Thursday, May 17, 2007

Take Pride

Every year, we at BIDMC hold an event to recognize people who have made significant contributions within the gay and lesbian community. Awardees may be individuals or organizations, employees or people external to BIDMC, or gay or straight. We look for candidates who advance the gay and lesbian agenda related to the workplace; volunteer time and effort on behalf of gay and lesbian initiatives; demonstrate leadership in advocating for gay and lesbian community; serve as a role model for gays and lesbians within the workplace; and/or make a positive impact on medical care to gay/lesbian/bisexual/transgender patients.

Each year, when we announce this event, I receive a note like this from one of our doctors:

From: The Committee to Restore Sensible Values and Perspective
To: Mr. Levy

We are again disappointed and frankly disgusted to see the leader of the medical center endorsing an inherently unhealthy, risky lifestyle. We remind you that this is offensive to members of the BIDMC who hold to moral principles and traditional values. But more to the point for a healthcare institution, is the fact that homosexual behavior involves well recognized higher risks of STD's, HIV and AIDS, anal cancer, hepatitis, parasitic intestinal infections, and psychiatric disorders. Life expectancy is significantly decreased as a result of HIV/AIDS, complications from the other health problems, and suicide. This alone should make it reprehensible to the medical community, regardless of your personal feelings for putting this on the politically correct list for "inclusion and respect." This action again jeopardizes the credibility of BIDMC as a healthcare institution and dishonors a large proportion of its community who continue to hold to the conviction that homosexuality is immoral, ungodly, unnatural, and of course unhealthy. As we pointed out in our letter a year ago, while the controversial effort to normalize homosexuality has clearly consumed the political arena, the health risks of homosexual behavior are well known and incontrovertible. Although the political world seems oblivious to these serious consequences of unhealthy behaviors, a healthcare institution should not be. It is all together inappropriate for BIDMC to endorse, affirm, or encourage these behaviors.

It's time to put our mission as a healthcare institution ahead of misguided zeal for political correctness and inclusiveness. After all, inclusiveness of the wrong values and behaviors only serves to dishonor and discredit BIDMC and the larger community it represents.

Last time, I started my response in this manner --

I am grateful to you for writing to me with such a clear exposition of your views. I respect greatly the range of views held by people on these issues, and I believe that one of the things that makes our country great is that we have the ability to live peacefully together and yet have a variety of viewpoints.

Then I made it very clear that this program will continue. Yes, every now and then, the CEO gets to make a decision. This one is easy.

If you would like to make a nomination for this year's award, please send an email before May 21 to egandelm@bidmc.harvard.edu or, for those inside BIDMC, go to our portal and download a nomination form.

98 comments:

Anonymous said...

Does a Committee by that name really exist?

Paul Levy said...

Dunno. That's the way the letter came.

Anonymous said...

I was hoping you had made up that letter, but apparently not. How incredibly scary, coming from a physician. To that physician, from this physician: whatever happened to your Hippocratic Oath, buddy?

Paul Levy said...

Interesting you raise that point. Another part of my letter to him said the following:

"But I am extremely troubled about the possible implications of your point of view with regard to the equal provision of medical care to all patients. Equal treatment of patients is an inviolate standard at our hospital, and it is an expectation of every member of our medical and administrative staff. Your letter raises the question for me of whether you can find it possible to treat homosexual patients in the same manner you would treat heterosexual patients. Perhaps you can, and that would be fine. But if any doctor in our hospital wrote a similar letter to me about an ethnic group, racial group, or religious group, it would raise a red flag about the ability of that physician to treat patients from that group in a manner equivalent to the broad population.

"Perhaps you have already done so, but I would ask you to look into your heart and answer the question: "Is my approach to treating homosexual patients at variance from treating heterosexual patients, as a result of my personal belief that homosexuality is immoral, ungodly, unnatural, and unhealthy?" If the answer is "yes", I would respectfully ask you to end your afffiliation with our hospital. (This, of course, would be a voluntary action on your part, as I do not mean to suggest that I have the personal authority to require such a result.) If the answer is "no", and you can separate your religious and political views from the obligation to provide equality of care, then of course my request would be unnecessary."

