My new patient looked around dodging my eye contact, scanning the ceiling, the room, and me. I felt that she was hiding something. In my clinic, I often find it one of the most difficult challenges to get new patients to open up, and one of the most beautiful moments when they finally do. I stopped interviewing midsentence and took a step back.
“Let’s just get to know each other. I’m here to help you, not to judge.” Her eyes landed on the rainbow LGBT+ ally sticker on my badge, and she sighed a breath of relief as she sunk back, relaxed in the chair.
When we see doctors, we are at some of the most vulnerable points in our lives. This is when we are weakest, and when we most need support. But when we go to that first appointment we still worry about how open we can be about ourselves, and how open we should be. The doctor might make assumptions or treat us differently depending on what language we speak, our religion, what clothes we wear, how intelligent we appear, our occupation, our weight … the list of worries goes on and on. It’s possible to find doctors on websites like Healthgrades, look up reviews, talk to friends — but you can’t expect to know how accepting they might be of you until your first appointment — and that can be incredibly nerve-wracking. In this unfortunate climate of rampant hate and prejudice, it is understandably worrisome when you have to choose a new doctor to care for something as intimate and important as your health.
As a doctor, I still find it intimidating when I visit a new doctor’s office for my own care. Neither websites nor reviews talk about how open and accepting doctors are of our beliefs, or of us as individuals. Websites don’t describe how a doctor might respond to a patient who wants to talk about sensitive topics such as sex with multiple partners, drug use, alcohol intake, sexual orientation, religion, or issues like difficulty getting food or being homeless. None of these factors should matter, especially not in the field of medicine where doctors are taught to relieve the suffering of all people — and yet they are still difficult topics to bring up in a climate of overt xenophobia, sexism, homophobia, and so on. There has been tremendous progress in our collective fight for freedom and rights, but the fear and anxiety of being different remain. It is imperative that those of us who condemn this type of discrimination stand up, speak up loudly, and not be apologetic about showing how accepting we are.
I hope that all my patients can open up to me about their joys and suffering — only then can I offer the best care. Details about patients’ backgrounds, life stories, and habits help me provide superior care for them because I know them better holistically. Patients know their bodies, habits, stresses, goals, and their overall lives much better than any doctor ever could. Some patients may be scared to admit that they used heroin or smoke cigarettes because they don’t know how I might respond or if I might be judgmental, but my only concern is how I can help them with reach their goals of care. When my patients disclose these sensitive details about themselves, I am proud of them for being brave enough to share something so intimate, and I take it as a small triumph that something in my office and our interaction made them feel comfortable enough to trust me as a partner in their health.
I humbly propose to all health care providers that those who are working as hard as we can to be welcoming should not assume that because we know we are open-minded, patients would automatically feel comfortable with talking about sensitive issues with us. Display signs of openness and acceptance — these can be as simple as a rainbow or “coexist” sticker, or statements such as: “Tell me anything; I’m here for you.”
To patients: If you found a provider and you are comfortable in that office but don’t notice any obvious welcoming signs, remember that other people might not be as fortunate or brave as you and could really use an outward symbol of acceptance and openness. We must work together to create environments that allow patients to feel comfortable to share all important information and ideas without worrying that they will be judged or treated differently.
This is certainly not a new concept; in my hospital, we occasionally see flashes of a small rainbow flag on ID badges, and there are posters in our clinic reminding women they don’t have to remove their hijabs and that all patients have a right to be comfortable with their provider. In medical school, we had volunteer LGBT+ training to improve our interactions with sexual minorities, and were then offered the opportunity to wear a rainbow caduceus pin on our white coats to show that we are “trained’ allies. We can do more. A glimpse of rainbow here and there is helpful, but if we as providers can’t clearly and unmistakably declare our openness, how can we expect patients to be absolutely comfortable sharing their intimate stories with us?
In this era when hatred is so unfortunately trumpeted, it is even more important for us as doctors to show explicitly how accepting we are. We must create safe zones for all people to feel okay with being vulnerable, knowing that they would be supported no matter what they believe and what they stand for. As we create easily identifiable safe zones in medicine, we encourage more people to be fully open and vulnerable, knowing that their doctors will accept them for who they are.
Dominic Wu is a family medicine resident.
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