
During my paediatrics rotation, a senior medical colleague would walk us through the ward and ask us to - without reading the patient notes - look at the patient and choose from two options.
Are they sick? Or are they 'rat-s**t'?
'Rat-s**t' was his term for a critically unwell child in need or urgent escalation to senior medical staff.
It was a crude assessment, and we had seconds to make the call.
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As junior doctors, we got it wrong most of the time whereas our boss rarely did.
So, what goes into making an accurate assessment of which one of these categories a patient falls into? Well, the appearance and behaviour of the patient is all we can go on.
Are they happily chatting to their family, eating a meal? Are they crying and in distress? Are they lying listless with laboured breathing, pale or flushed?
A lot of these ‘snap judgements’ in medicine come from years of learning, training and practice.
But what if almost all that learning, training and practice is on white children and white adults?
What if all the medical textbooks only feature patients with white skin?
What if almost all the literature that guides medical students and junior doctors focuses on how white people present with illness or distress?
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