His reply was that his personal beliefs are not transmitted to patients and do not affect his treatment of patients who come to see him. I felt I should respect his statement, and, indeed, we have received no complaints that would indicate otherwise.

Rob said...

"We remind you that this is offensive to members of the BIDMC who hold to moral principles and traditional values."

As opposed to the rest of us who have nor morals nor values whatsoever? This says it all. "I am the ultimate arbiter of what's acceptable." In that, the writer already lost the argument.

Well answered.

Anonymous said...

DAMN what a controversial issue. I give credit to both sides for writing their letters with such intellegence and tact.

Anonymous said...

Bigots throughout history have tried to use science to promote their bigotry. However, as usual, in this case the author is not following the science to its logical conclusion:
ALL sexual behavior raises the risks for all the diseases he cites, compared to abstinence. Therefore, the only moral position BIDMC can take is to have an "abstinence event" during which lifelong abstinence awards are given. Paul should also issue a memo encouraging lifelong abstinence in all his employees, patients, and, most importantly to set an example, medical staff.

alefty said...

Hurray to you for standing up for your principles. We need more of that in this country! I would be proud to work in an organization with your leadership.

Anonymous said...

(unrelated to this topic) why do these comments take 30 mins from the time their written to the time their posted. Does paul have to approve them to be posted?

Paul Levy said...

Yes.

wannatakethisoutside said...

Way to stand up for what is right. Sometimes, you have to pick a side. Attempting to remain neutral can make you part of the oppression.

Are the awards specific to people in the health care field? I can think of a few possible great nominees.

Paul Levy said...

Nope, they don't have to be in health care. Please, send an email to the address listed with your ideas.

Brian said...

Do you specifically conduct events to celebrate other individuals such as those who have made significant contributions to Judaism, Christianity, heterosexuality, contributions to their race or ethnicity, etc?

Anonymous (posted at 8:43)...if one woman and one man came together in marriage relationship, having no prior sexual partners - there would be no disease. That was God's intention from Creation. Still His intent today, we've messed it up by not obeying His command in Gen 2:24.

Rob - I dont think that it was the physician's intent to come across as if he was the ultimate arbiter of truth. Rather, in this postmodern age that says truth is relative, I believe he was trying to say (without explicitly saying so) that there is absolute truth to be known and there is only One who is the source/ultimate arbiter of that truth.

Apollo said...

Though not yet a physician but at least an avid student and learner, I would like to suggest the possibility that this physician's letter demonstrates the potential for medical professionals to mix certain personal convictions incompatible with the principles of medicine with their professional judgment, and in doing so, abuse their influence. His or her choice of language (particularly the inclusion of "and frankly disgusted") quite clearly indicates his or her personal views on homosexuality. To suggest that the "health risks of homosexual behavior are well known and incontrovertible" is, at best, a misleading statement: the long history of stigmatization of homosexuals extends to the medical profession, and it is quite possible that many health problems facing homosexuals (which are not exclusive to homosexuals but are observed in higher rates) are or were exacerbated by a difference in treatment offered by physicians. This is not to say that some physicians have intentionally denied treatment or provided a lower quality of treatment to homosexuals: however, physicians have not been well-trained to ask the right questions and know how to most effectively counsel homosexual patients.

This physician stops just short of suggesting causation, perhaps with the intention to mislead (i.e. his letter seems to project the notion that homosexuality causes the diseases and conditions he mentions without stating this outright). There are always "increased risks" associated with marginalized populations. There are numerous (recent) studies demonstrating that African-Americans continue to have poorer outcomes with certain diseases, such as prostate cancer. Would this doctor suggest that BIDMC shouldn't celebrate Black History Month because there are greater risks for disease associated with being black?

If anything, BIDMC and other academic medical centers should welcome marginalized populations with open arms: how else can our health system remove obstacles of stigmatization and find better ways of treating these patients (so that these "greater risks" of disease are minimized)? Whether with or without intention, the passionate words of physicians such as this one further stigmatize a segment of our population and may further propagate differences in health outcomes as a result of nonexclusive diseases, perhaps giving intolerant individuals a continued supply of fuel by which to condemn this group.

Labor Nurse said...

Paul, you get a standing ovation from me on this one. I'm curious to know how that physician responded to your follow up letter.

