Prejudice is a part of us that has no place in medicine

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Watching the happy smiles of medical graduates this week assures the seasoned observer that they have no idea how they have subtly evolved in society from young, attractive and hopeful to signs before -runners of disease and death.

Jthey have no idea that by simply putting on the white coat (well, now when they’ve thrown off the black qualifying robes) and assuming the title of “doctor” they’ve become someone the rest of us would rather avoid. Not, of course, that they were in any way socially abrasive or bad company, but in the same way friends in my youth used to avoid befriending members of An Garda Síochána – for fear of having to live within what we then thought were the too narrow confines of the law – the general public would much rather avoid doctors altogether.

This nuance will be missed by the young graduate – having been celebrated and cherished for many years for his hard work, intelligence and ability by very important people – professors, consultants, surgeons and academics – perhaps even journalists! They may have won medals, topped their cohort or class – they may even have earned postgraduate degrees. But the average woman on the street would rather not meet them professionally, and the more qualified they are, the less they would like to meet them professionally.

Often the newly minted physician has very little understanding of this phenomenon. Their own circle will probably have been very supportive of their studies and achievements. Medicine often runs through families like genes – the desire to help others, the opportunity, the privilege to heal don’t usually fall from the trees.

And it in no way reflects the actual person behind the stethoscope. The patient is certainly looking to make sure the fingernails are clean, the shirt is fresh, and the person is presentable and looks like a doctor. But for every person sitting across from their doctor, there’s someone who would much rather be somewhere else.

Like in one of those cartoons, the doctor assumes his patient is looking at him and seeing the person, but in fact the patient may be looking at something else. In their minds they can see the worst results of cancer, dementia or leprosy.

One might laugh at the thought of someone contracting leprosy in Ireland in 2022, but for the patient it is not the accuracy of their medical knowledge that is important to them, but their honest and sincere belief about of his illness which animates all his thoughts and fears. .

It is in this spirit that I recommend reading Dr. Brendan O’Shea piece in the current edition of Irish medical times which you can access here. He rightly points out that prejudice – which he diplomatically calls “stigma” – is part of our humanity and has no place in medicine. It’s hard enough to bring the patient to a comfort level where they can explain what’s ailing them – adding your own body language signifying disgust or discomfort will only add to that.

I had the experience as a young man of getting a series of tests related to what young men do, and one of those tests was for HIV. In those days, if you did the right thing and took care of your sexual health (don’t mention it), you went to an outpatient department of a major hospital.

While I was there, sitting in a waiting room that might as well have had a sign saying “Drug addicts, gays, prostitutes wait here”, two Gardaí arrived with a handcuffed man between them. There was shoving, shoving, a bit of shouting and a lot of coercion. Presumably, they then added “Violent criminals” to this imaginary sign.

In reality, this sign, if it had been written, would have used much more pejorative words. But no problem there, the consultant was above that. When I finally got the results three weeks later, I had to wait in the same room for 45 minutes and then was ushered into a room with the revered doctor.

Imagine the wait! Will I live or die at 21? Was there going to be a miserable, painful, stigmatized life or death?

He looked at me (with disdain, or so I thought) then returned to his office where he reviewed my file. He flipped through a few pages, giving each a few seconds, then closed the folder and said dismissively, “Well, you’re negative.” He looked disappointed.

The seconds tick away. “What does that mean?” I said.

We both knew that some of the other STDs were, by comparison, inconsequential. HIV was the virus that kills – all young people dreaded it, feared it, saw Gay Byrne put a condom on a dildo on live TV and were scared to death.

“Oh,” he replied, “you don’t have it. You’re not infected.

He then started to lecture me on sex and the need to protect myself, but all I heard were the two words “uninfected”. Condoms were still illegal in Ireland at that time – or at least very hard to get, but I wasn’t thinking condoms – I was thinking “Uninfected, uninfected, uninfected”.

Fear is the thing. That’s what makes everyone sick. Covid-19 has done it in all areas. The virus has made us all think about death like HIV has made us equate sex with death. This time the deaths are those of our loved ones, a meaningless random death for no reason other than the luck of the draw, and whether it’s a condom or a mask, there’s always a risk , and most people don’t take solace from mathematical statistics and equations. Doctors can know the statistics and rejoice. They don’t do much for the “well worried” out there except add another visual reminder wherever they go that death is here and ever present.

In a world where Russia is bombing schools and hospitals, the US President is planning to end democracy, the Japanese Prime Minister is shot during his campaign and the Covid-19 virus is prowling the world, it is difficult for the person average to have good mental health and maintain a positive outlook. And then you can get sick.

These young physicians face this new world with a duty to empathize and share their tremendous knowledge and judgment without stigma or prejudice. The first job is kindness, compassion and empathy. This is what makes the job difficult. The rest is just science.

They must remember that they have become doctors, nurses, healers – and in some cases friends. But not God.

Although, for some patients, they inevitably will be – give or take life with their words. Let’s just hope they remember – no one wants to talk to God.

At least not today.

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