For more Q & A, see my
Test your knowledge of ER terms by solving my ER crossword puzzle that was featured in the Prudential Securities Healthcare Group 2002 calendar. Or take the ER-MCAT to see if you have what it takes to be an ER physician.
Amy reviews ER computer games
I've been to the emergency
room a couple times in the past ten years, once for a fainting spell/seizure
that I had in a nightclub (so I was dressed fairly well) and again last summer
when I had what they thought was a kidney stone. Both were humiliating
experiences, mainly because I felt like I was being looked at by my docs as "a
chick" as much as "a patient." A little more smiling and eye contact than I
was comfortable with from the person examining my body and my situation, if
you know what I mean, when all I really wanted was to be taken seriously and
given straight answers.
Commentary by Kevin Pezzi, MD
What is the "pitfall of being pulchritudinous" that I mentioned in the page subtitle? I contend that extraordinarily attractive women are more likely to receive substandard treatment from male physicians. I will discuss some reasons for this, then present a mea culpa in which I reveal how I've succumbed to this problem, too.
Given that attractive women often receive more attention, it may seem counterintuitive to suggest that this surfeit of attention results in second-rate medical care. However, this does occur because the heightened attention is focused on the woman's beauty, not the woman's health problem. Hence, simple gawking can sidetrack the physician's attention. He may also be distracted by thinking of her as a potential date. Is she wearing a wedding ring? Does her chart indicate her marital status? Has she said anything to suggest whether or not she is available? If not, how can I evoke such a revelation?
Stunning beauty can also discombobulate men, including physicians. Once a male retina imprints on a pulchritudinous woman, a neurophysiological response is induced that is not conducive to concentration . . . at least not concentration on cerebral matters. Thus, even if a doc does his best to zero in on the medical problem, he must fight eons of programming that divert his attention elsewhere.
A strikingly attractive woman may also receive poor medical care because her beauty is sufficiently intimidating to deter the physician from doing some exam because he fears that the patient might question the legitimacy of it. I will illustrate this by divulging one of my cases. I had a patient who was a knockout. She was cute, beautiful, sexy, and exuded a playfulness that I found captivating. Unfortunately for me, her breasts were so tantalizing that I couldn't help but notice them; they were large, full, and would jiggle distractingly whenever she moved. I said "unfortunately" because she had, alas, chest pain. I did the usual ER evaluation, including an EKG, chest x-ray, various blood tests, blood oxygen level, cardiac monitoring, and whatnot. The history was similarly unhelpful in diagnosing her problem, so with more than a bit of trepidation, I embarked on the physical exam. Ordinarily, I exam patients before ordering tests, but this patient was signed out to me by the doc who worked the preceding shift, thus explaining the apparently illogical sequence of evaluation.
If you've been to medical school, you know about the mitral area. If not, I will explain it. There are four cardinal points on the anterior chest wall for cardiac auscultation: the aortic, pulmonary, tricuspid, and mitral areas, named after the corresponding heart valves. These areas represent the zones at which sounds emanating from the valves are best heard (in most cases; I won't explain the exceptions and turn this into a cardiology lecture). The aortic and pulmonary areas are positioned high enough on the chest wall to be made visible by a moderately plunging neckline. Thus, auscultation of these areas typically does not induce much discomfiture on part of the physician. The tricuspid area is smack-dab in the area where the cleavage begins to get very interesting, and when a doc has a lusciously well-endowed woman as a patient, he may be hesitant to plant his stethoscope in this area, fearing that the woman might think he is fixated more on titillation than heart sounds. The mitral area is even more of a challenge, since it is often covered by a pendulous left breast. Since breast tissue and cloth attenuate sound, the best thing to do is to expose this spot and displace the breast before listening. However much I would have enjoyed touching her breast, I thought there was too much opportunity for my actions to be misconstrued, so I asked that she displace her breast while I listened through her gown—undraping her breasts seemed to be too much of a dream come true to justify doing it for some flimsy excuse, such as a cardiac exam. Hence, her gown stayed on.
I suppose most doctors are not as finicky as I am about auscultation (except in treating women who are supremely attractive), but in the process of developing my electronic stethoscopes, phonocardiographs, and echophonocardiographs, I spent thousands of hours listening to heart sounds and analyzing them in every way possible, during which time I became very persnickety about the process. Consequently, I generally eschew anything that interferes with auscultation, even slightly. Most physicians do not mind a bit of intervening cloth, so my failure to remove her gown may seem inconsequential. However, if a person has chest pain, it is important to consider every possible serious cause of it, including breast diseases such as infection and cancer. Thus, inspection and palpation aren't optional, unless the doc has a Ouija board or crystal ball in fine tune. You may think of breast cancer as a disease that affects older women, but I've seen women as young as twenty who were killed by it (that is, by the way, a story I'm saving for my next book of ER stories). Since my beautiful bombshell was in her late twenties, that was possible. Highly unlikely, considering that her tenderness seemed to be confined to the area around the sternum (breastbone), but possible. Therefore, after I determined that the peristernal area was tender, I should have verified that other areas were not. In short, I should have done a complete exam, but I settled for an almost complete exam. I diagnosed her as having costochondritis, an inflammation of the joints between the ribs and sternum. Almost undoubtedly, this was the correct diagnosis, but why leave it to chance? If she were less attractive, I would not have hesitated to complete the examination.
The reluctance of physicians to completely examine beautiful women is somewhat similar to the VIP syndrome, in which doctors are intimidated by patients who are celebrities, dignitaries, bigwigs, or otherwise luminaries. Generally, the VIP's do nothing to trigger this intimidation, but their status may be sufficient to make doctors loath to perform breast, pelvic, genital, or rectal exams. One of the most notorious cases of the VIP syndrome going awry is that of Jackie Gleason, the famous comedian. Because Gleason was a celebrity, his physician neglected to perform a rectal exam on him, thus missing a rectal tumor that might otherwise have been detected early enough to have been cured. Instead, the cancer was discovered at an advanced stage, and Gleason died. And then there is Elvis Presley, whose penchant for drugs was fueled by a doctor who gave The King what he wanted. And then there is Michael Jackson, whose plastic surgeons evidently don't know when to say no.
I am not susceptible to the VIP syndrome, perhaps because my knowledge of popular culture is so sketchy that I rarely knew that my patient was a celebrity until a gushing nurse pointed it out to me. Even then, I am not easily impressed by big shots, so if one had an orifice that needed probing, I'd probe it. But very beautiful women are another story. In retrospect, my reluctance to treat them the same as other patients was inexcusable. Perhaps surprisingly, I never hesitated to do a pelvic or rectal exam if one was needed, but I recall two cases in which I did not do a breast exam simply because the woman was drop-dead gorgeous. Had there been a specific reason for doing the exam (such as a breast discharge), I would have done it. When physicians perform a complete exam, some of the things they check are vitally necessary because of hints from the patient history, but other aspects of the exam are tantamount to a wild-goose chase yet are done for the sake of completeness. Sometimes, these low-yield exam components reveal an important finding, thus they aren't worthless. The threshold for determining what constitutes a wild-goose chase seems to be inversely proportional to the woman's beauty. Therefore, beautiful women should be cognizant of this tendency for male physicians to treat them differently and, if necessary, take steps to ensure that their care is not compromised. I am a fan of the direct approach, so if a woman detects that her physician is spellbound, she should matter-of-factly acknowledge his apparent captivation and request that she be treated as any other woman. If that doesn't suffice, she should suggest that the doctor do something he may be reluctant to do, such as a breast exam. Don't let your beauty turn you into the next Jackie Gleason.