irrelevant words matter


It was Friday afternoon and the last patient of the clinic day had arrived. A new patient to me. While the medical assistant asked her screening questions (Do you smoke cigarettes? Do you have pain? Have you fallen recently?) and checked his vitals (blood pressure, heart rate, weight), I started to get to know him through his medical record. I began with the clinic referral to find out why he was in my clinic in the first place. Would I be figuring out why he had an electrolyte problem (like low potassium levels) or thousands of grams of protein in his urine (when normal is less than 30 milligrams)? Or would I find the usual, a case of irreversible kidney damage caused by high blood pressure and/or diabetes? The first line read: 70 year-old formerly incarcerated man with recent hospital admission for…


Formerly. Incarcerated.


I had to go back and re-read these words. They gave me pause. They took me back to my days as a resident physician when I was involved in a case so interesting the details of it were spoken and written by doctors from several different teams. Perhaps more interesting, I don’t remember what unusual diagnosis the patient had, but I do remember feeling an overwhelming darkness every time I entered the patient’s room that extended beyond the closed blinds and low fluorescent lights. I remember greasy-appearing strands of black hair behind a receding hairline that grazed his shoulders. Thick black-framed glasses magnifying dark, murky eyes above a dour, thin-lipped mouth. His large frame ominously hunched in the hospital bed. And I remember how each and every one of us started the case presentation: This is a 54 year-old pedophile presenting with….




One could almost feel the tightening and shifting—and judging—happening within every young doctor hearing this word. Then a senior doctor spoke.


“Why are we hearing about what he did? It has nothing to do with figuring out his diagnosis. All it does is bias how we think about him,” she said.


A stunned silence fell over the room. Or maybe it was just an ashamed one. Or a bit of both. I don’t remember what broke that silence and allowed us to move on to a clinical discussion of the case, but I do remember no one mentioned his pedophilia again.


I walked into the exam room where my new “formerly incarcerated” patient sat, his mouth thin-lipped and dour. His mouth reminded me of my patient all those years ago. And as I talked to my new patient as if I hadn’t read those words, I was struck by how his mouth softened and spoke openly. Like a mouth not being judged before it opened.


I have found that doctors can take extreme offense at the suggestion that we could be biased in any way. That our scientific minds could somehow be swayed by our humanness. Or how we engage patients might factor into how they interact with us or follow our medical advice. But how could it not?


This is why when I wrote my note about my new patient’s clinical problem in his medical record, the words “formerly incarcerated” were not included. Those words had nothing to do with the kidney problem I was supposed to help him with. Those words could only serve to make others prejudge him in ways that maybe they weren’t even conscious of.


For the very same reasons, I did not include his race either.