Discussing beautiful women in the ER . . . is it taboo?

I received a sanctimonious e-mail from a man who took umbrage at the fact that I was audacious enough to discuss the subject of why beautiful women are less likely to become ER patients. He said that his father, a "dedicated and caring" retired physician, also read the page and was upset by it because he thought it was unprofessional and possibly immature to broach such a topic for discussion. My response follows:

With all due respect to you and your father, I think you missed the point of that page. Personally, I could not care less if female ER patients are unattractive or supermodel clones. My interest is in discovering the factors responsible for disease and injury that leads people to visit an ER. Many if not most diseases and injuries are preventable. Most physicians give lip service to addressing disease and accident prevention, yet do virtually nothing to intervene. I am strongly interested in prevention, and as an ER physician who treated tens of thousands of patients, I made the simple observation that pulchritude is relatively rare amongst female ER patients. By the way, that is just not my observation — it is the collective observation of many of my friends and colleagues of both sexes who work in the ER as doctors, nurses, techs, and secretaries. Coincidentally, I recently discussed this issue with one of my friends (a woman who works as an ER secretary) and when I told her that some people dispute my observation that beautiful women are less likely to wind up in the ER, she laughed and said that anyone who thinks that evidently does not work in an ER. Are we all "unprofessional" for stating the obvious? Is it taboo to utter what our eyes are telling us? Is political correctness attempting to stamp out yet another aspect of free speech and thought? When you and your father walk down a sidewalk or in a mall, you undoubtedly notice that some people are attractive and some are not. No one would say that you are immature for doing so. For heaven's sake, scientific research has demonstrated that even babies notice beauty! (FYI: One study showed that babies smile more, and gaze for longer periods, at caregivers with attractive faces. In another study, researchers from Stockholm University published a paper entitled Chickens Prefer Beautiful Humans.) Thus, the affinity for beauty seems to be hardwired, and is not an aberration manifested only by immature ER doctors.

Many of the things that makes people attractive also makes them healthy. Thus, any physician who failed to notice whether the factors that constitute beauty are present or absent is derelict in his duty to do everything possible to foster the health of his patients. Oh, speaking of patients . . . I bent over backwards to give every patient the best possible care from both a technical and humanistic perspective, regardless of their attractiveness. Obviously, it would be unprofessional to give short shrift treatment to unattractive patients. I don't know of any physician who would do such a heinous thing. But simply notice and comment upon beauty, or lack thereof? Honestly, I don't know why this riled you so much. Perhaps you feared that I only gave first-rate care to beautiful women. Hardly. Actually, as I pointed out in one of my ER books, the medical care that beautiful women receive in the ER is sometimes worse than average because some doctors are discombobulated by exceptional beauty. Come to think of it, so are many men in general, which is why they get weak in the knees while interacting with stunning women.

Instead of sweeping this topic under the rug as you and your father suggest, I think that medical schools should discuss all aspects of how beauty affects medical practice. Besides the ones already mentioned, there are other topics that were unwisely ignored. For example, I noticed that some young women looked extremely uncomfortable with breast or pelvic exams. If I appeared old enough to be their father or grandfather, they likely wouldn't be so self-conscious. Should I ignore their anxiety? Should I address it? If so, how? Medical schools and residency programs routinely ignore such topics to the detriment of their students and the future patients of those students. The first time I had a young female patient who looked as if she was about to melt when I mentioned the need for a breast exam, I wasn't sure how to respond because I'd never thought about this situation and no professor ever mentioned it. Isn't it the duty of educators to prepare their students for such inevitable dilemmas? Instead, today's medical curricula include some courses of obviously lower priority, such as one medical school that has a class in art appreciation. Art appreciation? Yikes! Let me ask you this: What is more important for medical students? Appreciating art, or learning ways to deal with potentially awkward situations that will certainly occur?

I am too pragmatic to understand why anyone with a whit of common sense would think that a course in art appreciation is worthwhile enough to displace more important subjects, such as how to mitigate patient anxiety, or how to keep patients free of the diseases and injuries that prompt ER visits. Do you think that doctors are already doing a good job of this? Dream on! I will give you a very basic example. When was the last time you heard a primary care doctor discuss the importance of reading the fine print on food ingredient labels so that consumers can spot products with hydrogenated or partially hydrogenated fats, and avoid them? Those constituents raise the bad cholesterol (LDL), lower the good cholesterol (HDL), and thereby increase the likelihood of everything from impotence to heart attacks and strokes. Pretty important subject to discuss, wouldn't you say?

Anyone who thinks that American doctors are focused on prevention is living in a fantasy land. Instead of counseling patients on ways to avoid diseases and injuries, they typically do nothing until a problem develops. In the case of many diseases and injuries, this Humpty Dumpty approach to medicine is too little, too late.

Humpty Dumpty sat on a wall;
Humpty Dumpty had a great fall.
All the king's horses and all the king's men
Couldn't put Humpty together again.

And neither can doctors, in many cases. Yet we've institutionalized this backward approach to keeping people well. Instead of showing them simple ways to avoid products with hydrogenated fats, doctors sit on their hands until patients' arteries are brimming with cholesterol and some damage has already occurred . . . then patients receive a prescription for an exorbitantly priced cholesterol-lowering medicine that may have devastating side effects. There is no side effect to avoiding unhealthy processed foods, is there?

In summary, I think that American physicians are doing an abysmal job of fostering the health and well-being of their patients. Whether it is something as basic as what to eat, or how to avoid many common injuries, virtually nothing is said or done until Humpty Dumpty falls off the wall. As I mentioned before, beautiful women are less liable to end up in an ER as a patient. Some of the reasons for this are rather obvious, and some are not so obvious. If we studied this matter, as I suggested, perhaps we could uncover some useful tips that everyone should know. In the search for ways to keep people healthy and happy, I don't think that any stone should be left unturned. You and your father evidently believe otherwise, and think that feigned propriety and rigid taboos of what is permissible to discuss are more important than health. I thought you said that your father was dedicated and caring?

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