How words create bridges to a therapeutic relationship


I am sensitive to language and the way we use it in health care; as the editor of the Oncology Nursing Society’s premier research journal, the Oncology Nursing Forum, and as a sexuality counselor, words are my business and the tools I use to educate, inform, and disseminate knowledge.

The conversation typically goes like this:

Me: “Hello, can I speak with Mr./Ms. X please?”

Patient: “This is Y. X.”

Me: “Hello, Mr./Ms. X. My name is Anne Katz, and I’m calling from the cancer clinic. I received a referral from Dr. B. to see you, and I would like to set up an appointment. Would it be convenient for you to come to the cancer center on the 12th of September at 10 am?”

Patient: “Uh, sure. Let me just check my calendar … yeah, that looks OK.”

Me: “Good. Please bring your partner with you to this appointment.”

A couple of things happen after my use of the word “partner.” Some people merely say “OK” and that is the end of the call. Others, often elderly patients, say, “Do you mean my wife/husband?” and I affirm that yes, they are please to bring their wife/husband with them. But every now and then there is a slight hesitation, a brief pause, and the person says, “Oh, sure, I’ll bring him/her.” And I breathe a sigh of relief because in that hesitation was affirmation that the patient’s partner is of the same sex, and I did not mess things up.

The latter conversation happened a couple of weeks ago. When the patient arrived for his appointment, his male partner was with him. Before we could start talking about the reason for the visit with me, the patient expressed his appreciation for my use of “partner.” He told me that with just that one word, he felt recognized and comfortable, and he was looking forward to our work together. He said that he felt recognized because I did not assume that his partner was a woman, and he was then comfortable to discuss any and all things with me, which he did.

Heterosexism in its mildest form is the assumption that all people are attracted to and in opposite-sex relationships and that this is the cultural and social norm. At the other end of the spectrum is homophobia, which implies irrational hatred and fear of those who identify as gay or lesbian. Many health care workers are not aware that their words and actions are heterosexist and create a barrier to providing holistic care. I have often been challenged when talking about this with my colleagues. The most frequent statement I hear is, “I treat everyone the same. Why should I treat gays or lesbians differently?”

The simple answer is that our gay and lesbian patients are different and their experience of life and health care in particular has in many instances been different. They report less satisfaction with their oncology care, experience discrimination in the health care setting from heterosexist attitudes and practices, and oncology care providers show lack of knowledge about gay/lesbian sexuality and the impact of cancer on these. While most oncology care providers state that they feel comfortable treating gay and lesbian patients, less than 50 percent answered knowledge questions correctly and only 26 percent routinely asked about sexual orientation when taking a health history.

With just the word “partner,” I opened the door to a more meaningful relationship with this man and his partner. They were able to ask me specific questions about sexual functioning after treatment for prostate cancer that were meaningful and useful to them. The patient felt comfortable bringing his partner with him to the appointment instead of excluding him or wondering if they would be judged.

Words can harm, and words can heal. They can also create bridges to a therapeutic relationship that makes a significant difference to our patients; we need to use them with care.

Anne Katz is a certified sexual counselor and a clinical nurse specialist at a large, regional cancer center in Canada who blogs at ASCO Connection, where this post originally appeared. She can be reached at her self-titled site, Dr. Anne Katz.

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