Maxine said...

Wow, I don't think I've ever been as stunned. I wonder if it's because a physician spewed that. I'm reminded that Jerry Falwell blamed the 9/11 attacks on the pagans, gays, lesbians, feminists abortionists, the ACLU etc of New York. And I'm afraid because I've just learned that those beliefs belong to people I've always considered more sane than the radical Christian right.

Anonymous said...

Well said, Apollo. My nephew is gay. I am glad he lives in California; otherwise I would have to advise him to avoid BIDMC since I would never, ever let him fall into the hands of this physician.......

Paul Levy said...

I can assure you that this doctor's feelings on this matter do not reflect the general sentiment of doctors here. Indeed, it was BIDMC who were viewed as the most accepting in Boston of gay people during the early days of the HIV/AIDS problem. I think your nephew would find a very, very welcoming attitude here.

Anonymous said...

Paul;

I am anon 1:37 (and 7:42, and 8:43; think I'm angry???) I wondered if you would take offense at my comment, sorry. The comment was actually rhetorical and directed at the physician, to let him consider the fact that perhaps it is he who is dishonoring BIDMC by his discriminatory attitudes toward patients (despite his claims to the contrary); rather than you dishonoring BIDMC in an attempt to be inclusive. In actuality, if my nephew needed care there, I would probably call you up and ask what speciality this guy practiced so we could avoid him. As a gay person's relative, I can testify that the last thing they need is more grief.
This physician may not read this blog, but he should read this comment from his peer.

Paul Levy said...

Thanks, I didn't take offense at all. Just didn't want people to get the wrong idea about our place!

Anonymous said...

I have no problem with the gay/lesbian/transgender community but why do they get a special week of recogntion and heterosexual employees don't ?

Rob said...

Brian:

Actually, by presenting him/herself as having the ultimate moral authority, that being that only those included in his/her group do comform to moral standards, s/he is implying that s/he is the only, singular arbiter of right and wrong. S/he is not adhering to any post-modern relativist thought (which I personally detest), but rather saying that s/he is the only moral person, and the only one with the truth.

When we think we know the truth is when we should think again. When we exclude others from us, we exclude us from them, too.

Anonymous said...

BIDMC's PRIDE celebration honors the entire LGBT community--not only employees but patients, neighbors, the community-at-large. The week's activities provide us with a time to reflect on our accomplishments as well as opportunities to improve care and to share our commitment to provide equitable care to all who come to BIDMC. As the first hospital in the nation to publish a Patient Bill of Rights, we recognize that certain groups have been discriminated against--consciously and unconsciously. We must be intentional in redressing these inequities.

Alison said...

I always think it’s cute when people use the disease angle to prove that Homosexuality Is Wrong.

Actually, heterosexuals are at greater risk for almost all STDs than lesbians are. By this logic, the hospital should be actively promoting lesbianism as a public health measure.

Anonymous said...

I am suprised no one has pointed out that simply being gay poses no additional health risks. Practicing anal sex may put you at an increased risk for contracting STD's, but there are straight couples who practice anal sex and gay males who do not. Also, I fail to see how being a homosexual female would put you at any increased health risk. The physician that wrote this letter needs to reevaluate the assumptions he makes about gay members of our community.

Anonymous said...

To brian and anon 3:43,

Your award is the ability to walk down the street holding hands with the person you love without having to fear for your life.

n, MD said...

I agree with many of the previous posters who point out that promiscuous behavior, not homosexual behavior, spreads disease and the physician's argument is specious. I find it remarkable that someone so ignorant actually got through medical school. . .

I think the PRIDE event is not so much to honor any particular individual of any particular orientation; rather, it tells the world who WE are and that we as an institution not only do not discriminate but we embrace our diversity.

It's sad that in 2007 we still have to make a point of this. The only "gay agenda" my homosexual friends have is to live and let live and have their sexual orientation NOT MATTER in their daily lives (other than their love lives, of course) just the way the rest of us take it for granted.

I look forward to the day that we won't have to observe "gay pride week" "black history month" "women's history month" etc. etc. etc. because no one will be able to remember or even imagine a time that any group was treated as being less than anyone else.

Anonymous said...

