Color Outside the Lines

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In the healthcare field, there are many unspoken expectations. We are often expected to look, act, or be a certain way, or do certain things. Falling outside of the patients’ typical expectations can have serious consequences; particularly since healthcare is largely based on patient satisfaction scores. Though many patients feel friendly towards me, I do realize that there is a significant amount of time in each visit answering questions such as, “How do you know?” when I give a new diagnosis or treatment plan, or “What makes you think…” or my personal favorite, “…you just look too young.”

As a personal sociological project over the years, I’ve discovered some patterns. People seem to “trust” me more (measured by the length of time I have to spend explaining my thought process, which translates to actual appointment length) when my hair is unhighlighted, I wear black or dark clothes, have little make up, and wear glasses. When I dress and look more similar to what they expect, my appointment times are shorter, I am more efficient.

By contrast, my hubby is not routinely asked “how do you know?” or questions of validity. He looks very much like the stereotypical healthcare provider. In fact, since I started in healthcare, my male counterparts have all had shorter appointment times and most do not endure the questions of validity. However, the data suggests that women are “better” providers, which is suspected to be secondary to longer appointment times, better patient satisfaction, longer explanations, and higher emotional intelligence.

This doesn’t translate into better salaries for female physicians, though, which is still stagnating at 25-30% lower than our male counterparts.

I suspect, though that these unconscious biases lead to an additional “weight” carried by female providers- we’ll call it the “Burden of Proof:” prove to the patients, administration, and partners that we are, in fact, valid and good providers. Does this mean that I cannot look the way I want to look, simply because of patient perception? Though administrators might like that, I refuse to let it dictate my life. Awareness of our own internal biases is the first step to pushing past the bias and becoming self-actualized- as individuals, and as a society. As physicians burn out at an alarming rate, patients with ageist, sexist, racist perceptions of providers will find that there will be fewer that fit their “ideals” as time progresses. Meanwhile, I refuse to make myself less sparkly to fit someone else’s ideal.

Just as I’ve heard so many times from previous interactions from patients, families, friends, as they sum up their inherent distrust: “I’m just not buying it.”

My response: “I’m not selling anything.” And truly, I am not selling a diagnosis or treatment protocol. No, I am not in the pocket of a pharmaceutical company. I didn’t just graduate from school yesterday. I am not 22. I do not own stock in drugs or drug companies. I do not get kickbacks. And honestly, when people insinuate all of these things, it not only illustrates their distrust, but it also drives a wedge in the patient-physician relationship. I hope if you are that patient who has said these things- think twice before disrespecting your caretakers with some of these insinuations, as it really only serves to harm your relationship with your physician. Or better yet, think twice about why you’re seeking advice from a doctor in the first place, if you don’t trust doctors or medicine or science.

It is death by a thousand cuts, enduring so many little slights, year after year. As physicians burn out at an alarming rate and leave medicine, there will be (and already is) a stark physician shortage.

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