Portal de Periódicos da CAPES

Careerealism

2016; Lippincott Williams & Wilkins; Volume: 38; Issue: 9 Linguagem: Inglês

10.1097/01.eem.0000499539.24562.b8

1552-3624

Chesney Fowler,

Healthcare Policy and Management

FigureFigureThere is little consequence to my life if I'm out with my son and am mistaken for his au pair. In fact, that's a problem most moms would probably be more than a little happy to have. Except that I'm an emergency physician, and in the ED looking like you could be someone's au pair can have very real, very negative consequences for the patient-doctor relationship. Residency is a more collegial atmosphere, and to everyone looks young. But the issue gets real once you're the attending. Looking like you're too young to be a doctor can affect whether patients are confident and satisfied with your care. If any portion of your compensation is tied to patient satisfaction, looking like a 30-something-year-old can affect your bottom line. Heaven forbid you look younger than that. It's difficult to find studies on the subject of how a doctor's demographic characteristics affect patient satisfaction, patient compliance with plan of care, or any of the other metrics that we track and care about. Much of the scholarly literature that exists is designed to look for unfairness in health care delivery to the patient, particularly with regard to race. Those studies look at whether a doctor's care or a doctor's perceptions of their patients is affected by patient demographic factors such as race, income, or education. But I haven't been able to find studies that go the other way, ones that measure whether a physician's age, perceived or otherwise, affects that physician's patient satisfaction scores. (If these studies do exist, please tweet them to me @MagpieMedicine.) I did a very unscientific survey of five physicians in my suburban community hospital. Four said they regularly receive comments about their age. Two of those are male. Admittedly, I was pleased that this affects my male colleagues, too. The fifth, who is never called Dr. Howser, has gone prematurely gray. The bottom line is that appearing too young is a challenge for physicians under 45, and there are a lot of us. When a patient's first thought is, “Is this person really old enough to be my doctor?” that's never a good starting point for building the trust we need to deliver excellent care. Even without the studies, common sense suggests that if a patient thinks you're too young to be qualified, he is less likely to trust your care decisions, more likely to push back when he doesn't get what he wants, and less likely to follow your discharge instructions. This is a serious problem from an outcome perspective and a patient satisfaction perspective. No Easy Solutions I'm sure I'm not the first to point out that patient satisfaction scores are often influenced by factors unrelated, or even in direct contradiction, to what is medically appropriate. Patients are often poor judges of whether they received appropriate medical care. Yet, it would be inappropriate to say from a national policy perspective that we as a medical community should not care at all about whether the patient is satisfied with his care. There are no easy solutions to this, although a recent CMS decision to stop tying reimbursement to patients' responses about pain-management satisfaction is probably a step in the right direction. One way I've managed to mitigate negative perceptions that I may be too young is to earn and maintain the trust of the nursing staff. When the nurses and I enter a room together and it's clear that they have full confidence in me, that perception will often rub off on the patient. Meanwhile, demographics show that a whole generation of older physicians are about to retire, and they will be replaced with an even larger cohort of millennial physicians, so it's possible that over time patients will simply become more used to seeing younger physicians. The perception of being too young isn't really a problem with geriatric patients; they're used to everyone being younger than they are. Nor is it usually a problem with parents, who are usually happy to have a younger person interacting with their child in the ED. Other than maintaining the full confidence of your colleagues, there's not much to be done about this. I unabashedly seek out the expertise of the oldest physician in the ED when I have an unusual case, and my elders seek me out for a little ultrasound training. I look forward to the experience that comes with age and to the patient confidence that will accompany it. In the meantime, I'll continue to pretend to be complimented when a patient says, “You look so young!” Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].