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On My Mind
August 2017

Making Conscious the Unconscious

Author Affiliations
  • 1Boston Children’s Hospital, Boston, Massachusetts
  • 2Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
JAMA Pediatr. 2017;171(8):725-726. doi:10.1001/jamapediatrics.2017.1011

“I love your toenail polish! Did you paint them yourself?” I said to the mother of one of my patients. Beautiful, intricate floral designs adorned each of her toenails. “Of course not,” she said, “but you would know where I had them done.” She winked. I was confused. “I don’t know what you mean,” I said, wondering if the lack of sleep had finally caught up to me. “You know, the nail salon, I’m sure you know people who work there,” she said, smiling.

It clicked. I’m an Asian American woman. She assumed, which I found quite surprising, that I therefore knew people who worked in nail salons. I was speechless. I often think about that conversation. If people make assumptions about me based on my appearance, I must make similar assumptions about my patients based on theirs. As physicians, we make snap judgments about people all the time, not only regarding race/ethnicity but also with respect to appearance, gender identity, and educational status. Our busy schedules and long hours often exacerbate these biases without our knowledge.