My APPLE program was Community Partners, but unfortunately my patient had to discontinue her participation, so I instead based my project on the patients I met over the phone while performing well-check calls during the COVID-19 pandemic. “Script” is a zine documenting several moments when a standard question elicited a response that caught me off guard. Each clinical vignette is complemented by evidence-based information about relevant social determinants of health (e.g. insurance coverage, loneliness, and disability). I chose the format of a mass-producible zine because I am interested in the intersection of artwork, writing, and medicine as tools for advocacy and social impact.
During this pandemic, it is not uncommon to ask patients if they have the means (e.g. hand sanitizer, masks) to protect themselves from the virus while they shop for necessities like food. But how do you respond when a patient indicates that his limited mobility prevents him from going to the grocery store at all? This patient faces a whole host of challenges that I was not even prepared to confront. Ultimately, I worked with him to obtain a new wheelchair via Medicaid, as his old one had been broken and nonfunctional for several months.
The standardized script for SNAP/EBT application includes a question about marriage status. It wasn’t until I heard my patient’s matter-of-fact response to that question — “widower” — that I stopped to think about the degree of isolation he must be experiencing now without even neighborly contact.
One patient I speak with regularly has severe mobility and speech limitations as a result of a CNS injury. Over the course of our first several conversations, I became aware of some of these limitations. However, my subconscious bias persisted, making me overlook some of the challenges this patient faced in daily life. During one conversation, I wanted to connect him with a free legal assistance agency. Unthinkingly, I said, “I’ll give you the number to call.” He patiently reminded me that he would not be able to write down any number I dictated to him over the phone.
These three vignettes represent the broader issue of provider bias, which is coded into the conversational frameworks we learn in medical school and reinforce while observing our colleagues. With this project, I challenge us to subvert the norms that pervade our field by questioning the scripts we are given.
About the Artist: Gabrielle Séjourné
These days, medical school occupies most of my time, but aside from that, some of my favorite things include running with friends, listening to podcasts at 1.5x speed, backpacking with lots of views, reading in a comfy place, and baking incessantly in pursuit of the perfect sourdough loaf.
