Commenting on patient's appearance

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AcronymAllergy said:
Can confirm.
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PsyDr said:
Since the literature, to include meta-analysis, says that attractiveness affects:

1) Perception of personality
2) Perceptions of competence
3) Perceptions of intelligence
4) Income


I don't know how "inappropriate" it is to comment on a clinically meaningful thing.

And before anyone says anything about gender, the literature says it works for both genders.

And before anyone says anything about subjectivity, the literature does not support that position.

Come on. I'm a lot of things, and have a lot of flaws, but this is not motivated by sexism.

There are similar lines of literature for rich people.

Noncomprehensive Sources:

Budesheim, T. L. and S. J. DePaola (1994). "Beauty or the Beast? The Effects of Appearance, Personality, and Issue Information on Evaluations of Political Candidates." Personality and Social Psychology Bulletin 20(4): 339-348.

Doorley, K. and E. Sierminska (2015). "Myth or fact? The beauty premium across the wage distribution in Germany." Economics Letters 129: 29-34.

Feingold, A. (1992). "Good-looking people are not what we think." Psychological Bulletin 111(2): 304-341.

Langlois, J. H., et al. (2000). "Maxims or myths of beauty? A meta-analytic and theoretical review." Psychol Bull 126(3): 390-423.

Ramsey, J. L. and J. H. Langlois (2002). "Effects of the “Beauty Is Good” Stereotype on Children's Information Processing." Journal of Experimental Child Psychology 81(3): 320-340.

Scholz, J. K. and K. Sicinski (2015). "Facial Attractiveness and Lifetime Earnings: Evidence from a Cohort Study." The Review of Economics and Statistics 97(1): 14-28.

Zebrowitz, L. A., et al. (2002). "Looking Smart and Looking Good: Facial Cues to Intelligence and their Origins." Personality and Social Psychology Bulletin 28(2): 238-249.
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I don't think it's inherently inappropriate to comment on attractiveness. I do, in our current world, think it has the potential to increase various risks even when done carefully and appropriately. I have only moderate risk tolerance. But if it impacts the conceptualization, I say it's fair game.
 
It's so subjective, though. Like if I saw Jason Momoa in my office, I would not remark on his being attractive, but as you know there are plenty of people who would think he is attractive.
 
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cara susanna said:
It's so subjective, though. Like if I saw Jason Momoa in my office, I would not remark on his being attractive, but as you know there are plenty of people who would think he is attractive.
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Except the literature shows that even infants prefer attractive people, and that attractiveness can be empirically derived, partially through facial symmetry and hip:waist ratio.

Admittedly the term of art “attractive” is probably a misnomer. Most people can identify a beautiful person without necessarily being attracted to them.
 
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I have always found the literature on attractiveness interesting and can see an argument for it being a factor in the clinical presentation. That being said, I can think of few situations in which it may be helpful to comment on or document their level of attractiveness. The closest I get is challenging unhelpful beliefs about their looks. I have not yet encountered a situation in which I needed to document or inform the individual of my thoughts on their attractiveness. My mind goes to making sure I have an ethical justification for bringing it up. Also, I am a woman who has had clients attracted to me, so I want to think about the impact and therapeutic necessity of broaching this topic.
 
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smalltownpsych said:
This discussion of inappropriate things to say reminds me of when my daughter was getting married and posted a picture wearing her wedding dress on Facebook and an old “friend” from high school said, “wow! She looks hot!” My wife said I needed to unfriend him. lol
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In my mind, that is the exact kind of person who would comment on a patient’s attractiveness in a mental status exam lol
 
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borne_before said:
I used to listen a radio show on XM. They had a reoccurring discussion about how some dudes just have a pervert button they can't stop of hitting...
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I’m so triggered because I know, or at least know of, a few folks like this in our field who are not as good at hiding their tendencies as they think they are. Whatever you do, just don’t be a creepy and lecherous psychologist because word gets around.
 
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PsyDr said:
Since the literature, to include meta-analysis, says that attractiveness affects:

1) Perception of personality
2) Perceptions of competence
3) Perceptions of intelligence
4) Income


I don't know how "inappropriate" it is to comment on a clinically meaningful thing.

