I walk into a clinic exam room or to a hospital bedside and introduce myself. The patient looks me up and down and declares, “You look too young to be a doctor!”
There are many variations on this scenario. Some patients state it as a question: “Are you sure you’re the doctor?” Some try to guess my age, incorrectly. Others simply give me a quizzical look. I interpret it (perhaps over-interpret it) to be a judgment on my youthful appearance. Behind it, I also see a judgment on my competence and authority.
I sympathize with the patient’s predicament. He or she is coming to the doctor with a medical complaint or condition, seeking diagnosis, treatment and advice. It may even be a life-threatening situation. It is important for the patient to have confidence in the wisdom and experience brought to bear on the case. I try to understand the patient’s vulnerability but, at the same time, I am bristling at the superficial prejudice that casts doubt on my credentials.
Another layer to my defensiveness is the impression that my female appearance is also working against me. Although female doctors are becoming more common, it remains a challenge to gain equal status in a traditionally male-dominated profession. I am sensitive to any suggestion that I am less worthy of the doctor role than my male counterparts.
Many possible reactions come to mind, when a patient remarks on how young I look. I imagine the critical retort: “Well, you look old and fat.” Or perhaps the affronted listing of qualifications: “I’ll have you know, I completed my medical training at prestigious institutions!” Or the harsh reality check: “I may look young, but I’m your doctor, so deal with it.” Or the facetious admission: “You caught me! I am actually a college student masquerading as a doctor.” Or the sarcastic comeback: “Oh, how insightful of you to notice. You are the first person ever to bring this to my attention.” Or the self-doubting crumble: “I guess I must be too young. Maybe I should give up and go home.”
I know that none of these responses is the correct approach. Simply ignoring the patient’s remark seems inadequate. I consider a positive spin, such as: “I work out and eat right to stay young.” I usually go for something more self-deprecating (and truthful): “I can’t take much credit for genetics. My whole family is skinny and young-looking.”
I move on quickly to talk about the patient, instead of myself. I do my best to build his or her confidence in me through our interaction. As we get to know each other, my physical characteristics become less important than my intellectual abilities and emotional engagement.
The important thing, for me, is to figure out what the patient needs from the encounter. My ego is secondary to discerning the patient’s insecurity and overcoming any potential barriers to a therapeutic relationship.