Kristin Prentiss Ott, M.D.

The Packaging of Providers as Something to Be Sold

“ORDER UP!”

“One McDreamy to ED room 18, a McSteamy to room 5, and Dr. Oz to psych bed 2.”

patrick-dempsey-04-1024Dr._Mark_Sloan dr-oz

As much as patients would like to order Patrick Dempsey, Eric Dane and Dr. Oz – we’re not there yet.

But healthcare dollars do buy choices. I picked a young, pretty woman for my primary care provider. I chose young, female ob/gyns to deliver my children. I like my healthcare served with flat-screen TVs, and a side of warmed blankets. And don’t forget my Diet Coke. I NEED Diet Coke.

I ordered my c-sections – “my way.” I requested not to have my uterus externalized. I wanted my rectus abdominis muscles reapproximated. I asked to have my skin closed with sub-q sutures – and I didn’t want the knots buried so I could trim them later. And if healthcare is just another product to be packaged and sold – we should be able to have it our way.

But there’s no “right” way to order fast food (other than politely) and there ARE rights (and wrongs) in medicine.

  • Patients with viral symptoms request “Z-packs” all the time. But we KNOW antibiotic resistance is dangerous.
  • Patients with unimpressive mechanisms of injuries want x-rays and CT scans. But we KNOW unnecessary radiation exposure unnecessarily increases cancer risk.
  • People with chronic pain routinely ask for prescriptions for schedule 2 narcotics. But we KNOW…well…we know they kill people.

In our current system of “the customer is always right” healthcare delivery – it can be hard to say, “no,” but sometimes we KNOW it’s the RIGHT thing to do.

Patients are ALL OF US. And ALL OF US have vastly different preferences based on vastly different backgrounds, levels of cultural awareness, and conscious and unconscious bias. There are patients who would not want a nurse wearing a hijab or a doctor with a tattoo. But we KNOW that hijabs and tattoos don’t negatively impact clinical skills. We KNOW racism and sexism and other “isms” are WRONG – so it should be the RIGHT thing to say “no,” to patient requests founded on these faulty principles.

My husband knew a surgeon whose patient requested not to have a black resident participate in his care. If we’re selling healthcare as a product, then patient prejudice should be accommodated. His body, his choice. In this particular situation, however, the surgeon gave the patient an ultimatum: accept the care of this resident or find yourself a new surgeon.

The patient’s choice in the matter was somewhat limited by the fact that he was ill and already admitted to the hospital – so he kept his surgeon and tolerated the care of the resident. And while I doubt this patient’s racism was cured by his forced acceptance of quality care from an undesired source, I think it was good medicine for him to swallow.

Part of what makes healthcare a “calling” is that we are called to care for all people. More than once, I have witnessed the gracious care of patients with tattoos of Nathan Bedford Forrest or swastikas by black and Jewish providers. I know of providers who oppose abortion, but still (RIGHTLY) provide women with information on the availability of this service. In the Emergency Department, the perception of someone’s ability to pay should not affect their care. And the care I give to a patient wearing a shirt that says, “I like my women barefoot and pregnant,” will be the same care I give to a patient wearing a shirt that says, “Be the doctor your mother wanted you to marry.”

Healthcare, at its best, is unbiased. We KNOW this is RIGHT. So why would we accommodate patient preferences founded on prejudice? If it is WRONG for us – it is WRONG period. Just like handing out narcotics like candy is bad medicine – bending to bias seems like bad medicine.

Unfortunately, the BUSINESS of medicine is getting in the way of our ideals. As patients increasingly exercise choice in all aspects of their care, the marketing of medicine as something to sell has never been greater. Most heathcare establishments are selling the same thing: quality care. What sets them apart is the packaging. Patients want their care in gleaming new facilities from providers with Crest-white smiles. Dress codes are part of the packaging. And I am sad to say that healthcare dress codes often exemplify unfounded bias rather than reject it.

I came across a study out of the UK that showed that nearly 70% of patients found facial jewelry “unacceptable” for a healthcare provider. In some cultures, however, this is traditional:

nose piercing black box

But rather than embrace a cultural history that might make some patients uncomfortable, most hospital dress codes require that piercings like this one be covered. One of the best charge nurses I have ever worked with covered the discreet stud in her left nostril with a not-so-discreet bandage every shift. Hospital policy.

Tattoos have long carried a stigma of being unprofessional. In Egypt, however, it is overwhelmingly common for Coptic Christians to have a cross tattooed on the inside of a wrist.

copticcross

A tattoo can’t be removed like a star of David necklace or cross earrings. So inside most hospitals, that provider’s wrist would have to look like this:

coptic2

Is it really better to have patients wonder what’s under a bandage than have them see a tattoo?

A nurse confided to me that she was told by a nursing administrator that her hair must appear, “clean.” She’s black. She was told dreadlocks and Afro hairstyles were prohibited. Perhaps some patients would think hair like this appears “dirty:”

dreads1 naturalafro2

But they would be uninformed.

How is it that inaccurate, POTENTIAL, perceptions are winning out over REAL perceptions of informed people who know these hairstyles are clean (and beautiful)?

A female physician with closely cropped hair was encouraged by an administrator to “soften” her look. It was suggested that she try “pearls and scarves.” I can only presume the administrator thought some patients might be uncomfortable with a female provider who doesn’t appear feminine.

But since when is ascribing to gender norms indicative of one’s ability to provide excellent medical care?

As scientists, we are taught to recognize and avoid bias. But it is a sad reality that many healthcare dress codes are biased in favor of narrow traditionalism that wasn’t very tolerant or culturally aware. Healthcare professionals should always reject popular opinion for truth. And the truth is:

  • A small stud in someone’s nostril is not a character flaw.
  • Tattoos do not change a provider’s clinical skill.
  • Natural black hairstyles are not “dirty.”
  • And gender norms are social constructs that do not require conformity.

Healthcare dollars are mighty. But they should not be able to buy the soul of a profession that is founded on the unbiased treatment of all people. Money will always buy patients choices, but it should never buy them the limitation of choices for others.

 

Photo credits: Flikr – SpeckledOwl (nostril piercing), Pedro Kwezi (black hairstyles); creative commons license – photos cropped, black boxes added.

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Kristin Prentiss Ott, M.D.

Author of the viral post: 10 Things to Know Before Your Next Visit to the Emergency Department. Board certified emergency medicine physician, wife, mother, aspiring novelist.
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2 Comments

  1. padrooga

    P.S. I thought it would be a safety issue to wear anything around your neck that could be pulled on by a patient. (pearls and scarves)

    And why is it women are subject to fashion police so much?

  2. padrooga

    Regarding facial piercings- Possible source/access to infection by droplet? If any of them might make it difficult to utilize proper safety gear… perhaps. Otherwise, no biggie. Tattoos? Not a fan, but hey, if you want to bumper sticker your body in order to draw attention to yourself, be my guest. Everyone wants a platform to tell their story.
    Times change, fashion changes.
    Although I do find it interesting that the med students that visit for their residency interviews are practically issued a uniform. I always see gaggles of them walking in the hallways. All have on the same black suit. Some of the women MAY wear a skirt, but all them are dressed in black, with white. NO INDIVIDUALITY at all. They have been trained in strategies for success and apparently presenting yourself as a clone is what it takes to be accepted. IS it any wonder so many docs can’t think outside of the algorithms they have had imprinted on their brains? Creativity is crushed from the poor souls.

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