Pity the young, pretty blonde doctor who’s constantly mistaken for being less accomplished than she truly is.
“Sexism is alive and well in medicine,” Dr. Elizabeth Horn lamented in a guest post this week at Kevin, MD, wherein she describes donning glasses and flat heels in an attempt to make people take her more seriously.
As someone who used to be mistaken for a college student well into my mid-20s, I certainly feel her pain. But let’s be fair: Doctors judge patients all the time on the basis of how old they appear to be.
It’s a longstanding practice in medicine to note in the chart whether adult patients appear to be older, younger or consistent with their stated age. Doctors defend it as a necessary piece of information that helps them discern the patient’s health status and the presence of any chronic diseases.
According to theory, patients who look older than their stated age are more likely to have poorer health, while those who look more youthful than their years are in better health. But does it have any basis in reality? Well, only slightly.
An interesting study was published a few years ago that examined this question. The researchers found that patients had to look at least 10 years older than their actual age for this to be a somewhat reliable indication of poor health. Beyond this, it didn’t have much value in helping doctors sort out their healthy patients at a glance. In fact, it turned out to have virtually no value in assessing the health of patients who looked their age.
Other studies – and there are only a few that have explored this issue – have come up with conflicting results but no clear consensus, other than the conclusion that judging someone’s apparent age is a subjective undertaking.
When there’s such limited evidence-based support for the usefulness of noting the patient’s apparent age, then why does the habit persist?
I’ve scoured the literature and can’t find a good answer. My best guess is that doctors are trained to constantly be on the lookout for risk factors – which patient is a heart attack waiting to happen, which one can’t safely be allowed to take a narcotic, which one is habitually non-adherent – and assessing apparent age vs. actual age is one more tool they think will help, a tool they may have learned during their training and continued to use without ever questioning its validity.
Appearances can be deceiving, however. A patient who looks their age or younger can still be sick. Someone who looks older can still be relatively hale and hearty.
And beware the eye-of-the-beholder effect. One of the studies that looked at this issue found that younger health care professionals consistently tended to overestimate the age of older adults. When you’re 30, everyone over the age of 60 looks like they’re 80, I guess.
Whether you’re a young physician fighting for the respect your training commands or a patient fighting against assumptions in the exam room, the message is the same: You can’t judge a book by its cover.