Medical

Judgement in Medicine

“Only God can judge me.” Tupac Shakur rapped these famous lyrics in his All Eyez on Me Album in 1996. Although this song stands far removed from the field of medicine, the statement “only God can judge me” is a reflection of one of our modern culture’s values: we simply do not like being judged.
This truth seems to resonate particularly in clinics and hospitals throughout the US. Physicians see patients of all different colors, shapes, and sizes and many of these patients enter into clinics with emotional wounds inflicted from previous physicians’ lack of judgmental tact. These patients have been negatively looked upon because of their skin color, weight, gender and countless other reasons resulting in an understandable defensiveness towards any medical professional. In addition, a fair number of patients, myself included, while not completely jaded, have had significant negative experiences with doctors. One of the most dangerous pathologies identified in a doctor’s office, ironically has nothing to do with actual “medicine”. What hurts the most is diagnosing the prejudice influencing our physicians’ health care.

As a medical student, I am taught not to judge patients. If a patient tells me that he has smoked cigarettes for forty years of his life despite the protests of his wife, I am supposed to nod my head understandingly without showing my inherent disapproval. If a patient tells me that she has given her husband genital herpes because she is cheating on him, I am not supposed to flinch. I agree with the heart of this teaching because it properly reflects the sacredness of a patient-doctor relationship. Patients share information with their doctors that they may not be able to share with anyone else, even their spouses. We do not want to repay our patients’ vulnerability with unsympathetic judgments. So how are we supposed to respond instead?
Our doctoring instructor at school, who teaches us the ins and outs of the doctor-patient relationship, tells us that he judges patients the minute they walk through the door. He believes judging is a critical part of the diagnostic and therapeutic process. His patient’s skin color matters – so does his or her age. Our doctoring instructor’s differential diagnosis could vary based on his patient’s weight; thus, he uses immediate judgments as vital components to his health care. In agreement with this methodology, I am forced to question, “How are we supposed to judge someone and not judge someone at the same time?” After all, we are humans too, and enter the profession with our own laundry list of issues and self-diagnoses. For example, if you are a doctor who, when growing up, had an alcoholic father who abused your mother, how are you supposed to not “judge” your alcoholic wife-beating patient?
While I do not have a concrete answer, I do know this: judging has a very negative connotation these days. But deep down inside, we all know that judging can be—and is often—morally neutral. What I mean is that we judge people everyday in order to help us make even the simplest decisions in our lives. I choose to be friends with someone because I have judged that he or she is a good person to be friends with. I go back to the same barber every time because I have positively evaluated his abilities to cut my hair to my liking. With the reality of judgment commonplace in our every day lives, the focus of interest shifts to what we do after we have judged someone as the ultimate core of this investigation. It is true that if an African-American male patient walks into my clinic, I cannot and will not ignore his ethnicity and gender in my medical judgment – for example, I should be aware of the fact that sickle cell anemia affects African-Americans more than any other ethnic group in the US. The real question becomes how I will treat him because of his ethnicity. Will I carry myself, converse, or administer health care differently because of his size, gender, or profession? I certainly hope not
Humans, by nature, tend toward favoritism. It is very easy to like people who are like us. But favoritism, especially if you are a doctor, can be fatal. I do not think it is right to treat a patient with greater attention simply because he is in the highest tax bracket. Perhaps this is the reason why medical schools are looking for mature, unique and compassionate individuals. Medical schools want to train future doctors who know how to place themselves in other people’s shoes and treat every patient with equal excellence.
As I continue my preparation to become a doctor, I hope to be a fair judge. It is only natural that I will indeed make judgments, but I want to strive to treat all patients with the respect they deserve, even if I do not agree with their lifestyle. I will not be blind to someone’s skin color, but I hope to embrace it. Does judgment have a place in medicine? I believe it has to, but without leading to inequality.
Edward Chang is a first year medical student at David Geffen School of Medicine at UCLA. He also attended UCLA as an undergraduate, graduating with a major in Molecular, Cell, and Developmental Biology. He manages ProspectiveDoctor.com and writes for US News Education and FindTheBest.com. Contact him at [email protected]. Follow ProspectiveDoctor.com on Twitter.