And before anyone says anything about gender, the literature says it works for both genders.

And before anyone says anything about subjectivity, the literature does not support that position.

Come on. I'm a lot of things, and have a lot of flaws, but this is not motivated by sexism.

There are similar lines of literature for rich people.

Noncomprehensive Sources:

Budesheim, T. L. and S. J. DePaola (1994). "Beauty or the Beast? The Effects of Appearance, Personality, and Issue Information on Evaluations of Political Candidates." Personality and Social Psychology Bulletin 20(4): 339-348.

Doorley, K. and E. Sierminska (2015). "Myth or fact? The beauty premium across the wage distribution in Germany." Economics Letters 129: 29-34.

Feingold, A. (1992). "Good-looking people are not what we think." Psychological Bulletin 111(2): 304-341.

Langlois, J. H., et al. (2000). "Maxims or myths of beauty? A meta-analytic and theoretical review." Psychol Bull 126(3): 390-423.

Ramsey, J. L. and J. H. Langlois (2002). "Effects of the “Beauty Is Good” Stereotype on Children's Information Processing." Journal of Experimental Child Psychology 81(3): 320-340.

Scholz, J. K. and K. Sicinski (2015). "Facial Attractiveness and Lifetime Earnings: Evidence from a Cohort Study." The Review of Economics and Statistics 97(1): 14-28.

Zebrowitz, L. A., et al. (2002). "Looking Smart and Looking Good: Facial Cues to Intelligence and their Origins." Personality and Social Psychology Bulletin 28(2): 238-249.
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There are a lot of things that affect how we are perceived out in the world, but I’m still failing to see how attractiveness would come to bear in a treatment or evaluation context, unless the purpose for the treatment or evaluation is that the person is experiencing some sort of distress or impairment because of how people treat them based on their looks. But that would be a very specific context that requires the issue of their attractiveness to be discussed.

No matter what the literature says, I would be quite perturbed if I were looking through my medical records, and I see that my doctor or treatment provider (regardless of their gender) commented on my attractiveness for reasons not directly related to my reason for seeking treatment. Like how would you even defend that in a potential malpractice setting? I don’t think “the literature says people are treated differently based on how they look so I had to comment on the patient’s attractiveness” would go over well with the Board. You would still have to explain how it was relevant to the treatment you were providing, and not just your random musings.

Also, we usually don’t know what personal relationship or complexes folks have with and about their own aesthetic. So I would also consider the risk of doing unnecessary harm vs. necessary good by commenting on their attractiveness.
 
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PsyDWannabe said:
There are a lot of things that affect how we are perceived out in the world, but I’m still failing to see how attractiveness would come to bear in a treatment or evaluation context, unless the purpose for the treatment or evaluation is that the person is experiencing some sort of distress or impairment because of how people treat them based on their looks. But that would be a very specific context that requires the issue of their attractiveness to be discussed.

No matter what the literature says, I would be quite perturbed if I were looking through my medical records, and I see that my doctor or treatment provider (regardless of their gender) commented on my attractiveness for reasons not directly related to my reason for seeking treatment. Like how would you even defend that in a potential malpractice setting? I don’t think “the literature says people are treated differently based on how they look so I had to comment on the patient’s attractiveness” would go over well with the Board. You would still have to explain how it was relevant to the treatment you were providing, and not just your random musings.

Also, we usually don’t know what personal relationship or complexes folks have with and about their own aesthetic. So I would also consider the risk of doing unnecessary harm vs. necessary good by commenting on their attractiveness.
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1) I think you have a reasoned position.
2) I think if someone is “harmed” by an observation in a clinical note, either the statement must be extreme or the response is characterological. If you file a board complaint because I write that you are mustachioed, in a manner reminiscent of a pirate... that degree of offense is probably not about me. Now if I call you something that a reasonable person would consider prerogative ... that's a different thing.
3) Zero issues with the board so long as there is a professional reason for that observation. In order for the board to take punitive actions, they would have to explain in public documents why an empirically supported position was not okay. Then a reasonable attorney would demand to know the legal bounds of that logic. Boards are not going to say, "Even though this practice is scientifically supported and relevant, we will restrict practice".

