For the second consecutive year, medical students, faculty advisors, and a collaboration of a dozen student clubs at SUNY Downstate organized a series of lectures, discussions, and workshops on a topic often overlooked—and a facet often underserved—within American medicine. In February, 2010, “Sex in Medicine Week” allowed participants and audience members to explore issues ranging from “Relationships, Sexuality, and Disability,” to sexual assault & the healthcare provider’s role, to the unique experiences of LGBT patients within a healthcare setting.
Conscientious Care for the Patient
By Alaina Burns
By Alaina Burns
Imagine that you and your life partner are about to board a cruise ship for a vacation with your three children when your partner suddenly suffers a massive stroke. Your partner is taken to the nearest hospital, but you are physically denied visitation rights; your partner dies eighteen hours later, and you are allowed entrance to the room only when the priest is reading the final rights.
…Or imagine that you have been receiving care from your physician for a chronic medical condition, and one day, you happen to mention your partner. Your physician, who has been treating you for over a year, suddenly refuses to write you your next prescription.
…Or imagine that you are a woman who has been receiving preparatory treatment for in vitro fertilization from the only in-network provider offered by your insurance plan. When, after a year, the staff at the clinic learn about your partner, they subsequently refuse to continue treatment.
These cases might seem unbelievable, but they are all true; and they all took place in recent years, right here in the United States: in Miami, Washington state and California, respectively. Welcome to the difficult reality faced by many lesbian, gay, bisexual and transgender (LGBT) patients who try to navigate the American healthcare system.
Doctor’s offices and hospitals are often vulnerable spaces for all patients, but they can be particularly unpleasant for people who identify as LGBT. As part of SUNY Downstate’s 2010 “Sex in Medicine Week,” Dr. Maile O’Hara gave a talk, entitled, “Being a Good Doctor for ALL of Your Patients: Specific Needs of Lesbian, Gay, Bisexual, and Transgender Patients,”* in which she spoke about what medical professionals can do to provide more sensitive care for LGBT patients. Dr. O’Hara, a clinical psychologist at the Bellevue/NYU Program for Survivors of Torture, has worked extensively with the LGBT population.
Among Dr. O’Hara’s recommendations for healthcare practitioners are these:- Treat your patients who are LGBT with the same respect with which you treat all patients.
- Recognize that many LGBT people have had negative experiences with the health care system in the past.
- Ensure that your office has a nondiscrimination policy and that decorations and selections of items such as magazines and pamphlets are inclusive of the LGBT community.
- Treat the partners of LGBT patients as you would spouses, even if they are not legally married.
Visiting the doctor, for any person, can often be stressful and scary for various reasons. But for LGBT people, in an unwelcoming healthcare setting, the experience can be doubly terrifying. Educating yourself and being aware of the unique issues faced by people who are LGBT is the first step in providing conscientious care for all of your patients.
*To view the slides presented during Dr. Maile O’Hara’s talk, given at SUNY Downstate on February 25, 2010, please click on the “LGBT Q&A” link on the top left margin of this page.
So let me start by stating that I wish to be a great doctor to all my patients. That being said, the legal cases posted here were really thought provoking. Having experienced discrimination myself in the past I can honestly relate to the patients in the legal cases. It would probably drive me crazy if I was denied medical care or deprived of the right to accompany a dying loved one because of who I am. Yet, while I cannot at all agree with the staff in the Miami case in any level, I do empathize to some degree with the physicians in Washington and California who denied care and then referred their patients to another doctor who would provide the service they could not. I personally don't hold religious beliefs as strong as the doctors in question, but I can relate to their dilemma and could see myself, like them, torn between my ethics/beliefs and my vow to do no harm. For example, and I hope I do not offend anyone by the example, I personally would not be able to perform an abortion if a pregnancy is past the 1st trimester and there was no serious risk to the mother (a conclusion I reached after a medical ethics course in college). Knowing this about myself, I found it reassuring to have the option to refer a patient to someone who could provide those services if needed. Yet, if I were forced by some reason to do such procedure, I am sure my internal struggles will probably impede my medical judgement and perhaps place the patient in harm. In a perhaps more ordinary example, have also heard of physicians who, when realizing that they have a very strong physical attraction to their patient, referred the patient to a colleague who would be able to properly care for their patient. Other physicians have referred patients that trigger memories or associations of past personal experiences that result in strong psychological reactions in the physician and could potentially blind the physician's medical judgement (from simple associations to the patient's lifestyle or work to more complex associations like crimes committed by the patient). In those cases it is recommended, if not expected, for a physician to remove themselves from the care of that patient for both the well-being of the patient and the psychological well being of the physician. Hence, I personally believe that if a doctor denies care to a patient, regardless of the reason, it is most probably because the doctor recognized a factor that will impede their medical judgement and promise of doing no harm to a patient. If that is true, then perhaps the physicians in these legal debates were also attempting to provide the best care for their patients by acknowledging that they would not be able to do so because of strongly held religious beliefs or fears or divine retribution. Of course, then the question arises of whether the patient will then be able to receive medical care at all or in a timely fashion, especially if dealing with acute or severe illnesses. While I am sure there is a lot more to both sides of the stories in these legal cases, as portrayed this is hard for me to decide whether the physicians were either right or wrong in their decision. Its looking like a pure gray area to me.
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