December 11th, 2018

No, I Am Not Patient Transport

Cassandra Fritz, MD

Cassandra Fritz, MD, is a Chief Resident at Washington University Hospital in St. Louis, MO

“Oh, you’re here to take me to my test.”  I have heard this too many times to count, and I have come to perfect my response. “No, I am not patient transport, your social worker, or your nurse. I am your doctor.” After a moment of confusion, I usually see a facial expression signaling that the patient is reframing his or her initial thoughts. Maybe I am misidentified because I am young, or black, or female. No matter the reason, I get annoyed instantly every time this happens.  Do patients have some preconceived notion about who I am? I always conclude my internal dialogue wondering… Will they trust me?

happy doctorIn sharing these experiences, I feel that women, especially minority women, deal with this more than other physicians. Although this issue may seem insignificant to some, continually having to define your role drains morale and can erode confidence. In spite of my white coat and MD,  patients mistake me for everything BUT a doctor. I have joked that, even if I tattooed MD on my forehead, there would still be misperceptions about my position. All kidding aside, the repeated misunderstanding about women being physicians speaks to the strength of implicit bias in medicine.

Implicit bias stems from our past experiences and stereotypes. It is an unconscious process that allows our brains to make automatic associations based on initial yet superficial qualities. Basically, implicit bias is one way our brain sifts through the information constantly bombarding us.  Patients may be more at-risk of relying on automatic unconscious associations when they are stressed or sick. Yet, I have often wondered, do these interactions affect patient care?

So if you find yourself annoyed by repeatedly stating “I am your doctor,” here are a few things to consider:

Implicit Bias Is Strong

doctor with patientPhysicians’ implicit bias toward patients is commonly discussed. Yet we aren’t taught how to deal with being on the receiving end of bias. Nonetheless, the “hidden curriculum” during medical school and residency has provided models of how to navigate these situations. What I have found most helpful is to quickly establish common humanity with patients. By sharing small aspects of my story, I can help people disassociate from their previous bias.  Giving patients the opportunity to reconstruct their thoughts about who I am, and hopefully establish a trusting and a therapeutic relationship.

Confronting Bias Is Important

find your voice noteI would be debt free if I had $10 every time a nurse asked for orders from my 6 ft+, usually white, male medical students in their short white coats. We all have biases about the type of person we look to for help.

During my second year of residency, I worked with an amazing female fellow in the ICU who helped me find my voice in high-stakes situations. She encouraged me to correct people when they were looking to the wrong members of the team for orders or guidance. She taught me something important in that moment — you have to confront bias head on.

Acknowledgement Is Key

As I mentioned above, confronting bias provides an opportunity for people to reconstruct their initial associations. This confrontation can be tricky though when a patient is involved. What is the appropriate way to “check” your patient? I think most of us already do this in a proper manner: We politely correct patients (no matter how many times it takes). Is it hard to repeatedly define your role? Absolutely! Yet this is why I think acknowledgement of the bias against you as a physician is very important.

Physicians need to acknowledge to their team that they are being bombarded by waves of implicit bias.  Because I just can’t believe that this doesn’t affect us. When this happens to me, I conscientiously tell my team about the interaction. I do this not to make people feel uncomfortable, but to make sure I am scrutinizing my own bias so as not to affect patient care.

Implicit Bias Is Everywhere

We are all guilty of making quick associations, especially in high-stakes situations. It is important to make patients feel comfortable, but there isn’t anything wrong with clarifying and re-clarifying your role. Most importantly, we should all try our best to support each other during these situations. Be open to the fact that some colleagues might need to air their frustrations as a way to manage their own bias toward patients. Acknowledging our human flaws and supporting each other really is what’s best for us and for our patients.

 

NEJM Resident 360

12 Responses to “No, I Am Not Patient Transport”

  1. R Colucci says:

    OMG….those pesky 6 ft plus, usually WHITE males!! What shall we do with them!! If your ego is that fragile that you need to speak of a patient’s implicit bias each time one thought you were a nurse, perhaps medicine was a wrong career choice. Do you know I’d be sent free as well each time I heard a patient refer to a nurse practitioner as “Doctor”?