4) I think the logical follow up to your position is:

What clinically relevant observations would you exclude, if it offended the patient? What is the plan for neurocognitive disorder due to obesity when the ICD11 launches?

How does that play out with opinions that the patient does not agree with?

I don't totally disagree with you, I just think this is an interesting area of discussion.
 
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PsyDWannabe said:
There are a lot of things that affect how we are perceived out in the world, but I’m still failing to see how attractiveness would come to bear in a treatment or evaluation context, unless the purpose for the treatment or evaluation is that the person is experiencing some sort of distress or impairment because of how people treat them based on their looks. But that would be a very specific context that requires the issue of their attractiveness to be discussed.

No matter what the literature says, I would be quite perturbed if I were looking through my medical records, and I see that my doctor or treatment provider (regardless of their gender) commented on my attractiveness for reasons not directly related to my reason for seeking treatment. Like how would you even defend that in a potential malpractice setting? I don’t think “the literature says people are treated differently based on how they look so I had to comment on the patient’s attractiveness” would go over well with the Board. You would still have to explain how it was relevant to the treatment you were providing, and not just your random musings.

Also, we usually don’t know what personal relationship or complexes folks have with and about their own aesthetic. So I would also consider the risk of doing unnecessary harm vs. necessary good by commenting on their attractiveness.
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Unless there were another ethical issue, that was clearly actionable, any Board could care less about this. Most Boards are not keen on taking punitive action in a case like this, because they would be easily sued, and lose, by the defending clinician.
 
I agree with PsyDr that attractiveness can be relevant clinically and I have had discussions with patients about it in the course of therapy numerous times. It tends to be about their own perceptions and attitudes and how it ties into their underlying beliefs and fears related to that. I might at times comment about how the research points to it being a rough measure of physiological health so self care can help with that. If they are a member of the incel crowd they might try to argue some stupid crap they got from the internet about how women only find men with tons of money attractive and I point out that having a job might be an attribute anyone would want for even a friend. Being a loser is not attractive so you might want to do something productive with your life instead of spending hours on the internet feeling sorry for yourself. Glad you are here today because it shows you are willing to do something about it.
 
PsyDWannabe said:
I’m so triggered because I know, or at least know of, a few folks like this in our field who are not as good at hiding their tendencies as they think they are. Whatever you do, just don’t be a creepy and lecherous psychologist because word gets around.
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To be fair, there are many ways to be creepy. If I was to carry out @smalltownpsych's little experiment, I would love to see how people reacted to comments like:

"Your elbows are very aesthetically pleasing"
"Your choice to wear sensible shoes is a very attractive quality in a person"
 
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Sanman said:
To be fair, there are many ways to be creepy. If I was to carry out @smalltownpsych's little experiment, I would love to see how people reacted to comments like:

"Your elbows are very aesthetically pleasing"
"Your choice to wear sensible shoes is a very attractive quality in a person"
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Are you going to start Keds/Skechers foot fetish OnlyFans channel now?
 
My other thought is I would absolutely never put that I thought a patient was physically unattractive. I would note if they thought it, but I would never make that assessment myself for documentation.
 
Shiori said:
My other thought is I would absolutely never put that I thought a patient was physically unattractive. I would note if they thought it, but I would never make that assessment myself for documentation.
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I think this would really depend on the case. In general, no. However, what is a patient was in a fire or accident and had significant facial scarring. This can play into things like agoraphobia and be clinically relevant.
 
I had a patient who was significantly disfigured and it was clearly relevant, as the presenting problem was agoraphobia and depression directly related to it. I am pretty sure I documented it in the chart and probably didn’t say anything more than what I just said. I might have also described how patient stated she was uncomfortable and frustrated with people commenting or reacting to her appearance, but might have just that myself. If I’m not doing a comprehensive assessment, I tend to be pretty sparse in my documentation.
 
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Sanman said:
I think this would really depend on the case. In general, no. However, what is a patient was in a fire or accident and had significant facial scarring. This can play into things like agoraphobia and be clinically relevant.
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I have had cases where there is a lot of physical damage to the person. I don't categorize it as attractiveness though. If I'm doing an assessment or intake, I'll put stuff in the medical section. Otherwise, it's still only as relevant as it is to the person. I guess I haven't structured my notes in a way that prioritizes notable physical traits beyond the bare minimum to appease the VA.

