Ignoring the cover

Issue: BCMJ, vol. 44, No. 8, October 2002, Pages 400-402 Editorials

I have always had a lingering, peri-marginal sense of how frequently our preconceptions of human nature based on physiognomy are wrong.

These fairly fuzzy, poorly focused, not-quite-randomly associated bits of bio-electric energy events crystallized for me the other day. I was nearing the end of a medium-long run that has a long, steep hill to navigate before finishing on a nice fairly flat piece. It was a hot, muggy morning and I was almost at the top of the hill and attempting unsuccessfully to suck in all the oxygen in the neighborhood. I’m pretty sure I was running critically short of cyclic AMP and remember wondering if my heart was going to be successful in its attempt to jump out of my throat, when I noticed two female runners approaching from the opposite direction. They were both accompanied by big black dogs tethered on leashes and looked a lot more comfortable running than I felt. One was short, blonde, and in her mid to late 50s; the other was tall, slim, blonde, athletic, and quite beautiful. I’m not saying the older woman wasn’t beautiful, but the two created an interesting contrast in body type and age. My immediate perception was that the older woman would be far more approachable and easy to talk to than the younger member of the duo. In other words, based on my 2-second visual assessment, my assumption was that the two must have quite different natures. I had made a number of critical assumptions about both of these individuals that would influence how I would interact with them. Interestingly, when I stopped to talk with my wife and daughter-in-law, I was reminded of how similar these two women are. They are both warm, intelligent, friendly people with the same kind of easy, infectious humor that engages new acquaintances immediately. Anyone not knowing them would have no sense of their basic similarities, and I’m quite sure that most people (both men and women) would make the same mistake my hypoxic brain made that morning.

As physicians we are trained not to be judgmental in our professional interactions. Physical appearances are not supposed to dictate how we deal with our patients. However, we are constantly assessing people by how they look, how they talk, how they smell, and how their value systems interact with our own. There are many instances I can recall where how I interacted with people initially was determined by how they looked. Only after I spent some time with them did it become apparent that my initial impressions were wrong. Unfortunately, I’m sure their comfort level with me was sub-optimal because of my approach, and I’m sure they went away wondering who that jerk was. 

In our personal and professional lives we are constantly making judgments about people that are often based on incomplete and, in many instances, inappropriate visual cues (i.e., would Joe Clark have made a better PM if his mandible were larger? Would Robert Stanfield have been better liked with a rounder, less sombre face?). 

I personally plan to continue to struggle with overcoming what I guess are societal drivers of my assumption banks and concentrate on spending a little more time ignoring the cover and not judging until I’ve at least turned a few pages in the book.


James A. Wilson, MD. Ignoring the cover. BCMJ, Vol. 44, No. 8, October, 2002, Page(s) 400-402 - Editorials.

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