Pain in Girls is Being Dismissed

It is a common experience for young women. We have long known that women with some conditions are more likely than men to be under-treated for pain, and that doctors are more likely to dismiss reports of illness as psychosomatic when they come from women. Now, a recent study from Yale researchers shows how early this gender bias starts. The study found that when adult participants were asked to rate the perceived pain of a child receiving a finger prick to draw blood, they attributed more pain to the child they thought was a boy than they did to the child they thought was a girl.

This is from “Why Are We Still Dismissing Girls’ Pain?” an Op-Ed piece in the February 18, 2019, NY Times by Laurie Edwards. 

Also see Cell2Soul Statistics of Sexual Violence.

The Informed Patient

by Helen Salisbury, BMJ February 2019

Admittedly, there are risks for patients who use the internet for health information: searches about the most innocuous of symptoms can lead down a terrifying rabbit hole to a terminal diagnosis within minutes However, there are many reliable and balanced sources of information, and people increasingly seem to be able to find them.

Dr. Salisbury feels that “as doctors it’s imperative that we find a way to ask our patients, ‘What have you found out so far?’”  This way we can learn from them and when necessary dispel false, frightening information.

This short piece is pregnant with meaning.  Full Text.

The Luneberg Sign

In 2003, a colleague lamented to me that her daughter had recently gotten a tattoo.  My friend said, “The only thing a tattoo qualifies her for is a job where she asks the customer, ‘Do you want fries with that?’”  I had been interested in tattoos for years and her comments did not resonate with me, so I decided to survey consecutive patients with tattoos and ask them what their ink meant to them.  Over a period of a few months, I collected 50 sequential patients.  With their permission, I photographed their tattoos. (No one declined to have a photograph taken!) In the process, I learned that many (not all) tattoos have special meaning for the patients I saw.  Often, their explanations gave me insight into the person before me.

The images of my patients are on Google Photos.  If you would like to see them, please email DJ Elpern and I’ll send you the link.

Permanent Ink, an recent essay in JAMA's “A Piece of My Mind,” is a reflective piece on patients' tattoos by Paige Lunenberg, an internist from Baltimore.  It resonated with me, and some of you may find it inspirational as well. 

See: Paige Luneburg, MD Permanent Ink

JAMA. 2019;321(6):545-546. Free Full Text.

It begins:

Over the years, I have developed a fascination with patients’ tattoos. I make a habit of asking about them. My team often jokes with me; I imagine them sitting in the conference room before morning rounds, telling each other, “Make sure you mention his tattoo. That’s her thing.” All attendings have quirks, and I guess a fascination with body art has become mine. One intern went so far as to eponymously brand novel information gleaned from a tattoo, “The Luneburg sign.” We all laughed, especially me.

I saw this patient in 2003 with a dragonfly tattoo on her lower back.  When I asked its significance, she told me that a few years earlier her sister had died.  At the funeral, a dragonfly landed on the coffin. She got this tattoo to commemorate her mother and that event. DJE

The Graphic Medical Student

Annals of Internal Medicine: Graphic Medicine     

Annals Graphic Medicine (http://annals.org/graphicmedicine) brings together original graphic narratives, comics, animation, and other creative forms by those who provide or receive health care. They address medically relevant topics—be they poignant, thought-provoking, or just plain entertaining. These are (for the present at least) available from The Annals free and open access.

The popularity of Annals Graphic Medicine has prompted The Editors to include it regular monthly column. 

In the February 5, 2019 Issue, there’s a fine graphic narrative called, “The Medical Student.”

For more about Graphic Medicine. see: the Graphic Medicine website. "Comics are “not just for kids.”  Over the past decade this underrated medium has begun to receive recognition and acclaim from literary critics, academics, and broadsheet reviewers. Thanks in part to the medical humanities movement many medical schools now have students read classic literature or modern novels to gain insight into the human condition. It is high time that graphic fiction is taken as seriously: comics, graphic novels, and graphic narratives are great resource for health professionals, trainees, students and the public.