If it is important, it usually comes out in session and I document it when it's brought up. A lot of my patients who are divorcing start thinking a lot about how they're perceived by others. Their perception of themselves and how they think about others perceiving them gives me a lot more to write about than my thoughts.

Just on a practical level, my thoughts are also very biased and I don't have a good mechanism for "calibrating" myself. I would be hard pressed to be able to articulate why I find someone attractive. I just kind of know? There is the baseline of "traditionally attractive," but I don't know that I trust myself to be able to discern when my own cultural and personal preferences sneak in. With other domains that I chart, I can do training and consulting and find a generally agreed upon anchor. This area just feels...too nebulous to be useful on a regular basis. If someone like Benedict Cumberbatch or David Tennant walked into my office...10/10. I have been told I'm wrong.
 
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Shiori said:
I have had cases where there is a lot of physical damage to the person. I don't categorize it as attractiveness though. If I'm doing an assessment or intake, I'll put stuff in the medical section. Otherwise, it's still only as relevant as it is to the person. I guess I haven't structured my notes in a way that prioritizes notable physical traits beyond the bare minimum to appease the VA.

If it is important, it usually comes out in session and I document it when it's brought up. A lot of my patients who are divorcing start thinking a lot about how they're perceived by others. Their perception of themselves and how they think about others perceiving them gives me a lot more to write about than my thoughts.

Just on a practical level, my thoughts are also very biased and I don't have a good mechanism for "calibrating" myself. I would be hard pressed to be able to articulate why I find someone attractive. I just kind of know? There is the baseline of "traditionally attractive," but I don't know that I trust myself to be able to discern when my own cultural and personal preferences sneak in. With other domains that I chart, I can do training and consulting and find a generally agreed upon anchor. This area just feels...too nebulous to be useful on a regular basis. If someone like Benedict Cumberbatch or David Tennant walked into my office...10/10. I have been told I'm wrong.
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So the way you judge attractiveness is based on if they are from the UK and played a fictional doctor?
 
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Sanman said:
So the way you judge attractiveness is based on if they are from the UK and played a fictional doctor?
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An accent and fashion sense immediately cloud my judgement.
 
texanpsychdoc said:
Gasp! you said "both genders." Didn't you know there's like 100+?
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1) weirdly, I have been identified as the LGBTQIA friendly psychologist in my area. I have no idea why.

2) I don't know really know how many genders there are. Maybe there are 100+. Different strokes for different folks. I probably don't care. I've seen masculine women, effeminate men, people that I can't even understand, and partner combinations of all varieties. Most of those combinations are mainstream people who rally against gender politics. Looking at you masculine lady who is married to a super effeminate guy, who told me about his trip to see Cher live with his friend.

3) Not sure how many genders there are, but
I can tell you that a homosexual dude, who is on the tail end of that part of the Kinsey scale, doesn’t want to have sex with his partner of 30+ years, if the partner has transitioned to being a lady. That was an early moment in my training. I’m not sure what that means for gender identity, sex, or love.
 
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cara susanna said:
"Speech: Patient spoke with a pleasing North London accent"
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I've always loved the hardy nature of the Quebecois accent myself.

I think the most interesting native english accent I've heard was Singlish (Singaporean English). The English fluency rate in Singapore is actually higher than the US. It was pretty damn interesting to hear but, like heavy Irish accents, it takes some serious immersion and getting used to as it can be thick.
 
The Cinnabon said:
I've always loved the hardy nature of the Quebecois accent myself.

I think the most interesting native english accent I've heard was Singlish (Singaporean English). The English fluency rate in Singapore is actually higher than the US. It was pretty damn interesting to hear but, like heavy Irish accents, it takes some serious immersion and getting used to as it can be thick.
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Where got problem with Singlish lah? Aiyah...

EDIT: It is actually a bit more of a proper creole language than an accent per se. The grammatical structure is significantly different than standard English, although the lexicon is English-based. There is also a Singaporean accent that exists but you can speak standard English with a Singaporean accent without speaking Singlish.
 
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clausewitz2 said:
Where got problem with Singlish lah? Aiyah...

