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INCIDENT REPORT No Place for Us vs. Them in Clinical Care The response to this incident was contributed by Leonor Fernandez, HMS instructor in medicine at Beth Israel Deaconess Medical Center and an HMS Academy scholar. Incident as reported by a student: During a second-year tutorial, we were discussing the side effects of interferon treatment for hepatitis, including depression. When asked how to manage patients with hepatitis who had a history of depression, the gastroenterologist tutor said, "I don't treat those people." He went on to say that he only treated otherwise "healthy people, like those in this room." Since several students in the room, including me, had undergone treatment for depression, it was at once upsetting, sad, and funny. Response: It is tempting at times to think of patients as "other," different from ourselves, because the distinction makes it seem less likely that illness can strike any of us. The need to protect ourselves emotionally, perhaps mixed with the desire to create a sense of community as caregivers, can lead us to this notion of us vs. Them. This may be at the root of the gastroenterologist's naive comment about "healthy people, like those in this room." Yet all of us are patients, and all of us have family members who have been ill. As teachers, we bear particular responsibility to examine the hidden assumptions behind our comments. Given how common depression is, it is, of course, silly to assume that an audience will not include folks who have experienced it. Often it is the unspoken--even unintended--implications that may be the most harmful part of what is termed the "hidden curriculum of medicine." Some students, for example, might actually interpret the gastroenterologist's comment as implying that a history of depression makes a person unfit to be a doctor. When stereotypes or misconceptions are common for a given topic, then a naive, ignorant, or even "innocent" remark may be thought to affirm such stereotypes. In these cases, the tone of our remarks is particularly important. I think it is helpful for all of us as citizens to think about this both when making and when interpreting such remarks, and to call people on such remarks in a thoughtful and respectful way.