Shall we resurrect this blog? Indeed.
Tonight the LGBT student group at ye' olde med school hosted an "Out in Medicine" panel. It featured several faculty members who direct courses or lecture in the clinical years in addition to attendings and a resident. The ranged both in age and medical interest. They shared anecdotes and insights and answered questions. It was, among other things, good to remind myself that we are a plentiful enough bunch. Though this bunch had primarily spent time in the "Gay Disneylands" of Boston, San Fran and LA, they carried experiences from many kinds of environments.
It was, on the whole, an optimistic evening. All have had the luck of good careers and supportive colleagues. It is generally agreed that medicine is at least perceived as a conservative institution. That perception is all too often a reflection of reality and is one piece of the root of disparities in health care quality for LGBT people. Even so, it really isn't my colleagues in medicine that I worry about being accepted by. One can choose colleagues. Though it may be hard to really understand the culture of a hospital or practice before you get there, some insight can certainly be gleaned and changing jobs is not impossible. What I worry about, are homophobic patients and my own emotional resilience.
As a second-year student, I am not yet tasked with any real responsibility for patients' health. Every Wednesday, I meet with bored patients in the hospital and practice taking a medical history and performing a physical exam. My instructors grade presentations and patient notes that I write, but no one who actually cares for those folks will ever see my work. This is strictly practice and principally for my own benefit.
Several weeks ago, I interviewed an elderly gentleman. As he began to relate some of his health history to me, the middle-aged daughter of his roommate said good-bye to her father and headed home. Not five seconds after she closed the door behind her, this fellow smacked his hand down on the table and said "Well, let me tell you about that one." He went on to relate to me, in melodramatically shocked tones, that his roommate's daughter was gay, and had come to visit with her "girlfriend, or boyfriend or whatever they call it." What followed was the longest homophobic tirade I've been subjected to since being harassed by passers-by while protesting "Don't Ask, Don't Tell" in Times Square a few years ago.
And I absolutely did not know what to do. Though I subject myself to hearing such things in the news, I have been blessed to generally avoid similar confrontations in my personal life. I know that in this moment I maintained a pretty flat affect, and inwardly I laughed that laugh of dark humor and discomfort. For days I blew it off as unimportant, but the more times I shared the story with friends, the more I realized how much it had affected me emotionally.
So tonight, I went to this panel with just one question: what do you do about homophobic patients. Not the ones who don't want to see you if they know you are gay, the ones who do see you, whether they know or not. And the answer was what it so often is in this field: self-sacrifice. Redirect to the task at hand, point out that whatever they are saying, be it homophobic, racist, sexist, is not what we are talking about right now. "Maybe, just maybe, and only after much later," I was advised, you will be able to address it in the future when you have an established relationship. This is a hard pill to swallow. For years, I have embraced being visibly out and I have worked to find ways to call out homophobic speech and attitudes in those around me. And after all that, it's hard to accept the idea of anything other than a direct confrontation of homophobia. But, things are changing in my life. The best health care I can deliver, that is becoming my new goal. Now, to complicate that a little bit, I am stuck on the knowledge that inequality, discrimination and disparities are all detractors from the positive health of our community. Part of me thinks that in confronting such attitudes in patients, doctors can do positive work. Yet the more time I spend with physicians I respect and their patients, the more I come to understand that the doctor-patient relationship can be a delicate thing. And it seems unlikely that any such positive work could be done in the moment or on a first encounter. The resident on the panel seemed, to me, most astute: treat the tirade as information. People at the doctor, especially in urgent situations, are vulnerable. This can bring out many things, including the worst of people. He suggested that an impulse to change that person's mind in the moment is more for you than the patient. The information you have learned can help you care for this patient.
So I asked myself, "am I obligated to treat homophobic patients?" And I wasn't sure. So I asked myself a moral extreme: "Am I obligated to treat murderers?" Yes, I really think that I am.