Purple Hair

While rushing off to meet with the cardiology ward team, a 40ish year-old woman with blonde and purple hair being pushed by a nurse caught my attention. What was her message to the world and why did she color her hair purple?  Later on that morning I met her again with my team as the attending cardiologist on service. Chris, the intern on the team, gave a detailed summary of her history and physical exam prior to the team’s entrance in the room.  I had already formed an impression of her upon first glance.  Does she do drugs, is she a punk rock musician, hippie, or just want to be unique?  The patient has a cardiac history and presented with chest pain.  During our interview of the patient, we were very kind and concerned about her symptoms.  We formulated a treatment plan in the room which included a diagnostic left heart catheterization.  Once we exited the room, closed the door and reconvened, my question to Chris was, “What’s up with the purple hair?”  I thought Chris may have insight since he was closer in age to the patient than I was. His response, “I don’t know. Dr. A, you didn’t ask me about her chest pain, but you wanted to know about her hair.”  The team and I laughed because the Diversity and Inclusion Officer (me) had some biases as well. 

We all have biases. Bias is an attitude that predisposes one to favor or disfavor something.  Biases are actually learned behaviors from our surroundings.  The 21^st century vernacular, “don’t judge me” is a better description to avoid biases.  Did you consider the patient with sickle cell crises might not be drug seeking, but merely unable to breathe due to a pulmonary infarction and pulmonary hypertension?  Or did you consider why the 30 year-old waitress with hypertrophic cardiomyopathy has multiple tattoos of unborn babies forced upon her due to her cardiologist recommendations?  These biases should never limit complete investigation of our patient’s physical, mental, and social dilemmas.  My mother drilled in us the golden rule, “Do unto others as you would have them do unto you.” We often do not see ourselves as patients. 

Here are a few tips to provide the best care and avoid biases affecting medical care:

1. Address your own bias, both implicit and explicit
   1. Implicit bias refers to the attitudes or stereotypes that affect us without us being aware of them.
   1. Explicit bias refers to an attitude or belief about a person or group on a conscious, intentional level.
2. Put aside your fears and stereotypes of patients.  Patients are humans requiring touch and interaction.  All patients are not nice, but you must develop a relationship of trust.  This may take several interactions.
3. Make a mental switch of shoes.  Walk in their shoes for a moment and ask yourself, “Am I being provided compassion, understanding, and the best medical care possible?”

You may find that it is hard to walk without a supportive family, with severe illness, with logger work boots, or the stiletto shoes of the CEO of a Fortune 500 company.

By the way, the 40ish year-old wife and mother with purple hair had non-obstructive coronary arteries.  Since hair coloring piqued my interest, I discovered purple-haired persons are intuitive, creative and fascinated with the spiritual and unknown. As Chris my intern reminded me, “We have to work hard to knock out our biases.”