Are You Who I Think I Am?

A few days ago, I wrote about going with Kelly the First to be a fake patient for a couple of groups of newbie medical students. After interviewing me (and several other fake patients), they had to write what I would call a reaction or response paper. Four of the eight students I talked to chose to write about me. Their papers were passed on to me with the request (taken from a discussion with the students themselves) that I neither sell nor publish them. Since I consider blogging to be a means of publication (however limited the scope, however few my readers--Hi, Mom!), I won’t be posting them here. Instead, here is my reaction to their reaction to me.

In general, the students’ responses were more positive than not and there were only a couple of places where they made factual errors, with my specific age, for example (which is not necessarily important) or with my specific health concerns (which is slightly more troubling).

Since I can’t publish the papers, here are a few phrases from the papers and my explanations of where I think those phrases come from:

The First Impression

”Upon entering the room, she took charge...”

“initial impression was that she was very sweet and somewhat reserved”

"confident, energentic [sic], and positive"

"A 'free spirit' this one is! "

I sometimes forget that often the first impression I make on people is one of confidence that can border on domineering. (The degree to which the person considers me domineering seems to depend on their level of insecurity. The more insecure the person, the more domineering I seem.) It's actually funny to me to think that someone might mistake me for "sweet" and "reserved," but I guess it's not terribly far-fetched. When I was teaching in Japan, for example, many students reported to management that I was "kind." My response was, "Kind of what?"

Are You Who I Think You Are?

“a noble example”

"I had actually become quite impressed with all the nonverbal cues as well: her confidence- as betrayed by her posture- her laugh, her eye-contact, etc..."

”very well spoken and educated”

First of all, let me say that my response to having the word noble applied to me or my situation is this: [GAG] Because, honestly? No, thank you.

The four who wrote were all a bit idealistic or were careful to define where they were straying from idealism. I’m inclined, old cynic that I am, to see that idealism and a parting from idealism as unconscious behavior.

During the interviews, one student in particular intrigued me by asking (and later writing about my answers to) questions that were quite sociological in nature. Some of the questions, for example, were about my status as an ethnic minority and my religious practices and my education. Of course I answered the questions; I'm not shy about discussing minority issues, religion, or my impressions of the traditional education system. I do also think that it’s important to discuss these issues in regards to their impact on health care. But I don’t agree that it is necessary to discuss those issues in a one-on-one health care setting. What I mean is, I want doctors to be aware of the kinds of cultural interactions they may be engaging in (after all the AMA recently issued an apology to the African-American community for a reason) and how those interactions affect the patient’s care and (often) their compliance with doctors’ treatment plans. However, the cultivation of that awareness should not be taking place within the confines of this kind of setting. If it does, that’s great, but I would hate to see the burden placed on the patient to educate the doctor. The way I see it, it is the doctor who has chosen to work in a specific, often multicultural setting (and in my home state, it’s a given that students who apply to the medical school are interested--or at least many of them are smart enough to feign an interest--in working with the non-white populations that are prevalent in this state) so it is her or his responsibility to seek understanding about the situations and conditions unique to these populations.

That said, there is a danger of having, say, a white person romanticising or stereotyping us brown folks as “noble,” as in: The Noble Savage. In this case, “noble” (when applied to a brown person like myself) also reeks a bit of Barack Obama being called “clean” and “articulate” by a fellow politician.

Are You Who I Think I Am?

”demonstrated the difficulty in talking to people of different and unfamiliar backgrounds”

”looking to her for a sense of safety”

This student was talking about the difficulty inherent in the interview process, the difficulty of interviewing someone like me, someone from a different background. But of course the students were not really writing about me, they were writing about themselves--no matter who they claimed was the subject of their paper.

The student who wrote the above quotes wondered why interviewing me had been difficult compared to interviewing homeless people and patients in clinics. (Maybe because homeless people and low-income clinic patients are overwhelmingly disenfranchised, marginalized, often powerless. Of course that often leads them to have less confidence and they are subsequently more willing than I am to allow someone else, someone who appears to be in a position of power, to take control of the conversation.) This student seems to have come into the interview harboring the paternalistic expectation that I would require someone--this student--to provide me with a safe environment, but in the end found that I was the one providing a sense of safety for the student.

Of course the papers don’t identify the students by name but I have my suspicious as to which student wrote which paper, and if I am correct in this case, this was one of the two (out of eight) students I met who I thought: This one’s going to be okay. This one’s going to make a good healthcare provider. (Five others I thought: This is going to take a lot of work. A lot of work. And one, I would’ve just tossed out. I feel sorry for anyone who comes under his care in the future.)

Who Are You?

I can’t say with any confidence that these students got it completely right. At best, they were positive and compassionate to some degree. At worst, they were self-centered and overly-pleased with their efforts. I know it took me years in the trenches before I could interact with people and be relatively comfortable doing so. The learning curve is pretty steep, and I am not inclined to be forgiving when it comes to healthcare providers (versus, say, waitresses). But that’s a whole different blog entry.

Am I glad I participated in this exercise? I am.