In one room, someone might be having a panic attack. In another, you’re asked to console a crying colleague.

Except the people were actors. And there were cameras everywhere.

You were given 15 minutes in each room before exiting back to the hallway, where a loudspeaker announced you had one minute to move on to the next.

I sucked at them.

The panicked patient hyperventilated faster by the time I left, and the crying coworker was trying not to laugh at my clumsy performance.

I didn’t get a single offer from those schools.

What’s wrong with me? I thought. Maybe I utterly lacked empathy? Was I a sociopath? Was I good doctor material? Should I retreat to a library and become a writer instead? [clear throat]

Until one day, I found myself laughing with a friend who had just been crying moments before. My dark humor worked to console her. And that was… totally okay.

That’s when I realized: I didn’t fail the test to become a doctor. I just flunked my auditions to become an actor in a medical drama.

Boys and girls, that was the story of why I didn’t become the next Sandra Oh.

(Among other minor reasons.)

I should have known the multi-mini interviews were a preview of what was to come.

A decade of training later, I enter a new exam room every 15 minutes to handle one situation after another, as if I should have all the answers. I repeat lines written for me by those who came before me, over and over. Then I exit the room to gather myself, only this time with no minute to spare, before entering the next.

The white coat is a costume. And we are trained to perform.

Sometimes, the lines are not entirely truthful.

“Ok, we’ll let the lidocaine work for a few minutes,” I said, my hand on the door handle after injecting local anesthesia before a biopsy. “And I’ll be RIGHT BACK.”

Lie #1: Lidocaine takes seconds to work, not minutes. Really, I had two other patients waiting, and I planned to see one or both while she waited.

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Everyday at work, I collect patients’ signatures. Lots, lots of signatures.

One busy afternoon in clinic, I sat down to catch up on charting when an email popped up. Subject: “This Month’s Missing Informed Consent Forms!!”

There it was—my name at the top, with nine missing signatures. And yes, the email was visible to all providers in the system.

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“On a scale of 0–10, the patient finds her meth addiction to be a ‘6,’” the medical student read it out loud while presenting a patient to me.

A 6 out of 10 addiction.

I pause.

What does that even mean?

I glance at his note. It’s a template. Of course it is. And in the History part, under disease severity, the number “6” was circled.

Someone, somewhere, decided this made sense.

I imagined the question being asked:

“On a scale of 0 to 10, how bothersome is your meth addiction?”

Then I imagined the patient answering:

“You mean the thing that dismantled my life?

Took my family. My work. My body. The thing the court is now forcing me to sit here and talk about with you?”

Mmmm. Let’s go with a 6.”

It would be funny.

If this weren’t real life.

Medicine has a 10/10 addiction for numbers.

We measure what we can’t tolerate not understanding,

quantify what makes us uncomfortable,

and assign scales to things that refuse to stay one-dimensional.

And to be fair, sometimes this helps. A number can be a bridge for a child who can’t explain their pain, for a patient who doesn’t have the words, or for research, tracking, outcomes, charts that need to look clean

But when we hold that number as a medical fact and ignore the patient’s bodily truth,

We stop listening,

And we reduce people to a number.

So maybe the better question is:

On a scale of 0 to 10, how alienating is the pain scale itself?

No use asking us in medicine, most of whom are healthy, able-bodied people who don’t yet live with pain.

So I asked patients instead.

Their answers helped me create The Embodied Pain Scale after realizing, together, how absurd it is to reduce something lived in the body to a number.

The background is black, because pain is not clean, sterile, or chart-friendly.

Those polite, cartoon faces we ask patients to choose from are gone.

Instead: magnified, polarized images of real patients’ tattoos, their original colors, texture, and stories preserved. We often say something is “skin-deep” to describe its superficiality. But even the skin remembers.

The images signify something permanent but dynamic. Something people live with, grow around, and learn to carry.

Something you can’t explain.

You can only witness.

The numbers?

They mean nothing without the words.

Real patients’ words.

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I was raised within a system of medicine largely written by people who did not look like Rita, an Indigenous Latina woman, or myself, for that matter. That means racial assumptions and biases are woven into the clinical reasoning I was taught to trust.

It wasn’t until I wrote the chapter on Medical Racism in Consented did I start digging more seriously into the data. The deeper I went, the clearer it became that we are working against something far more entrenched than individual prejudice.

Medical racism is a prodigious and insidious force built quietly into the foundations of modern medicine.

Last year, I was invited back to Dartmouth to give a lecture on medical racism. Preparing that talk meant returning to the literature with a different set of questions.

Here’s the video of that lecture.

Preparing the lecture forced me to ask a simple question: when medicine lists race as a risk factor, what exactly are we saying?

The answer, buried in decades of research, is unsettling. For paid subscribers this week in Behind the Chart, I’m sharing one of the most heavily researched passages from Consented, along with the studies behind it.

I’ve also included a small preorder thank-you for paid subscribers at the end.😉

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One morning, my father decided to fix the problem. He placed a few coins in my hand and pointed to the ticket booth at the entrance to the park.

“Go buy the tickets,” he said.

I froze.

We went to that park every morning. But until that day, my dad had always bought the tickets. This time he folded his arms and gave me an ultimatum: either I walked up to the counter and asked for the tickets myself, or we weren’t going into the park.

I stood there for ten minutes with my head down and tears running down my face before realizing he wasn’t going to budge. Finally, I took the money from his hand and marched over to the counter.

The auntie behind the glass didn’t hear me the first time I spoke. My eyes filled with tears again. I turned to look at my dad. He smiled and mouthed from a distance, What a brave girl!

I wiped my tears and snot with my sleeve and tried again.

“Two tickets to the park, please,” I said, louder this time.

We went into the park. That day, I learned that my voice was the ticket. From then on, I skidded up to the counter every morning to use it.

And I haven’t stopped using it since.

Until I entered medical education.

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If you didn’t know, part of the medical board exam in the U.S. used to involve fake patients — actors hired to test the clinical skills of future doctors. The scenarios were randomized; you wouldn’t know what you were walking into until seconds before entering the (fake) exam room.

“Hi, my name is Dr. Zha (even though I wasn’t yet), it’s nice to meet you!” I would say after knocking.

Then I’d perform the ritual: wash my hands in front of the patient or use hand sanitizer so the examiner watching through the camera could check a box: hand hygiene, done.

It always felt more like an audition than a test.

You knew you were being judged on how you performed on camera, as if your ability to act convincingly would determine whether you earned the letters you’d spent a decade chasing.

No wonder they say you must fake it until you make it. It felt… performative.

It’s performative medicine.

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