We are taught patient profiling

I recently read an article entitled, “Are you a victim of patient profiling?” on KevinMD.com (link to article) and it got me thinking about my medical school career thus far, particularly my recent preparations for USMLE step 1.

Patient profiling is part of medical school curriculum. Many of the practice questions that I’ve done for step 1 have relied on patient profiling (a euphemism for prejudice I believe) to get the correct answer. If the question starts out with “The patient is a 35 year old African-American female…” a list of diseases already begins to populate in my mind: sickle cell anemia, sarcoidosis, and fibroids all come to mind in the first 0.5 seconds, and I don’t even know her symptoms yet.

If you were to change the question to “The patient is a 35 year old Asian-American female…” my mental list of prejudiced diagnoses changes drastically: Takayasu’s arteritis, or perhaps alpha-thalassemia.

How can one possibly expect that these types of snap judgments that we are taught to make during the first 2 years of medical school, and are thoroughly reinforced during weeks on end of studying for a board exam, will suddenly go away? How can we be expected to keep an open mind, and consider all of the diagnostic possibilities if we are trained to jump to conclusions based on such a meager amount of information?

Please don’t misunderstand me; it is true that certain groups of individuals are disproportionately affected by certain illnesses. Having knowledge of these differences is a good thing, because it can help to bring relevant diseases to one’s mind. However when that knowledge gets in the way of listening to the patient, and understanding that individual patient’s story we can run into trouble. Indeed, we could really harm our patients (I seem to recall reciting some oath to the effect that we’re not supposed to do that) if our judgment is too clouded to hear them out. Medicine is not one-size-fits-all.

Of course, it is easy for me, as someone who has yet to enter the clinical phase of my training, to get up on my high horse about such things. I’ve not yet been “in the trenches” of clinical medicine. I am far from perfect; there are plenty of people who would tell you so. I too will inadvertently wield medical prejudice as a tool to attempt to make quick work of my patients.

I believe that prejudice is a part of the human condition, no matter how much we may like to believe that it is not. We all make snap judgments. What we can do is struggle against it, but the first step is to acknowledge that we pre-judge. From there, we can try to keep vigilant, and remind ourselves to keep an open mind when we feel that snap judgment coming. We must make a concerted effort to grow in this area, not only as a medical community, but also as human beings.