You’ve worked hard in the Emergency Department with a patient, providing the best care you can provide, spending time explaining the plan and diagnosis, speaking to family members, and you feel good about the rapport you’ve developed with the patient and his/her family. Several weeks later, you get a complaint in your email, “We were in the Emergency Room for five hours. We have a great nurse, but we never saw the doctor!”
Unfortunately, this scenario is common, and it happens for a variety of reasons, not least of which is that the general perception by society is that men are doctors and women are nurses. Most upper year residents and attendings have developed strategies against this misperception, but as evidenced by Dr. Sandra Scott Simons piece “ER Goddess: Yes, I’m Really the Doctor”1 it still happens to the best of us. New residents, don’t despair. There are a few tips that will help patients recognize that the woman who has been providing their medical care is, indeed, the doctor.
- Say my name, say my name.
This one can be difficult for EM providers because we are generally casual, preferring to be called by a nickname or first name. It feels painfully formal to hear somebody refer to me as, “Dr. Shafer.” I usually protest and insist that they call me by my first name, and I would hate for any of my ED co-workers to feel like they should call me by anything but my first name. However, as a woman, the first thing I do when I walk into a patient’s room is shake their hand and introduce myself as, “Dr. Shafer.” This is a small step that goes far to establish myself as the treating physician. This method isn’t perfect by any means, and some people will still confuse me for the nurse, but setting the dynamic early in the encounter goes a long way in establishing the proper roles.
- White coat, or not to white coat?
White coats as a physician marker have become more controversial as their presence have become more ubiquitous in a hospital setting. They also serve as a fomite in the health care setting.2 However, white coats are still strongly identified with physicians by the general public, despite the fact that the same people downplayed the importance of a white coat.3 Other physician markers, such as a clearly displayed ID tag, business casual dress, and neat grooming, were also highly preferred by patients.
- To be the doctor, be the doctor.
If you haven’t heard of it yet, “Imposter Syndrome” describes the feeling that many individuals feel when they do not internalize their deserved success. Instead, they feel like their success is undeserved, and they develop fear about being discovered as a “fraud”.4 Feelings of imposter syndrome generally worsen during times of transition, such as the transition from medical school to clinical training. This self-doubt can materialize during patient communication as hesitation or doubt when communicating the medical plan. Even if you are a new physician, confident communication and body language will further establish yourself as a leader in the care plan, even when the attending changes the plan later on.
These are only a few strategies that I have developed during my residency training to help patients and their families recognize my role in the care team. However, this list is far from all-inclusive. One of my colleagues reports that one of her more powerful strategies is to “address the hierarchy” when she enters the room by asking, “How have my residents and nurses been treating you during your ER visit?” What are other strategies that you use to identify yourself as the physician?
- Simons, SS. ER Goddness: Yes I’m Really the Doctor. Emergency Medicine News. 2015; 37(12): 8. doi: 10.1097/01.EEM.0000475569.69320.b9.
- Treakle AM, Thom KA, Furuno JP, Strauss SM, Harris AD, Perencevich EN. Bacterial contamination of health care workers’ white coats. American journal of infection control. 2009;37(2):101-105. doi:10.1016/j.ajic.2008.03.009.
- Au S, Khandwala F, Stelfox HT. Physician Attire in the Intensive Care Unit and Patient Family Perceptions of Physician Professional Characteristics. JAMA Intern Med. 2013;173(6):465-467. doi:10.1001/jamainternmed.2013.2732.
- Salkuku, J, Alexander, J. The Imposter Phenomenon. International Journal of Behavior Science. 2011; 6(1):73-92.