Farrin A. Manian, MD, MPH
Mass General Hospital, Boston, Massachusetts, United States
|Photo of Geraldo Rivera by John Brian Silverio|
As physicians, we are often valued by our patients for our compassion, medical knowledge, and skills in managing diseases and restoring health. Physical attributes such as facial features are not supposed to have an appreciable impact on our professional relationship with our patients. But what happens when a patient believes her doctor resembles someone famous, or infamous?
The first time I realized that looks may matter in my profession was in the 1980’s when I was on hospital ward duty as an intern, a young man in his late 20’s with olive-colored skin, dark beard, and shoulder-length brown hair. While on call one day, I was paged STAT by a nurse to evaluate a new admission, an obtunded elderly woman with widely-metastatic terminal cancer. I hurried to her room where I encountered a half-a-dozen family members standing around the patient’s bed, loudly praying to Jesus to save “Mom”. As I approached her bed, the prayers ceased abruptly. Without wasting any time, I introduced myself and proceeded to ask the family the standard questions about events leading to Mom’s admission. Not unexpectedly, the entire family seemed to be responding to my questions simultaneously. Eventually, I was able to piece the history of present illness together. It appeared that Mom lived with her close-knit family in a sparsely-populated rural area, only seeking medical advice when absolutely necessary, despite her ongoing battle with cancer. At a recent visit to her doctor, she apparently was advised to take her narcotic medications around-the-clock for better pain control. Over the ensuing days, however, she had become increasingly lethargic and difficult to arouse, further convincing the family to drive her to the hospital for evaluation.
After obtaining the history, I proceeded to examine Mom.
She was essentially comatose with pinpoint pupils, consistent with narcotic overdose. Rather excited and confident with my tentative diagnosis, I promptly asked the nurse for a vial of naloxone in hopes of reversing the narcotic-induced excess sedation. I informed the family, as I was injecting the “antidote” into Mom’s vein, that she should wake up shortly. Mom opened her eyes almost instantaneously and pulled herself up in bed much to the astonishment of the onlookers. She then gazed around the room, began to recognize her loved ones, and called them by name, something she had not done for days apparently. There was a sudden outburst of joy and chants of Halleluiahs in the room. Although I knew that Mom would soon begin to feel her excruciating pain again, I shared the family’s temporary jubilation. As I prepared to leave the room, I was surprised to see all eyes turning toward me with chants of Halleluiahs giving way to the soft murmuring of “He is Jesus! He is Jesus! That’s Him!” My confidence soon led to nervousness and a bit of confusion, responding with “No! No! I just gave her some medicine”. But the believers wanted no part of my “lame” explanation. As far as they were concerned they had witnessed a miracle before their own eyes. “That medicine in the syringe” was given by “divine hands”, they countered. I left the room amidst much commotion, not knowing exactly how I should be feeling, happy, sad, or unintentionally deceitful. Despite my continued efforts during the remainder of Mom’s hospitalization, I don’t think I ever convinced her family that I was not who they thought I was. Indeed, Mom’s family continued to treat me with a level of respect and deference that I was not accustomed to at all as an intern every time I entered her room. To this day, I can’t help but wonder if the family’s perception would have been any different had I lacked a beard or had short hair.