Who is the “we” in the letter? Was this a group of BIDMC physicians? I hope not.

It is so, so, so sad that this individual is taking care of patients at our institution. As a BIDMC physician, I am deeply troubled by this post as I did not believe that overt discrimination like this existed here.

jb said...

A little perspective goes a long way here. The letter contains purported facts and opinions. Leaving the opinion part aside for a moment, aren't some of the facts correct- that homosexual behavior is correlated with a higher risk of STDs and especially HIV, which still has the potential to be lethal? If true, the letter writer has a poorly expressed and nasty but nevertheless valid point. Promoting and celebrating homosexuality is contributing to advancing disease. An analogy to smoking cigarets may fit- we should not morally condemn or refuse care to smokers, but cigarets are no longer tolerated in or near most hospitals, and we certainly don't see hospitals promoting smoking (even though it's great for business). You can argue that sexuality is hardwired and smoking is a choice, but that still does not mean that homosexuality should be celebrated IF it is actually a greater contributor to disease than heterosexual behavior. Even if the 2 sides are equally associated with disease, it can not be disputed that at least heterosexual behavior has the benefit of survival of the human race on its side, whereas homosexual behavior is all about making yourself and your partner feel good. Nothing wrong with that , but we must also consider the price to be paid.

Graham said...

Really appreciate your very public stance on this issue, Paul. As a gay, future ER resident (and one applying to BIDMC's program in October!) it's really great to see the hospital's CEO set the tone.

Anonymous said...

The opinions expressed by that doctor are exactly why I am so hesitant to discuss my orientation and sexual behavior with medical professionals. You never know when someone is harboring the feeling that I am "immoral," "ungodly," and "unnatural." Even if this doctor successfully hides his views from his patients, his willingness to express his bigotry damages health care for all non-heterosexual patients by fostering an atmosphere of distrust and fear. He may provide the same recommendations to gay and straight patients who present identical symptoms, he may arrive at the same differential diagnoses, but equal treatment of patients generally depends on communication being equally open from those patients. That cannot happen when doctors like this one are lurking in the shadows.

I don't want to be a second-class patient, and I don't want to worry about whether I'm secretly being considered a second-class patient by my treating physician.

Leaving aside this doctor's shaky grasp on the links between "homosexual behavior" and health, I don't understand why a hospital tolerates a doctor who expresses the view that a class of his patients (and colleagues) are immoral, ungodly, and unnatural. How is that consistent with providing equal access to quality health care?

Paul Levy said...

The simple answer is that this is a free country, and people are allowed to express their views. As long as we have no indication that patients are harmed by a doctor or likely to be harmed, we have no right to remove privileges.

Dave said...

Paul -

I am the same "Dave" who asked you about how you have time to blog. Since then, I confess that you've won me over. I do not back off my comments that it takes narcissism (and addiction) to feel compelled to write this frequently, but the more I read the more I have come to respect that you and this are in fact nothing but good for your institution. You are disarmingly honest and have a keen sense of what is right and how it will be interpreted. As such, this is not a dangerous strategy at all, just one that should be infrequently emulated becasue few could pull it off without inadvertent collateral damage to their organizations. Obviously, you are in possession of great interpersonal skills and the intrinsic un-premeditated ability to judge how things will be received and act in accordance with that, which makes your motley list of past accomplishments all make sense. There are very few among us who are capable of leadership in this manner, and it is no surprise when we (my own narcissism exposed by my choice of pronoun) succeed in multiple and varied disciplines. I have never read a blog before and must confess that yours has opened my eyes.

As far as the present topic is concerned, all issues have been covered very well. I would echo that it is alarming that a physician would state these views, but wholedheartedly agree that homophobia is not permitted or accepted in healthcare environments. Indeed, they are in my experience uniformally more accepting than other institutions and I imagine that the poor author must find the dizzying pace at which the rest of us are progressing to be more isolating than it is to be gay! I always say, when confronted with miserable and/or judgmental people, that as long as their actions won't harm others (a valid concern in this case), the best thing to do is to act nobly, respond civilly, and walk away. This serves dual purposes: it is the right thing to do and put you in the muck, and it serves to exasperate the offender even more because it's frustrating that their inflammation is met with such coolheadedness and sincere disagreement. Beyond that, there can be no greater misery bestowed upon the miserable than the fact that they have to walk in their own, self-isolating, small-minded shoes each and every day. Imagine the horror of being so judgmental - each day would be met with anger and returned with the same intolerance.

