Addressing the Elephant in the Room: Discussing Taboos During Patient Encounters

Four year agos, I sat in a lecture hall at the Johns Hopkins School of Public Health discussing with fellow health professionals the ways in which diseases discriminate. It is a well-documented fact that women are at higher risk for Alzheimer’s and multiple sclerosis. African Americans are at higher risk for heart disease and stroke. Obesity increases one’s risk for type 2 diabetes and osteoarthritis. These inequalities in disease distribution are partly due to genetics and partly due to lack of equity in care. Yet as I transitioned from the realm of public health to providing care to patients, I rarely witness the dissemination of such information directly to patients.

In an already cramped 15–20 minute patient encounter, addressing race or weight is uncomfortable and awkward at best. It is easier to dilute recommendations with flowery niceties that makes us feel like we addressed the issue without causing discomfort. Yet, I am realizing that not directly addressing race, weight, or sex and its contribution to certain diseases is a grave disservice.

In my specialty of obstetrics, I witness the ramifications of not addressing such issues in palpable ways. I meet pregnant black women who chalk up headaches to lack of sleep without realizing their higher risk for eclamptic seizures and stroke. Obese women discount a day of decreased fetal movement as “just an off day” without recognizing their higher risk of delivering a stillborn. Often, after a bad outcome, when we are forced to explain all of the risk factors that may have contributed to a maternal or fetal death, patients feel blindsided.

As a result of these experiences, I have slowly changed how I practice medicine. In all of my new patient visits, I devote five minutes to discuss what risk factors the patient has for particular diseases and what, if anything, can be done to modify those risk factors. Of course, some risk factors are non-modifiable, in those instances I shift more to educating why certain symptoms deserve greater attention in that patient as opposed to someone else.

As the pressures to practice fast medicine mounts, we ought to take a moment to recenter ourselves in the meaning of “doctoring”. As its origin in the latin root, docco, which means “to teach” suggests, we should continue to spend time teaching about the ways in which biology intersects with one’s biography and empower patients to take a greater control in creating their health biographies.

Dr. Jerome Chelliah is a resident physician in Obstetrics and Gynecology as well as a 2018–2019 Doximity Author.

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