My beard gave way to a well-groomed mustache after completion of my residency program. Not long after beginning private practice, I noted that some of my patients, particularly women, thought that I reminded them of Geraldo Rivera, the well-known celebrity with his own popular day-time television show at that time. I found my Geraldo-smitten patients overly pleasant and friendly, often greeting me with the level of enthusiasm expected of an audience waiting for its favorite celebrity to set foot on the stage. One family member who did not even know much about me went so far as confidently informing me that I shouldn’t have any problems getting along with her mother because she loved Geraldo so much. Although I welcomed any attribute that might enhance my relationship with patients, the biggest pay-off for being a Geraldo “look-alike” was not materialized until I was asked to see an elderly woman (“Mary”) with pneumonia in consultation. In advance of laying eyes on Mary, I was informed by her nurse that any attempt to arouse her would likely be futile as she had been comatose since admission. As I entered Mary’s room, I found an elderly woman lying supine in her hospital bed. As a matter of formality, I approached Mary, placed my face only inches away from her half-open eyes, and loudly introduced myself, fully expecting no reaction. However, to my surprise, Mary slowly opened her eyes and began to stare at my face. A bit perplexed, I returned her stare. After a few long seconds, she began to stammer “You … You … Look … Look … Like … Like…” while pointing toward the television on the wall. I remained baffled and looked at the nurse who was equally as perplexed. After several unsuccessful attempts in completing her broken sentence, it suddenly occurred to me that she may very well be a Geraldo fan and shouted “Geraldo?”. She immediately let out a loud sigh of relief, and grudgingly uttered “Yes!” while closing her eyes, as if wondering why I made such a poor partner at this game of charades. The nurse shook her head in disbelief. As for me, I felt a great sense of accomplishment, achieving something no one else had previously done during Mary’s hospitalization i.e. finally waking her up and forcing her to say a few words! I thanked Geraldo that day.
The beard returned later in my career, a year or so before the 9-11 tragedy. Following this horrific act, almost overnight my looks were compared to those of many anti-American terrorists by some of my patients. I recall a longtime patient of mine blurting out to his roommate in the hospital how he would feel uncomfortable boarding a plane with someone who looked like me. Another patient asked me if I had been subject to any discrimination following 9-11. Such comments and questions forced me to wonder what went through the heads of patients whom I was seeing for the first time in consultation? The public was bombarded with television coverage of anti-American terrorists often with dark hair and beard with a singular goal of destroying us on our home turf. No one was safe from chemical, biological, or other agents of bioterrorism, we were constantly reminded. Against this background, I could perfectly understand an already anxious, ill, and vulnerable patient having hesitations about being greeted by a person who at least physically met the initial criteria of a potential terrorist. How could the patient be sure that I wasn’t one of them? Although for some patients my looks might have not been as “threatening”, I wasn’t taking any chances. I showered my patients with kind words and gentle squeeze of hands more so than ever before. Some of my colleagues were also concerned about how my patients may perceive me. They wondered why I hadn’t shaved my beard to look more “American”. Despite their plea, I refused to shave my beard, an act which I considered tantamount to surrendering to prejudice and stereotypes. "Shouldn’t patients get accustomed to seeing physicians with dark beards from time to time to dispel the myth that only terrorists have dark beards?" I argued. Besides, I did not recall seeing any sculptures of Hippocrates, the father of medicine, not having a beard. Fortunately, as time passed, comments about my potential terrorist looks gradually waned and patients began to comment once again that my face resembled less threatening people such as Omar Sharif, Tony Orlando, the lead singer of the band “Alabama”, and of course Geraldo “with a beard”.
Recently, I wondered if other physicians had had similar experience as mine during their career. During my hospital rounds, I stopped several of my colleagues and asked them if any of their patients thought they resembled someone else. Several physicians related that they indeed had been told by some of their patients that they resembled celebrities such as Rod Stewart, David Letterman, Rick Moranis, and Denzel Washington. None of these physicians appeared to bemoan such comments, and in fact many shared their stories with a grin and occasionally with slight hubris. Not all of the comments were favorable, however, as evident by the experience of one of my male colleagues. This particular physician confided that one day as he was about to enter the room of a patient whom he had never seen before, he was stopped by an angry woman meeting him at the door and demanding him to leave immediately. Shocked and dismayed, he inquired about the reason for such request to which the woman responded: "You remind me too much of my ex-husband!"
I thanked Geraldo again that day.
FARRIN A. MANIAN, MD, MPH received his Masters of Science in Public Health-Epidemiology and M.D. (cum laude) degrees from the University of Missouri-Columbia, and is a member of the Alpha Omega Alpha National Honors Society. He has authored or coauthored over 90 scientific articles and book chapters. He is the author of the book, Mosby’s Curbside Clinician: Infectious Diseases. He has been voted as one of America’s “Top Doctors” in Infectious Diseases. He is currently an Inpatient Clinician Educator at Massachusetts General Hospital and a Visiting Associate Professor of Medicine at Harvard Medical School.