Having said that, thanks to the author who pointed out the importance of gay pride events with the example that our (heterosexual's) reward is to walk down the street holding hands without fear of brutality. He or she swung my perspective with that one statement.

Best to you and yours,

Dave

Dave said...

Paul - one last comment in response to your most recent reply. In the private sector comments such as the author's would immediately be sent to HR and result in serious repercussions. If you expressed such feelings you'd be removed from your position, as would I. Perhaps that is because public sentiment would turn against us and we would thus be made ineffective leaders. However, notwithstanding the pacifist approach I championed in my last comment, I do share the last poster's (anon 11:15) frustration that the person cannot be publicly "outed" (what better word?) and at least no longer be permitted to lurk in the shadows.

Actions have consequences, and an e-mail such as the one he wrote to you is risky business. I think he is extraordinarily fortunate that you are so tolerant and that your organization is run in such a way that doctors have tenure or other forms of job protection. Without at all disagreeing with your approach, I would have probably ended up being more confrontational with him because tolerance of such ignorance is dangerous. There is such a thing as being too liberal; just as actions have consequences, so too do inactions. As such, you may unwittingly, unwantingly, and unknowingly have blood on your hands by not taking a stand against a bigot who can do real harm to his (or, theoretically, her. . . although I highly doubt it) patients. It's impossible for me to believe the doctor could possibly provide the best care given his intolerance. Therefore, as faras I'm concerned, he's not likely to be fully competent at his job.

My question is this: were there no legal repercussions or were a vehicle to mitigate them to be identified, would you take a different approach? My suspicion is that you'll say "no" and believe it, but I think that as you rightfully said, "sometimes the CEO gets to make a decision". In this case, I think at least more aggressively confronting/ scaring the man (or fictional woman) is at the very least warranted. The lack of repercussions for doctors in large academic institutions is troubling: he doesn't see you as his boss but as someone to be managed around or entirely dismissed. It seems to me that medical institutions suffer from this plague of arrogance and lawlessness because they are anarchies without fear of real-world repercussions like losing your job. Doctors would complain a lot less about their salaries if they walked out in the real world and saw that risk and reward and coupled and that their only occupational risks are needlesticks and malpractice - not losing their jobs entirely (and before the full wrath of judgment is thrown upon me, I hold a medical degree and practiced for three years in my youth).

On a related (and, I promise, final) note, is there a more horrifically flawed concept than "tenure", especially when added to the volatile mix of difficult to manage physicians in the first place?

Anonymous said...

jb -

You fail to differentiate between specific sexual behaviors. Some sexual behaviors entail more health risks than others, but that is true among the heterosexual population as well as the homosexual population. To follow your analogy with tolerating smoking, I'd be ok with BIDMC banning unprotected anal sex in all public areas, particularly in waiting rooms and check-in areas. But I'm not sure that's been a major problem.

If you consider public health and not just individual treatment, we are all better served by health care reaching as many people as possible. We want all patient communities, including gay patients, to be welcomed and treated by health care facilities so that we can reduce the spread of diseases within and between those communities. That's true whether you want to reduce the spread of HIV or the spread of influenza.

As for your rhetoric about heterosexual behavior having the benefit of survival of the human race on its side, are you seriously suggesting that hospitals should be in the business of (1) promoting reproductive intercourse between fertile heterosexuals to ensure that the human race continues and (2) advocating against all other sexual behavior (such as non-reproductive sexual activities, sex with an infertile partner, sex after the age of 40, sex when the woman isn't ovulating, sex with a partner of the same gender, etc.) because that behavior is associated with a greater incidence of various health problems?

eeka said...

