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Wednesday, August 21, 2013

LIfe at Grady: Dressing the part

I walked into the clinic room and introduced myself. “Hello. My name is Dr. Manning and I’m one of the senior doctors in the clinic who works with your primary doctor.”

This Grady elder sucked her teeth. Hard. She looked me all the way up and then all the way down. Then she suctioned her tongue against her back teeth once more like she had something caught back in a molar. Her lip jutted out and her brow furrowed.

“Your doctor has told me a lot about you. It’s a pleasure to meet you.” I tried to break up the uncomfortable once-over she was giving me. But it didn’t work.

“Who you said you was?” she asked. This time her face was twisted up and her nose was wrinkled like a bad smell had wafted into the room.

“I’m Dr. Manning. I work with your doctor.” I tried to smile as brightly as possible.

She curled her lips and then grunted. “Unnh.” Kind of like the way mean girls size up other mean girls at high school basketball games. That grunt was not an approving one, that’s for sure.

I decided that I didn’t have the energy to try to decipher all of that, so I just came right out and asked. “Is something wrong, ma’am?”

Her response to that question started with a slow roll of her eyes. Her voice came out throaty. Almost like a growl. “Look to me like if you a doctor that you should have on something that makes somebody know who you is.”

I looked down at myself to see where all of this was coming from. I was wearing my badge. It was facing forward with my name and title prominently displayed. I was dressed professionally in a dress that hit at the knee and a low-heeled shoe. As a matter of fact, that dress was freshly pressed from the dry cleaner and you could tell from looking at it. Hell, I even had a stethoscope around my neck. What could she possibly be--

Aaah.

I figured it out. On this day, I wasn’t wearing my white coat. And honestly, the only reason I wasn’t was because that morning I’d decided that it was too dirty around the sleeves. Just before walking into the primary care center, I decided that it wasn’t up to snuff and that my patients--ones like this woman--deserved better.

“Oh, are you saying that because I’m not wearing a white coat?”

“You look like a sec-a-tary. Not a doctor. A sec-a-tary with a step-a-scope ‘round yo’ neck. Like you some kinda pretend doctor.”

Ouch. I chuckled, more because I was uncomfortable than amused. She didn’t even crack the tiniest smirk.

“I apologize if that made you feel less comfortable. This morning when I looked at my coat I saw a little. . .well. . . grit on it. Kind of like ‘ring around the collar’ but on the sleeve.” I gestured to show what I meant. “I didn’t want to come and see you with a dirty coat. Since the other ones weren’t readily available to me, I just took that lab coat off and clipped my badge to my dress. But it sounds like you prefer to see your doctor in a white coat?”

“I jest don’t want no sec-a-tary coming at me talking ‘bout my medicines, that’s all. I swear fo’ God I thought you was the lady at the front desk. Definitely not no doctor.”

Zing.

I nodded and pressed my lips together. I turned up the deference to see if it would help. “Yes, ma’am. I’m sorry for that. I really am. I want you to feel comfortable. Are you okay with me participating in your care? Without my jacket?”

My resident wanted to defend me so he jumped in. “Mrs. Johnson, did you know that these lab coats can carry infections? Like, a lot of doctors never wear them at all anymore. And they can scare kids. So a lot of doctors don’t wear white coats at all. Or even neck ties. Isn’t that funny?”

She was not amused. Or convinced by that argument.

“Look here, Miss Manning. I’m ‘bout to mek ninety next year. And in ninety-some-odd-years I seen a lot. See, in my time, some colored people ain’t even want no colored doctor. Ain’t want nothin’ to do wit’ ‘em. That’s ‘cawse with all the colored hospitals, see, they ain’t have all the same stuff. Or you ain’t know if the people in there had all they had credentials.”

Damn.

I thought about all of the doctors from my alma mater, Meharry, that had come before me. The legions of African-American physicians trained from 1876 until the year I graduated in 1996. I wanted to tell of the excellent medical education I received and that it didn’t start with me. That, as a ninety-year-old, more than likely every single one of those black physicians that she came into contact with trained at either Meharry Medical College or Howard University College of Medicine. And that every single one of us earned those credentials. We did.

But. Instead, I stayed silent. And just listened.

“It used to be where when I saw doctors here at the Gradys, I ain’t want to see no colored doctors. Or no lady doctors, neither. And for a long time it wasn’t na’an so I ain’t have to even say, you know, that this my preference. But then I start seeing more and more. Colored doctors and lady doctors, too. At first I ain’t won’t none of ‘em. But after time, you ain’t always got no choice, you know? But I seen ‘em and turn out that they was good. Good as anybody, I guess.”

“Hmmm.” That was all I could think to say in response. She went on.

“Yeah, the colored doctors and the lady doctors seem okay. But look to me like I always get particular about how they look.”

“How they. . .look?”

“Mmmm hmmm. Like, do they look like a real doctor, you know? And could I mistake ‘em for something different.”

I nodded. “So. . . . that’s what bothered you about me not having on my lab coat. You weren’t sure if I was a doctor?”

“Maybe. I think it’s jest the times I came up in, you know? Like you always need to prove yourself. See, this young man here? He don’t got to worry ‘bout all that. But you? You do.” She gestured to the resident physician standing next to the examining table, his pale face now crimson. “Otherwise somebody don’t know how to feel ‘bout you comin’ in they direction like you s’posed to be somebody.”

Wow. I narrowed my eyes and let that marinate. After a few moments, I decided not to say anything in return. I chewed the inside of my cheek and tried not to look like I was filing all of this to think about more when I had time.

“Do you understand what I’m sayin’?” she finally asked me.

“Umm. . .kind of. I think I do.” And that was the end of that.

She let me examine her body and be a part of her care plan but most of her questions she directed at the resident doctor. And this woman--let me be completely clear--was African-American.

I am still trying to pick that whole interaction apart. Her thinking that I was a secretary. Her previously refusing black or “colored” physicians. Or lady ones. Her life experiences that brought her to this place. What this meant about how she felt about herself and her own people. And, of course, how all of this played into her disdain at the absence of my white coat. I couldn’t sort out whether or not it embarrassed her that I was without it or underscored some preconceived idea she’d had before I even walked in. Or both.

I don’t know. But either way…this? This, my friends, is Grady.

Kimberly Manning, MD, FACP, FAAP is an associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia where she teaches medical students and residents at Grady Hospital. This post is adapted from Reflections of a Grady Doctor, Dr. Manning’s blog about teaching, learning, caring and growing in medicine and life. It has been adapted and reprinted with permission. Identifying information has been changed to protect individuals’ privacy.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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