to agree, I was taught similar anecdotes.

We all know that stereotypes are exaggerations of truth. Is their truth in what the nurse had shared?“ Are we as health care professionals, to get nervous if an Asian person says they are in pain, because Asians usually don’t complain? Or are we doing our patients a disservice by stereotyping them before we even take a proper history and physical? The nurse than described how she had a Latin woman as a patient who was screaming in pain and agony for what turned out to be carpal tunnel. “Latinos, she said, cannot tolerate pain.” While the conversation eventually made me slightly uncomfortable, I must admit that I carry around the same tented vision.

Even beyond race, it is true that with the first look of a patient, we judge them. When you approach the patient with the tattered clothes, dirty hands, and worn out look, you automatically assume he is homeless, and maybe even is an alcoholic or drug addict. Do you assume that all of your African American patients have hypertension? And, are you wrong if you do? I don’t have an answer to any of these questions. However, from the perspective of young, perhaps even naive intern, I hope we can keep an open-mind about our patients; treating them as individuals, and not as a collective demographic.

Health Despair-ities is a column that addresses the day-to-day and global issues surrounding disparities in the administration of health care. Teresa Smith, MD is an intern at NYU/Bellevue Hospital Center

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