This behavior seems to go against several AMA positions:

http://www.ama-assn.org/ama/pub/category/14754.html

The easiest issue to tackle though is that, as others have mentioned, this physician is presenting medically inaccurate information regarding disease transmission and so forth. Sexual orientation and/or gender identity does not determine disease risk; behavior does. I think you have an ethical obligation to report this individual for spreading medically inaccurate information and insist that s/he receive further training. People ARE likely to be harmed by physicians who are spreading these kinds of views. It was harmful to me when a physician insisted I undergo STD testing based on my identity rather than asking about my sexual or drug-related behaviors. It's harmful to me every time a provider asks me if I'm married and then asks what "his" name is. I think you have an obligation to have this physician shadowed and assess whether s/he is in fact treating people equally.

Finally, I'd like to encourage you and your organization to use more progressive and respectful language when referring to GLBT individuals. While some portions of the medical field use the term "homosexual," it's typically viewed as an outdated term in the social sciences and by most members of the GLBT community. Here's a resource regarding language:

http://www.apastyle.org/sexuality.html

Keep fighting the good fight!

Paul Levy said...

Wow, Dave, you are a marvelous writer yourself, and I appreciate the many compliments. I will try not to fall into a trap and believe that my narcissism is fully justified. After all, remember what happened to poor Narcissus, who "languished beside the pool, dying either from starvation or excessive self-love." http://www.mythweb.com/encyc/entries/narcissus.html

But this phrase -- "there can be no greater misery bestowed upon the miserable than the fact that they have to walk in their own, self-isolating, small-minded shoes each and every day" -- is off the charts in terms of construction and imagery. Bravo!

eeka said...

Anonymous said...

To brian and anon 3:43,

Your award is the ability to walk down the street holding hands with the person you love without having to fear for your life.


That's beautifully stated. Kudos.

Anonymous said...

Paul,

You wrote, "if any doctor in our hospital wrote a similar letter to me about an ethnic group, racial group, or religious group, it would raise a red flag about the ability of that physician to treat patients from that group in a manner equivalent to the broad population."

That raises some important questions. Other than raising a red flag, what would the consequences be (if any) if a doctor wrote a similar letter to you about his black patients or his Jewish patients? Can a doctor freely express anti-Semitic or racist views, as long as he assures you that he doesn't allow it to affect the way he practices medicine?

Paul Levy said...

Deer eeka and others,

I cannot remove patient care privileges from all of the doctors (or nurses, or others) who say things to me that I consider unpleasant, inaccurate, prejudiced, or repulsive. We have many ways to detect harmful and improper behavior and language by caregivers when they are in the presence of patients. When we encounter that, we do apply discipline or training as appropriate.

I personally do, quite directly, tell people when I disagree and have urged them to think about the ramifications of what they say. Nonetheless, even a person who has gone through years of medical training has every right to believe what s/he wants and to say it out loud.

As a further point, as CEO, I actually don't have the authority to remove a doctor's privileges without due process. The hospital's medical executive committee has the responsibility to examine instances of harm or potential harm to patients and then to make recommendations to me. As eeka points out, harm does not just have to be physical harm -- it can relate to the verbal interaction with a patient and the emotional harm that might ensue from that.

In this case, I did mention the letters to the chief of this person's division, and s/he assured me that there had been no indication of improper behavior by this doctor in the presence of patients, whether gay or straight.

Miya said...

Thank you for the sober reminder that ignorance and prejudice exist even in advanced institutions and liberal cities, and for your no-nonsense response to such nonsense. I am also learning a lot from the fascinating responses that have followed (special thanks to eeka for the very helpful article about language).

As a first year med student the greatest gift given me has been the opportunity to follow a gay man with AIDS over the course of the year. He is very happily receiving excellent care--at BIDMC! However, he tells horror stories of a time not too long ago when views like those of your letter writer were used by medical professionals to justify denying care to himself and other members of the gay community. Thank you for helping to make your hospital a place of safety and healing for all comers.

Anonymous said...

Thank you for letting us know what steps you can and did take. I'm comforted to know that this doctor's views are at least a matter of concern. And I'm glad that you're vocal about opposing his views, because that's the best way to limit the damage he can cause.

Most of us posting here are looking at this from the patient's point of view. Since the hospital is also a workplace for many people, aren't you worried that he is creating a hostile workplace environment for your non-heterosexual employees? Hateful speech can and should be limited in various environments, such as workplaces.

Anonymous said...