EDIT: It is actually a bit more of a proper creole language than an accent per se. The grammatical structure is significantly different than standard English, although the lexicon is English-based. There is also a Singaporean accent that exists but you can speak standard English with a Singaporean accent without speaking Singlish.
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All of this Singapore is making me miss Toast Box, chicken rice, and sambal fried rice.

No hawker centers in New Mexico unfortunately.
 
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The Cinnabon said:
All of this Singapore is making me miss Toast Box, chicken rice, and sambal fried rice.

No hawker centers in New Mexico unfortunately.
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Chili crab is likewise unavailable in Pennsylvania, it would seem. No Signboard for life.

Who am I kidding, though, in S'pore you can throw a brick in a random direction and hit a place selling food so good that it would be in my top three restaurants if it was in my area.
 
The Cinnabon said:
All of this Singapore is making me miss Toast Box, chicken rice, and sambal fried rice.

No hawker centers in New Mexico unfortunately.
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How do you like new mexico? I almost took a job in Las Cruces to do 'tism work at a uni clinic...

Love the food. Found Las Cruces to be charming.
 
borne_before said:
How do you like new mexico? I almost took a job in Las Cruces to do 'tism work at a uni clinic...

Love the food. Found Las Cruces to be charming.
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If you asked me a year ago I would have said I hated it, but it grew on me pretty hard and I'll be sad this august going back to the Midwest for the PhD.

Culturally it's a very distinct state as far as the lower 48 goes, I've really appreciated that unique quality is has to it. Seriously this state has a deep recorded history to it, the Pueblo tribes have been here forever and the Conquistadors arrived during the late 16th century. We're pretty sure New Mexican Spanish is about as close to how the Conquistadors sounded out of almost any other spanish dialect, and New Mexican Spanish is still spoken here pretty commonly. In this respect, it definitely feels like the intersection between Latin America and Americana on a cultural level.

Just a super interesting state overall. I don't think I'd want to settle down here, but that's out of wanderlust and wanting to see more of the world.

Amazing food and weather too. Cruces isn't far from White Sands which is probably one of the most gorgeous places I've ever been to, at least during the sunset.
 
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The Cinnabon said:
I've always loved the hardy nature of the Quebecois accent myself.

I think the most interesting native english accent I've heard was Singlish (Singaporean English). The English fluency rate in Singapore is actually higher than the US. It was pretty damn interesting to hear but, like heavy Irish accents, it takes some serious immersion and getting used to as it can be thick.
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South African accent is always a fun one for people.
 
Sanman said:
I think this would really depend on the case. In general, no. However, what is a patient was in a fire or accident and had significant facial scarring. This can play into things like agoraphobia and be clinically relevant.
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In such a case I would just say "appropriately dressed and groomed, with facial scarring."
Seriously, is there an argument for putting "unattractive appearance due to facial scarring" in a mental status exam???
It adds no information except to make the note writer look like a jerk.
 
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Was just reviewing a patient's prior evaluation when they were a child and the psychologist described them as an attractive 10-year-old. It already felt odd for the adult patients...
 
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RxPsych said:
Was just reviewing a patient's prior evaluation when they were a child and the psychologist described them as an attractive 10-year-old. It already felt odd for the adult patients...
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It's a bad day to be able to know how to read
 
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1) I don't think "unattractive" should ever be put in the note.
2) I don't really like the fact that the literature uses the term "attractive", but I don't like many professional terms .
3) I wonder how this would go in a discussion of "Pretty privilege".
4) I hope everyone knows you can tell that someone is attractive, without being attracted to them.
RxPsych said:
Was just reviewing a patient's prior evaluation when they were a child and the psychologist described them as an attractive 10-year-old. It already felt odd for the adult patients...
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Oh, it gets more interesting than that:

jamanetwork.com

UNUSUAL APPEARING CHILD

To the Editor.—The term "funny looking kid (FLK)" has unfortunately crept into the pediatrician's jargon in describing a patient with an unusual facial appearance. It is now also being used by nurses and paramedical personnel, particularly those working in the field of genetics and mental...
jamanetwork.com jamanetwork.com

www.ncbi.nlm.nih.gov

Smith's recognizable patterns of human malformation, 6th edition

www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

Most of this was just to stimulate debate. I wouldn't put most of this in the chart.
 
