Physicians are often compared to detectives. Sometimes, biases clouds our judgements, and other times, they work well to detect diseases early. For example, your clothing and belongings tell a lot about your financial status, cultural background, health status and educational level. Here are some cases:
If a patient….
S/he may….
Shows up with a suitcase filled with clothing and basic toiletries
Have had hospitalised many times
Sees a doctor in pyjamas in daytime
Have a chronic disease
Wears an expensive suit with a stain on his collar
Be having an ongoing financial difficulty
Working clothes, Suits, etc
Suggests Occupation
Patterns of the tie he wears
Suggests his hobby
Women wearing scarf
Could be hiding her enlarged thyroid
Many zips instead of buttons
May have progressive joint pain and having difficulty making fine movement
Loose belts
Recent weight loss
Unseasonable clothes
Thyroid problems
A sandal
Suggests arthralgia, trauma, gout, etc
Loosened shoelaces
Suggests foot oedema, inflammation
Extra belt loop
Ascites, Weight gain, etc
Many candies in their pockets
May have diabetes and taking insuin
Writing
Suggests Parkinson’s disease
Time printed on receipts
Suggests where they were and what they did
Many receipts of bars
Raise Alcohol abuse as a differential diagnosis
Picture on their driving license
Could be a clue to diagnose acromegaly
Magazines, Books
Suggests patients’ educational level
To what extent are they appropriate, and what kind of guess is inappropriate? Some doctors I know talk humorously (or sometimes flippantly) about glasses and sandals with hello kitty print. They call them “Glasses sign positive” and “Hello Kitty sign positive.” The former is for elderly patients and suggests they are getting back to their baseline cognitive and mental ability and are starting to read papers/ watch TVs/ communicate with their family. It is a good, harmless guess. But the latter is problematic and inappropriate, in my opinion.
According to the doctors who like to say the flippant remark, ‘Hello Kitty sign’ is used to refer to young women wearing the flashy Hello Kitty Sandals (‘キティッパ’), and they indicate their casual, unprotected sex with multiple partners. Therefore the pretest probability of sexually-transmitted diseases or ectopic pregnancy is high.
I go against them primarily because that bias could easily go beyond medical context and lead to prejudice. The guesses listed above are not only harmless but also actually useful. On the other hand, guessing somebody’s sexual activities is often unnecessary because with or without the guess, we need to do some blood test/ micro-organisms test/ pregnancy test or whatever if we think it is relevant to the symptom. If we test them anyway, what is the point of speaking ill of and making fun of patients at their back, by saying ‘By the way was her Kitty sign positive?’ In Japan (and elsewhere in the world too?), where the victims of sexual assault are blamed for what they wear, sexual harrassement is all too common, and having a polygamous relationship is considered to be bad, this stigma could quickly lead to a grave consequence.
Although the flashy hello kitty sandals are often associated with low educational level and bad taste in clothing by non-physicians too (might be actually the social consensus), I think that reinforcing the image with stronger and highly personal issues as a medical doctor is potentially harmful and unjustifiable.
As a side note, this kind of ‘sign’ does exist in other countries too, and one famous example is Teddy bear sign. Does the teddy bear sign predict psychogenic nonepileptic seizures? evaluated whether adults and older teenagers who bring toy stuffed animals to an epilepsy monitoring unit, i.e., the ‘teddy bear sign,’ were more likely to be diagnosed with psychogenic nonepileptic seizures than with epilepsy. Although this research is interesting, they conclude that patient possession of toy stuffed animals in the EMU is not a reliable sign of PNES.
Also while I was looking for the website to explain Teddy Bear Sign, I came across this blog introducing other signs: Incidental findings. And this Don’t become a doctor series is great. I can’t agree more, except for the title of the series don’t-become-a-doctor.
Black Boxが出版された当初は、いわゆるネトウヨが、彼女の書き記したレイプ被害を矮小化して彼女のことを散々に罵倒しているのを見て、加害者の山口氏が安倍首相と仲が良いことにあまり焦点を当てて欲しくないと思った。性被害者を取り巻く環境や性被害者の気持ちを考えたこともないような人たちが、彼女の主張を政治問題として寄ってたかって糾弾するのが全くもって許せなかった。
Apricot Jam 