This post comes after I have spent much time in the clinic shadowing other clinicians. While seeing patients again gives me the greatest sense of peace, I can only imagine the thoughts that run through their heads when I enter the room. Thoughts like, “Why is he walking and talking like that? I wonder what happened.” I am actually in the midst of creating a document that they will be given to patients before our encounter explaining my condition. The purpose of this document is to curb any reservations patients may have upon seeing me, and more importantly, divert attention away from my condition as the visit should be 100% devoted to them; if even one second of our encounter is spent addressing my condition, the patient would be cheated of the optimal care they deserve. The reason I bring this up is that it has forced me to think about the first impression I create and if I was given half a page to explain myself, what should I say? (When I finish it I’ll share it with you).
—- Labels —-
This ‘first impression’ I create brings up the topic of labeling. We as a society have a love-hate relationship with labeling: Love in that we attempt to put a label on everything (for example, calling a movie a ‘horror film’ is a form of labeling; or claiming that someone is ‘overly concerned with their looks’ because of an excessive amount of make-up is also labeling). With some things we need labels; we often base ‘instincts’ or ‘gut feelings’ on labels that we have created. If you’re forced to make a split second decision, you don’t have time to ponder the situation, it is the labels you’ve come up with that make your decision. In medicine, this is no better portrayed than during a cardiac arrest. The patient’s heart has stopped and you’re at the helm. You’re given only the information that is readily available (ie age, recent lab work, symptoms). Labeling then takes over: the people in the room and their roles is labeled (in your mind), the patient is labeled (ie is the patient morbidly obese? Is he/she diabetic? Does he/she smoke?). You are only given a limited amount of information and are asked to make life-altering decisions. Even though societies like the Advanced Cardiac Life Support (ACLS) make algorithms in an attempt to regulate this process, quick thinking and labeling must be performed to salvage this life.
Even though this labeling is so crucial to many parts of our lives, there are also instances where we severely condemn it: someone need look no further than the issue of racism to see an example of this negative labeling. Looking at someone of Asian descent and assuming they are a dangerous driver portrays this. In my mind, I put racism as a subset of racism. The more I thought about it, I was exposed to much of this growing up. My high school had 1500 students in it; in my class there were 500 students, 2 of them were Asian: me and another boy. I remember a bully stopping me in the hall to say, “You play tennis right? How do you even see the court with your slanty eyes? You should go back to China.” I was stunned, how could someone say something like that? I immediately went to the bathroom and cried.
—- Let Me Explain —-
The point is that while we need some labels, we also (rightfully) hate others. I accidentally overheard a conversation in which my speech was deemed “like a retard”. I know this is not the politically correct term, and that ‘mentally challenged’ would be better, but obviously this person wasn’t trying to be politically correct. Regardless of the source, the question remains: if a loved one thought this, what would a patient think? In thinking of seeing patients again I initially came up with a prepared statement I would tell the patients: it went something like this: “First off, thank you, thank you for allowing me to be part of your care. Now you’ve seen me walk in and speak to you, let me explain my condition. In 2013 I was found to have a benign brain tumor. The surgery took over 14 hours and I spent over a month afterwards in the ICU and Rehabilitation Floor. My recovery has been a long journey with my balance and speech being the slowest to recover. This comes with good news though. Even though my walking and talking has been affected, my mind has not; I’ve gone through many tests that show my mind to be as sharp as before the surgery. Before the surgery I was slated to become chief resident here, and before that I attended Harvard University. I cannot promise I would score as high on the SAT as I did in high school, but my mind is still sharp. More than anything else, this experience has given me a priceless perspective that I will use to fight for you and for your health.” I hope to use some of this in the document I’m preparing. If I did not have the chance to ‘prepare’ them for the visit would they label me? What would their label be? If they did label me, would it be as a ‘retard’, as I had been labeled before? While part of me resents this, as this ‘labeler’ is missing a lot of information (my being a physician and my time spent in Cambridge at Harvard), but another part of me knows that I cannot introduce myself to everyone thus expecting them not to label me is unrealistic.