RxPsych said:
Was just reviewing a patient's prior evaluation when they were a child and the psychologist described them as an attractive 10-year-old. It already felt odd for the adult patients...
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I have a multidisciplinary team evaluation (MET) report about myself that describes ME as a attractive... For you ppl ignorant in the ways of school special education, the MET is the first step to getting individualized education plan (IEP), and they are mandated at least every three years.

Protip: if you are requesting school records, the IEP is most likely useless for psychology reasons. What you really want to request is the IEP and the MET. The review of existing evaluation data (sometimes called the "REED", which is a subsection of an IEP) can be useful, but most people slack on that part of the IEP. About the only useful part of an IEP is seeing how many minutes per week/month they're getting in certain areas - because that will tell you what the school thinks is important. IEP goals usually suck.

Maybe a thread about how to read an IEP/MET for psychologists and deal with schools/special education for those without school experience could be helpful.
 
RxPsych said:
Was just reviewing a patient's prior evaluation when they were a child and the psychologist described them as an attractive 10-year-old. It already felt odd for the adult patients...
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Jesus Antonio Christ.
 
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borne_before said:
I have a multidisciplinary team evaluation (MET) report about myself that describes ME as a attractive... For you ppl ignorant in the ways of school special education, the MET is the first step to getting individualized education plan (IEP), and they are mandated at least every three years.

Protip: if you are requesting school records, the IEP is most likely useless for psychology reasons. What you really want to request is the IEP and the MET. The review of existing evaluation data (sometimes called the "REED", which is a subsection of an IEP) can be useful, but most people slack on that part of the IEP. About the only useful part of an IEP is seeing how many minutes per week/month they're getting in certain areas - because that will tell you what the school thinks is important. IEP goals usually suck.

Maybe a thread about how to read an IEP/MET for psychologists and deal with schools/special education for those without school experience could be helpful.
Click to expand...
I would only comment on appearance in my summary section if it is related to a specific, new, recommendation that I am making (usually related to seeking out a pediatrician referral for genetics or neurology). All the kids I see are super cute so no need to comment on that! I start with a general statement of behavior, and then just get into the specific performance and symptom related stuff. I rotate between a few general descriptors- active; engaging; playful; quiet; curious; etc.. Dress is largely irrelevant to diagnosis, as the toddlers don't pick out their own clothes. If there is something "diagnostic" about their clothing (e.g., shoes too small because he'll only wear that specific pair; disney princess dress because child refuse to remove halloween costume) I'll definitely mention it. It's somewhat related to the dominant culture in the area I work, but most of these 2 year olds are impeccably dressed anyways, with the most incredible (and complex) hair styles. It's all pretty cool, but not related to the assessment so it has no real place in my report.

IEP goals can be the worst. A long time ago I did a conference presentation on writing IEP goals where we presented real examples to and participants had to identify what actual behavioral outcomes were being measured. A personal favorite- "Student will apply cognitive skills to the area of woodworking technology"
 
ClinicalABA said:
I would only comment on appearance in my summary section if it is related to a specific, new, recommendation that I am making (usually related to seeking out a pediatrician referral for genetics or neurology). All the kids I see are super cute so no need to comment on that! I start with a general statement of behavior, and then just get into the specific performance and symptom related stuff. I rotate between a few general descriptors- active; engaging; playful; quiet; curious; etc.. Dress is largely irrelevant to diagnosis, as the toddlers don't pick out their own clothes. If there is something "diagnostic" about their clothing (e.g., shoes too small because he'll only wear that specific pair; disney princess dress because child refuse to remove halloween costume) I'll definitely mention it. It's somewhat related to the dominant culture in the area I work, but most of these 2 year olds are impeccably dressed anyways, with the most incredible (and complex) hair styles. It's all pretty cool, but not related to the assessment so it has no real place in my report.

IEP goals can be the worst. A long time ago I did a conference presentation on writing IEP goals where we presented real examples to and participants had to identify what actual behavioral outcomes were being measured. A personal favorite- "Student will apply cognitive skills to the area of woodworking technology"
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I'd love to see your template or forms if you use any?
 
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