A classmate recently recounted a story to me of some not-so-great assumptions one of her attendings had made about a young girl recently diagnosed with diabetes:
The girl, of Hispanic origin, was in clinic with her family and the attending was giving her family her diagnosis for the first time–diabetes. But what bugged me is that he told me he didn’t want to spend his time explaining the cause of diabetes to the family, because he assumed they weren’t educated enough to understand it in the first place.
Let’s assume, for the sake of argument, that this attending didn’t start off this way; I’m hoping this is a safe assumption to make, as I think it would be among my classmates. I hypothesize, then, that this is the downside of physician training. Physicians are masters of pattern recognition–one of the reasons we haven’t been totally run out of business by computers (yet). You start to see certain patterns of diseases, drug side effects, and diagnostic workups that things truly start to reveal themselves, and then burn themselves into your head. You tell me your list of drugs, and I can probably tell you which diseases you have. You tell me your dosages, and I can probably tell you how bad your disease is. Or show me a picture of someone with a certain symptom, and I could probably come up with a couple guesses as to other symptoms they’re having (I’m still working on this ability). We are predictors, trying to make sense out of the world with the clues we’ve gathered.
But there’s always two sides to a coin. Perhaps some of us (like the above attending) take our prediction powers too far, and use them not for diseases or treatments, but for people. Maybe the attending had seen several other similar girls before, and he tried explaining, and felt like he was wasting his time. Maybe he’s seen hundreds. Either way, I think we’ve got to separate one from the other. Otherwise, we risk missing golden opportunities with patients.
This is no easy task. I’d imagine the doctor spent his time getting something else done with the time that he saved–calling a patient with abnormal lab results, spending more time with another patient, etc. Were the patient white, would he have skipped the pathophysiology speech? We can’t say.
Maybe one solution is to give patients a handout to read over at first, so when the doctor comes in, she or he can answer questions about it.