“So you’re currently not taking any steps towards improving your nutrition?” I asked.
The woman glared; my face flushed.
“No,” she said sharply, “I told you. I’m not losing weight.”
I was at the end of my checklist with one of my first standardized patients. Also known as SPs, standardized patients are paid actors who help teach new medical students the art of the history and physical. Twice a week, first-years practice on them: we fish around for their pulses, move our stethoscopes up and down their backs, and press on their bellies. We note their scripted symptoms, take a family history, and try to find the least awkward way to ask about sexual activity.
SPs are wonderful teachers. We stumble and fumble around them, learning new skills and practicing different ways of phrasing deeply personal questions. At the end, they give us feedback.
“I felt cared for,” offered my SP. “But when you asked about my diet in three different ways, I began to feel judged.”
Nutrition had been the last item on my history checklist. Unsure of how to end our encounter, I circled around diet, buying time. I asked my SP what she typically ate, and, when she answered mostly fast food, I urged her to consider changes. No wonder she felt judged: I failed to listen to her answer and hear her tone as she reported how her partner was pressuring her to lose weight, and how she just didn’t feel ready to diet. I had unwittingly added to the pressure she was getting at home.
Shortly after this encounter, I listened to the podcast She’s All Fat, produced and hosted by April K. Quioh and Stanford-alum Sophie Carter-Kahn, a show where fat women tell their stories and promote body positivity.
In this episode (#3) on body positivity — the idea that all bodies deserve respect — April remarks, “I go to the doctor and he just assumes I have diabetes.” (She does not have diabetes.) In this one line, April points to the problem of medical bias.
We doctors-in-training are taught to make particular kinds of assumptions based on visual cues, physical findings, and patient histories. But assumptions, as She’s All Fat demonstrates, can be hurtful and often wrong. So how do I balance clinical judgments and my assumptions? How can I best shape my patients’ behaviors without seeming judgmental?
What I have learned thus far is that, even more than practicing the script for taking a patient history or the choreography of the physical exam, I need to hone the skills of listening to words and hearing beyond them. I am a bit clumsy right now: juggling listening to heartbeats with my stethoscope while also hearing to my patients’ stories. But I will keep practicing, grateful for the patient actors who teach me how to listen and the podcasts that keep me thinking.
Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.
Orly Farber is a first-year medical student from Washington D.C. She graduated from UChicago in 2015 and spent the following two years in an allergy lab at the National Institutes of Health. While Orly’s heart remains in Chicago, her body is thrilled to be in the Bay Area! She loves running, hiking, rock climbing, baking bread, and tending to her plants — fully embracing the West Coast lifestyle.
Photo by annekarakash
