Close-ups

A Patient's Perspective

Without Judgment



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Am Fam Physician. 2008 Oct 15;78(8):942.

I was admitted to the hospital in the spring of 2002 through the emergency department. I didn't have a personal doctor at the time, so I was at the mercy of whomever the hospital assigned to me. It was a confusing and anxiety-ridden experience because I had always been healthy and had never had any intestinal problems. Not only were my symptoms (which were caused by Crohn disease) frightening and painful, I was so sick that I had to rely on and communicate through my life partner.

I spent three weeks in the hospital. During this time, my partner visited me, supported me, and encouraged me to get better. Sometimes, she communicated with the medical team for me. For the most part, my doctors were comforting and accepting; but, once, some student doctors really focused on what I thought were the wrong issues, asking, “Who is the woman that visits with you every day—is she your sister?” “What is your relationship with her?” “You say you experienced symptoms throughout the night into the early morning hours; was she with you all night into the morning?” “Did you have to call her to come over?” The questioning felt antagonistic and almost mocking. Because it seemed so immature and didn't pertain to my medical care, a visiting relative angrily disclosed to them that the woman they were prying about was my partner, and questioned their professionalism. The worst part was that the presiding doctor didn't seem to notice or try to redirect the conversation.

It made me so aware that when you are sick and vulnerable, you just don't need to be worrying about what your medical team thinks about you and your lifestyle—it shouldn't be an issue. I had never been in this situation before, but I was lucky that I had support from family and friends. I could only imagine how much anxiety experiencing intolerance from a doctor could cause someone who doesn't have that social support.

I usually wouldn't write about this because my lifestyle is only one part of who I am, but I could not resist the opportunity to suggest to medical professionals that part of the Hippocratic Oath should be Do Not Be Judgmental and Do Not Cause Undue Anxiety.—v.r.

COMMENTARY

Medical students and residents may only get minimal experience with nonbiased communication skills in their training. Because of perceived and real bias, many persons who are gay, lesbian, bisexual, or transgendered do not seek timely medical care, and when they do, they may not reveal their sexual orientation, even when that information could help their care. This scenario reminds us of the twin errors of prurience and avoidance. Gratuitous inquiry into lifestyle can offend even more than failure to take an appropriate sexual history. When I see a patient who has others in the room, I first greet the patient and then introduce myself to everyone else. I shake their hands and casually ask, “Friend or family?” As long as the patient wants the visitors there, I don't generally need additional information at that point. Patients and families will provide details when they feel accepted and supported. There are resources to help physicians improve verbal and written communication in their practices.

RESOURCES

Gay and Lesbian Medical Association. http://www.glma.org. Click on “For Providers and Researchers” and then on “Provider Guidelines for Creating a Welcoming Environment”

Close-ups is coordinated by Caroline Wellbery, MD, associate deputy editor, with assistance from Amy Crawford-Faucher, MD, Tony Miksanek, MD, and Jo Marie Reilly, MD. Questions about this department may be sent to Dr. Wellbery at wellberc@georgetown.edu.

The editors of AFP welcome submissions for Close-ups. Guidelines for contributing to this feature can be found in the Authors' Guide at http://www.aafp.org/afp/authors.


Copyright © 2008 by the American Academy of Family Physicians.
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