So let’s say you’re seeing your doctor, whether for a checkup or an acute problem. She looks you over carefully. Just on the basis of your appearance, she decides you’re at risk for significant health problems.
Sure, most readers of this blog are aware that appearance counts for a lot (too much!) when it comes to work and dating. But in the doctor’s office? Did you know that one common measure of health is whether you look your age? For all the time I’ve spent studying medicine, this practice was new to me.
“Few people are aware that when physicians describe their patients to other physicians, they often include an assessment of whether the patient looks older than his or her actual age,” says Dr. Stephen Hwang, a research scientist at St. Michael’s Hospital and an associate professor at the University of Toronto. “This long standing medical practice assumes that people who look older than their actual age are likely to be in poor health, but our study shows this isn’t always true.”
For patients, it means looking a few years older than their age does not always indicate poor health status. The study found that when a physician rated an individual as looking up to five years older than their actual age, it had little value in predicting whether or not the person was in poor health. However, when a physician thought that a person looked 10 or more years older than their actual age, 99 per cent of these individuals had very poor physical or mental health.
Where I live – in an Appalachian county in Southeast Ohio – I suspect you actually do see lots of people who look a decade older than their chronological age. I’m basing this on anecdata gathered partly while in the waiting room at the ob/gyn’s office, where grandmothers-to-be often accompany their young pregnant daughters. I live in a pocket of endemic poverty. Poverty does beat people down. It ensures that they’ll grab cheap, satiating calories over a bunch of colorful veggies – just because it’s not pleasant to go to sleep at night with a gnawing sensation in one’s belly. We know that diabetes, for instance, is rampant in this region. So is extreme obesity.
But the pitfalls of using appearance as a proxy for health ought to be obvious, too. Take, for example, your faithful blogger Sungold, whose miraculously youthful complexion is due to … being born near the 49th latitude with her head in a book. I think I probably do look a few years younger than my age (especially compared to the local population) just because I didn’t get much sun as a youngster. But does that mean I’m healthy? Long-time readers know that I’ve got something undiagnosed, which is sort of like fibromyalgia and a bit like thyroid issues and a mimic of multiple sclerosis – but is apparently none of the above.
People who have a medical problem but look healthy are not well served by this rough-grained appearance test. Doctors will tend to dismiss their complaints because hey, they don’t look sick.
People who look much older than their actual age may also be poorly served. For example, too many doctors address problems like obesity on a radically individualized level, often with a dollop of shaming for letting oneself get too fat. The people in my region look old because they face multiple oppressions. Whatever wise or foolish decisions they’ve made in the past, they need a doctor to propose constructive solutions, not prejudge them based on appearance.
I hope doctors will take this study to heart and move toward evidence-based medicine when it comes to appearance. By all means, if someone looks extraordinarily aged, use that as a reason to inquire further. But do inquire. Please do ask. Appearance can only project a 2-D image. Patients’ words and embodied experiences can supply the essential third dimension.