Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Be careful of the labels we assign our patients

Ethan L. Bernstein, MD
Physician
February 11, 2017
Share
Tweet
Share

Reducing the essence of a human being to a single sentence is impossible, but in taking care of patients, we doctors do it all the time

The one-liner attempts to summarize an individual and an illness into a single, typically run-on, sentence to expedite communication.  It is a thesis statement for your diagnosis. Word choice and omission are critical.  By the end of this thesis statement, your audience, in spite of the known perils of anchoring and premature closure, has already placed the patient into a familiar box.

Take, for example, my 62-year-old patient who was an IV drug user and developed an infection of his tricuspid valve.  Thus framed, the audience is prone to labeling him as “shooter with a fever.” In so doing, they partially blame him for his present illness.  The one-liner doesn’t permit me as a presenter to explain that he suffered a back injury while working construction in the 1980s, was given a lifetime supply of opioids, and then started using heroin when his scripts ran out. With its limited words and content, the one-liner can generate bias.

This is a 55-year-old woman with a history of diabetes and hypertension presenting with crushing substernal chest pain that radiates to the left arm.

This is a 55-year-old woman with a history of fibromyalgia and anxiety presenting with squeezing substernal chest pain in the setting of recent divorce.

This is a 55-year-old woman with a history of sickle cell disease presenting with stabbing substernal chest pain.

The one-liner has evolved over the years to include only what is truly medically relevant.  For instance, when my grandfather started internship in 1958, he was taught to always include race because it is an important determinant of disease.  My father, 30 years later, still placed race in the one-liner but only so that “you could picture the patient.”  When I was taught oral presentations a few years ago, the dogma was to almost never include it.  Evidence had emerged that ethnicity inappropriately influences how physicians treat pain from long bone fractures and choose chemotherapy regimens for ovarian cancer.

As I started my intern year, an admission called into question my own perceptions of the idiosyncratic one-liner.  I was admitting a patient for a complicated urinary tract infection. While walking back from the ED, I wondered where and how to include that she was a trans woman.  If this were a CHF exacerbation, perhaps I wouldn’t include it at all or simply mention it in passing with other routine data.

I thought of my team members trying to “picture” the patient and how “trans” would affect those images.  Ultimately, with the hope that it wouldn’t influence her care, I said “trans woman” in the one-liner because it seemed relevant to a complicated UTI.

We have just finished a year that has made the divisions in our society more palpable than ever.  As a medical community, we should be more cognizant of the labels we assign to our patients.  The one-liner can engender premature closure and anchoring by placing patients in inflexible boxes right at the beginning of the presentation. But I believe we can avoid the bias through conscious scrutiny of the words we put into that single critical sentence.

Ethan L. Bernstein is an internal medicine resident.

Image credit: Shutterstock.com

Prev

A specter from the implementation and demise of the ACA

February 11, 2017 Kevin 2
…
Next

Your doctors may be lying about how long they worked today

February 11, 2017 Kevin 7
…

ADVERTISEMENT

Tagged as: Hospital-Based Medicine

Post navigation

< Previous Post
A specter from the implementation and demise of the ACA
Next Post >
Your doctors may be lying about how long they worked today

ADVERTISEMENT

More by Ethan L. Bernstein, MD

  • Burgers with a side of glomerulonephritis

    Ethan L. Bernstein, MD

Related Posts

  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • You are abandoning your patients if you are not active on social media

    Pat Rich
  • Physician Suicide Awareness Day: Where are the patients? 

    Jennifer M. Sweeney
  • Is physician shadowing immoral?

    David Penner
  • A love letter to patients

    Marcie Costello
  • Patients are not passengers

    Christopher Noll, RN, MSN

More in Physician

  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • How regulatory overreach is destroying innovation in U.S. health care

    Kayvan Haddadan, MD
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...