Dr. Anita Chary is on the blog today discussing her experience as a physician in the Emergency Department. She calls to attention how often she is confused for a non-physician due to her gender. Dr. Chary shares how this issue of being mistaken as other members of the team but NOT the physicians is ultimately a patient safety issue and puts our patients at risk for HARM.
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As a female physician, it’s essentially a rite of passage to have your patient mistake you for a nurse, a technician, or another type of non-physician role. Despite introducing myself as “Dr. Chary” in every encounter, patients still mistake me for a nurse or non-clinical role. My female attending mentors, decades into their clinical careers, tell me that this experience does not go away over time—even if you wear a white coat, sport a “DOCTOR” badge, or hand out business cards with your professional title.
Early in residency, I found this experience frustrating. When I expressed misgivings about being confused for a non-physician, colleagues’ first assumption was that I took offense that my years of education and personal sacrifice were being disregarded. To some degree, that is true, but it felt less about me specifically and more about being a woman in medicine facing daily sexism: I find the pervasiveness of implicit gender bias tiring. We’ve been socially conditioned to imagine physicians as males—often white males—and when someone’s appearance deviates from that, it simply doesn’t fit into our doctor schema. We’ve also been socially conditioned to imagine women in caregiving roles. Indeed, throughout residency, some of my colleagues encouraged me to reframe role confusion as a compliment. Nurses tend to provide patients with emotional support and care—isn’t it nice that patients associate you, as a woman, with that?
Early on in residency, as patients mistook me over and over again for a non-physician, I quickly came to realize that offense was not actually at the heart of this experience for me. What concerned me more was how role confusion can lead to poor patient care or perceptions of poor care.
The first patient I saw as an intern had chronic lower extremity paralysis and needed help getting on a bedpan, a task I had minimal experience with. She asked me to grab one after I had finished my history and physical exam. When I inevitably struggled, alone, to get the patient situated, she exclaimed, “What kind of nurse doesn’t know how to get their patient on a bedpan?” Reintroducing myself as a doctor led to a slew of questions about where I had gone to college and medical school.
What upset me about this situation was not merely being mistaken for a non-physician. It was also that my patient perceived she was receiving poor quality nursing care. My inability to perform the task quickly and efficiently led her to question not only my capabilities, but my institution’s reputation.
As a senior resident, on a busy overnight, I held an extensive discussion with a patient’s brother about her prognosis and goals of care in the setting of catastrophic illness and minimal response to emergency therapies. I had introduced myself as the patient’s doctor the first time I walked into the room to assess the patient and begin leading her resuscitation, and had reintroduced myself as “Dr. Chary” when initiating the goals of care conversation. After we had spoken for about 15 minutes and he had come to the decision to transition to comfort measures, he surprised me with: ”Thanks for going through this with me. When is the doctor going to get here?”
What’s dangerous about the above situation is the potential confusion over a life-and-death care plan. I clarified with the patient’s brother that he had thought I was one of the nurses. What he had communicated to me was what would go in as a physician’s order on my end—comfort measures only—but he was still apparently waiting to speak to a physician to finalize this decision.
I’ve had patients complain, hours into their emergency department stay, that they still haven’t met a doctor yet—because they met me, my female attending, and a female consultant. I’ve had patients whom I’ve seen within 5 minutes of their arrival voice concern that they weren’t quickly evaluated by a doctor for what they thought was an emergency. I often loop back into those rooms to clarify my role and attempt to reassure patients that we are working hard to provide them with excellent care. It feels like my obligation to my patients and my institution to do so, and perhaps to the more progressive society that I hope to create. However, each time I do this, it drains me of emotional energy, and I wish I didn’t have to.
I don’t blame my patients for forgetting my name or forgetting my role. In the emergency department, most people are in crisis mode and it’s difficult to assimilate new information. I also greatly value my colleagues—nurses, techs, environmental services—and my concern over being mistaken for these roles does not stem from a devaluation of them. We depend on each other’s input, insights, and skills to provide our patients with high quality care as a team. However, assumptions that I serve in another team member’s professional role, rather than as a physician, can do my patients harm. This is why it’s important for my patients to know I am their doctor.