June 2001 • Volume 7 • Number 6
More on GLBT issues
To the editor:
The responses to the March FP Report article on sexual identity (letters printed in the May FP Report) are ample evidence that these types of articles and education are badly needed.
All physicians should be aware that the American Psychiatric Association regards therapy to change sexual orientation as harmful and unethical. Physicians who believe that they don't have gay, lesbian, bisexual or transgender patients in their practice probably haven't asked the right questions in order to find out. Without an atmosphere of acceptance and an openness to discuss GLBT issues, most patients will keep information about their sexual orientation to themselves rather than be subjected to rejection, harassment or referral to change their orientation. The GLBT community is as diverse as the rest of society and mainly invisible. Unless physicians are taught ways to address the sensitive issue of sexual orientation, these patients will remain unidentified and inadequately cared for.
Stephen Adams, M.D.
Springfield, Mo.To the editor:
I'm writing in response to (the May FP Report letters from) doctors who are outraged by your special section on sexual orientation issues.
Straight physicians and staff take for granted their heterosexual privilege. If we value diversity, we must constantly ask ourselves what our prejudices are and challenge those prejudices. If I had a different sexual orientation, I would not want to be seen by a physician who could not overcome that prejudice any more than I would want to see a racist physician if I were nonwhite. This assumes that there is an adequate supply of enlightened physicians.
It amazed me that people continue to be prejudiced about sexual orientation. It has taken us decades to get equal protection for all races, creeds and colors. What will it take to provide gays, lesbians, bisexuals and transgender people with basic civil rights? Laws!
Susan Schmitt, M.D.
St. George, W.Va.To the editor:
I was saddened to read some of my colleagues' letters to the editor in the May edition of FP Report regarding the earlier articles about sexual orientation (March FP Report).
I believe, as a family physician, my job is to support and nurture all of my patients and to make them feel welcome. My practice has lesbian, bisexual and transgender patients. I treat each with respect and caring, and they have felt welcomed and have become loyal patients. We do not need to "agree" with our patients' lifestyle to care for them and respect them. I happen to be Jewish, but I care for patients of all religions. I also care for patients who smoke, who are alcoholics, who overeat, etc.
Aren't we supposed to be healers? A patient's race, religion or sexual orientation should not change that. Perhaps if we treated our patients as people without trying to categorize them first, we would be most effective as physicians.
Wayne Strouse, M.D.
Penn Yan, N.Y.To the editor:
The three members objecting to the report on sexual orientation (March FP Report) all seem to lack sensitivity to the fear of many gay or lesbian patients that they will not be accepted by their physician if they discuss their sexual orientation.
Many physicians have strong prejudices against homosexuality and may either embarrass a patient or imply that the patient is "sick" and should change. Some may even try to suggest a referral for change (as one letter- writer did) even if the patient is not seeking a change in sexual orientation.
If a GLBT patient hears a doctor speaking nonjudgmentally about gay people or sees some statement or sign that assures him or her that he or she will be treated with acceptance and understanding, the patient is more likely to confide in the physician. If there is no such hint or sign that this is a safe place to discuss sexual orientation, the patient will be silent and will not reveal what might be an important part of the history.
Joseph Norquist, M.D.
St. Paul, Minn.Do what's right
To the editor:
Recently, there was an AAFP mailing that basically asked, "What do you want AAFP to be?" It is almost as if we are willing to become whatever people seem to want for motives that remain unstated. Is profit the motive? Human pride? Desire to be the biggest and best on the block? Physician recruitment?
We should do what is right rather than what is popular. We should look to our heritage.
It is right to be honest. It is right to be compassionate. It is right to practice preventive medicine. It is right to be the advocate of the patient -- who works and sacrifices to pay the bill -- rather than to cave to a marketing program in the choice of a medication. It is right to help patients weigh their options and make the best choice. It is right to guide patients to the best specialist when this is necessary.
There are primary care docs out there whose sole purpose is to make the biggest profit. We need not attack them, but at the same time, we need not lower our standards to lure them into membership.
Your advertising campaign does justice to the high ideals of AAFP. Let us do our best to make sure that the people get what they need and what we promise to deliver.
Daniel Siemer, M.D.
Hammond, Ind.Tailoring residency training
To the editor:
It was exciting to read "Changes in the Pipeline?" and "Join in: Reassessment of the Specialty Expands to Include All Stakeholders" in the April FP Report. It is refreshing to hear that the residency curriculum may become more adaptable.
As a chief resident and family physician, I have been frustrated by the curriculum limits that stifle the opportunity for individualized training.
For example, I have at times asked myself why I am obligated to do several months of obstetrics training even though I do not plan to practice obstetrics after graduation. My time would be better spent mastering other skill sets that I would more frequently use.
Many internal medicine residencies offer a "traditional" track that is more hospital-based and a "primary care" track that is more outpatient-based. Obviously, our specialty is diverse, with family physicians operating in a multitude of geographic locations and practice settings. The residency curriculum should reflect this. Thus, on graduation, each individual may have expertise in specific subject areas while maintaining the core competencies. It is unclear to me whether this future flexibility in training requirements will need to be on an individual basis or on an interresidency basis. Either way, our specialty must change to reflect the reality of today's world and modernize residency training by emphasizing the core strengths of family practice based on an individual's future practice expectations.
Paul Lewis, M.D.
Indian Rocks Beach, Fla.
To the reader: Write us letters of 200 words or fewer (subject to editing), using the FP Report address pbinder@aafp.org or FP Report, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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