Having served on medical executive committees (nowhere near Boston), I can affirm that Paul is correct about the "rules" and the limits of his authority. JCAHO does, I believe, require hospitals to have a "disruptive physician" policy addressing definition of and action to be taken regarding incidents of inappropriate behavior by physicians with staff or patients. In reality, the exec committee would rely on patient or staff complaints to uncover any inappropriate behavior by this physician, since there is really no other way to detect it. (One hopes his gay patients would speak up, and I believe at least some of them would.) They would then use the disruptive physician policy to enforce disciplinary action. (This legal pussyfooting is necessary since, in my experience, virtually all formal disciplinary actions are contested, with assistance of legal counsel.)
But eeka is correct; if in fact he tells patients that "homosexual behavior" is what is associated with all these diseases, that is inaccurate information. It is a) multiple sexual partners during a lifetime, and b) anal sex which are specifically statistically associated with increased risk of HIV. I think it would be appropriate for his chief of division to ensure that he is aware of these facts and is counseling all his patients (including heterosexual ones) accordingly, should that be part of his specialty practice.

And by the way, Dave, I agree with Paul that you are an outstanding writer, and I suggest that you start your own anonymous blog regarding your private investment world - I am sure we would all learn a great deal.

eeka said...

I'm glad you've mentioned the letters to the appropriate people. I still think there are cracks though -- the fact that you mentioned it and the supervisor said there was no indication of improper behavior only essentially means that no patient has complained.

In terms of emotional harm, it goes further than that. I'm sure you've read plenty of literature about best practices for GLBT health care -- there are tons of stats regarding how GLBT folks at large receive less health care, because most of us have had unpleasant experiences with homophobia in health care, and we tend to avoid health care settings. This is especially true for our trans brothers and sisters (who I notice you're mostly leaving out when you discuss the GLBT community).

It's your duty, having received this letter, to ensure that this doctor is treating patients equally. Not just to make sure there haven't been complaints. But to actually have a supervisor work closely with this doctor to ensure that patients are in fact being treated equally. This would include taking sexual histories in a nonjudgmental manner from ALL patients regardless of marital status and so forth, as this is an essential part of taking a medical history. This would include assessing whether all patients have an appropriate support network, as this is also part of providing appropriate care -- is it even possible for this physician to feel that same-sex relationships are "unhealthy," yet be able to assess a patient in a same-sex relationship as being mentally healthy and having an appropriate support network? I really question whether this is possible.

I agree with the sentiment of others that it's unfortunate that you've chosen, for whatever reason, not to release the name of this individual. It's one thing if the person had made the comment to you in the lunchroom, but this person sent you a formal letter, pretending to be a committee. If this physician wants to have these beliefs, I think they should be made completely public so that we can all choose to stay the hell away from him or her. I can definitely tell you that after finding out that such a person exists and is not really being dealt with, I'm never setting foot in that hospital again.

eeka said...

Nonetheless, even a person who has gone through years of medical training has every right to believe what s/he wants and to say it out loud.

Not entirely. If a physician said to a patient that s/he was "unhealthy" on the basis of identifying as GLBT, it would constitute abuse.

Paul Levy said...

eeka,

Once a doctor is through training and licensed, s/he is subject to the rules and regulations of the state and the hospital. My duty and that of the hospital clinical leaders is to make sure we have procedures in place that provide proper discipline for a doctor who has caused harm. If violations are alleged, we investigate and follow very carefully designed procedures.

You don't do a pre-emptive investigation of this sort without evidence of harm. No, the letter is not evidence of harm -- however much I might not like what s/he says. Likewise, putting a supervisor in for each exam and appointment does not solve a problem.

There is a system of due process, and we follow that because it is important to protect everybody's rights. I doubt you will find a hospital that would do it differently.

eeka said...

He chose to bring it to your attention that he has some basic medical facts incorrect (regarding disease transmission and that being GLBT is inherently unhealthy).

Have you addressed this issue and made sure that he's receiving appropriate remedial training in these areas?

Anonymous said...

