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

  • Complicity vs. protest: a doctor’s choice

    Patrick Hudson, MD
  • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

    Yousuf Zafar, MD
  • The hidden rewards of a primary care career

    Jerina Gani, MD, MPH
  • Why doctors regret specialty choices in their 30s

    Jeremiah J. Whittington, MD
  • 10 hard truths about practicing medicine they don’t teach in school

    Steven Goldsmith, MD
  • How I learned to love my unique name as a doctor

    Zoran Naumovski, MD
  • Most Popular

  • Past Week

    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Complicity vs. protest: a doctor’s choice

      Patrick Hudson, MD | Physician
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • Complicity vs. protest: a doctor’s choice

      Patrick Hudson, MD | Physician
    • How physician burnout and system reform are shaping the future of U.S. health care

      Irim Salik, MD | Policy
    • How nature is inspiring the future of pain medicine

      Varun Mangal | Conditions
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, 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

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Complicity vs. protest: a doctor’s choice

      Patrick Hudson, MD | Physician
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • Complicity vs. protest: a doctor’s choice

      Patrick Hudson, MD | Physician
    • How physician burnout and system reform are shaping the future of U.S. health care

      Irim Salik, MD | Policy
    • How nature is inspiring the future of pain medicine

      Varun Mangal | Conditions
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, 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...