    • Dr. Michelle O'Brien says:

      Why would you want to negate someone’s real-life experiences? Not helpful at all not really indicated and certainly not asked for. As someone who similarly gets this daily – it is totally wearing and just utterly frustrating. Mr. R Colucci, you obviously do not know what it is like…so perhaps LISTEN and take the comment on board rather than jumping to dismiss it.

  2. Brian says:

    While it is true that there is nothing wrong with clarifying your role, no where did I read in this note the following: “Hello Mrs. Jones, I am Dr. Fritz and I will be your doctor”.

    There is nothing we can do about the preconceptions or biases of others. Knowing this, it is our responsibility to communicate clearly with patients who are often times out of their element in the hospital setting.

    • anonymous says:

      I have clearly introduced myself as “the doctor” to patients many a time, and even then, they still sometimes miss it (how many times does a white male doctor have to introduce themselves before patients finally understand they are the doctor?). Once, while supervising a medical student, the patient clearly kept calling him “doctor”- although both os us clearly identified him as a student, and me as the doctor- while referring to me as “sweetie”. Implicit bias is real, and yes, by drawing attention to it, we can change it.

  3. SWomeldorf says:

    Nicely said! I appreciate your emphasis on dealing with your frustration andwhere to go from the point of misunderstanding, rather than feeling on the anger. You are right – it happens, it shouldn’t happen nearly as often as it does – but how we respond sets the tone for our workplace and for the patients experience and care.

    Looking very closely at 50, I no longer get told on a daily basis that I must be too young to be a doctor, but I do still have to clarify that I am one. I will try anew to be patient and kind when correcting that assumption.

  4. Esteban Ardila says:

    I completely understand your position and although it is quite boring to keep correcting the patient’s implicit bias it should not prompt anger or frustration on the physician. Somehow this anger actually comes from our own desire to validate ourselves and we do not take into accoount our context eg. whenever I am practicing in my own country (Colombia) people instantly recognize me as their doctor. However, when I approach a patient in a different coutry with a different race mayority, they tend to mistakenly assume I must be a clerk (a lot of Latinos play that role in that country). It does not anger me whatsoever.

    As you so clearly stated, it is an unconscious behavior coming from previous experiences and so it means no offense and should not be felt that way.

    It is an innocent mistake we all make in certain situations. Quite a few times have I found myself talking to a teacher in a different faculty as if he or she were a student due to their young age. But then again, I mean no offense and once I stand corrected it does not (or at least should not) affect my relationship with that particular person.

  5. Caitlin Kesari says:

    Thanks for your article
    As a new(ish) attending I am still seeing a lot of new patients in my office and i have grown extremely self conscious over the fact that I can sense their disbelief when they see me walk in the room. I feel how they lack trust in me at first. It resolves as they get to know me but it’s painful at first

  6. Emily says:

    Well said!

  7. Emily says:

    It’s not about ego, it’s about maintaining a trusting relationship with the patient.

  8. Bogumila says:

    Seriously, I don’t get your point of view. I’m a white, young and female doctor from Europe. Even if patient or family member takes me for a nurse or transport I just explain my role, sometimes it’s very funny to watch concern or embarrassment on their faces. Don’t be so serious, your life will be much easier
    P.S. My boyfriend doesn’t have these problems. But you know what? I don’t care, good for him!

    • Dr. Michelle O'Brien says:

      You can enjoy not being serious… but as a physician it is important that I should be taken seriously by patients. I certainly take my role seriously – don’t you?
      It is important patients know who we are.

      It is not helpful to just dismiss others’ opinions when they differ from yours…their experiences are just as valid as yours.

  9. Stephen says:

    Bias is everywhere. I am reminded that I must be aware of my own every minute lest it spoil my interactions with others, including patients, other caregivers, acquaintances, friends and relatives

    Incidentally, I’m nearly 70 and a white Jewish male. Most often I am mistaken for a priest

Resident Bloggers

2018-2019 Chief Resident Panel

Justin Davis, MBBS
Cassandra Fritz, MD
Scott Hippe, MD
Ashley McMullen, MD
Ellen Poulose-Redger, MD

Resident chiefs in hospital, internal, and family medicine

Learn more about Insights on Residency Training.