To eeka;

Although I am as outraged by this physician as you(I am the one with the gay nephew and anon 2:52), keep in mind that this letter sent to Paul was an internal hospital communication, not a letter to a newspaper or something. It was Paul who chose to put it on this blog as an illustration. "Outing" this person, while I hear is a popular practice in blogs, really is professionally and legally inappropriate in this situation, and I think it's unfair for you to demand it of Paul. It will also have a chilling effect on his willingness to make such posts in the future and we will all be the poorer for it. The purpose of this blog, as I experience it at least, is for all of us to gain some insight into the workings of a hospital from its CEO's perspective, and to civilly debate the issues it raises.
As I mentioned in a previous post, if my nephew needed care at BIDMC, I would inquire of Paul what this person's medical specialty is. If it were likely to impact my nephew, I'd keep him away - but perhaps only to unknowingly go to another hospital where his physician holds the same views.

Paul Levy said...

Thank you. Exactly right.

jb said...

We are now nearing "thought crime" territory. Absent any evidence that quality of care is negatively affected, a lot of posters above want to punish this doc because of his beliefs. From there it's a short way to go to having to believe in the right god to get privileges in your institution.

One of the posters who objected to my previous post appears to not believe that there is not an association between anal sex and (male) homosexuality. Another objects to the very term homosexual. I couldn't make up better examples of mindless political correctness.

Is it permissible at your hospital for an Obstetrician to have negative feeling about the 16 year old unmarried girl on Medicaid who is delivering her second or third child (elsewhere universally recognized to be a formula for social pathology), or is that also a thought crime?

I'll stop thinking now, so I can keep my job.

eeka said...

JB, How's it thought policing now?

He didn't have enough sense to keep his bigoted beliefs to himself. He took it upon himself to write a formal letter to the CEO of the hospital, pretending to be a freakin committee, in order to express his views. That's not very consistent with having good boundaries and knowing how to separate his personal beliefs from his professional beliefs.

eeka said...

Also, JB, if you're referring to me, I've just stated that I prefer other terms, and explained that most people in the GLBT community find the term to be outdated and associated with pathologizing our existence. I'm not sure why you can't respect a simple statement indicating what terms I prefer. Apparently it oppresses you in some way when others prefer to identify a certain way.

Incidentally, I was chatting just now with a gay male friend of mine who has not ever had any sort of sex with another person. I'm sure he'd be happy to hear that you correlate him with anal sex.

But thank you for making my point about how providers need to talk openly with people of all backgrounds about their sexual history and cultural alignments, rather than making assumptions. I'm hoping the awards being given will help people recognize just how valued people are who take the time to do this.

Liat said...

I am a bit late to this party, please forgive.

I am very saddened to hear that a physician would express such views, more so that nothing will be done about it.

I am female, and I accompanied my wife to an appointment at BIDMC a couple years ago. The doctor barely looked at her and told her she was fine. She still has the same problems, but she is not inclined to seek further treatment based on that experience.

Now I will always wonder whether that doctor or any other one we've seen there was the one who wrote that note. We will no longer be choosing BIDMC for our family's medical needs, as we will always wonder whether the physician we are seeing is the same one who writes an annual hate letter. How can we believe that someone who has that negative an opinion of our very existence will give us fair treatment?

Paul Levy said...

I would hope that any patient experiencing inadequate treatment by any doctor in our hospital would file a complaint.

Liat said...

Unfortunately, we had no way of knowing if this doctor is always like this, or didn't like the fact that we're queer, or was just having a bad day, and "perceived dismissive attitude" isn't much to hang a complaint on.

I doubt any of your physicians are likely to come out with direct homophobic statements to patients, but as I said, now we would always wonder if we receive care from a BIDMC doctor whether said doctor wrote this letter to you, and now we also know that we can't count on backup from administration.

Paul Levy said...

Dear Liat, and others,

If you feel that you should not come to our hospital because of this blog exchange, I respect your decision.

It is a shame, though, in that in so doing you ignore the extensive history of this hospital, where there is a culture based on respect for and care of all people.

This doctor expressed his opinion to me. There are doctors in every institution who have opinions that you or I might consider unacceptable. Most of them do not say them out loud -- but that makes it no less likely that you will go to see one whose opinions you don't like.

As noted above, I cannot and will not take action against a physician based on opinions expressed. As someone mentioned, that is acting as "thought police", a concept that is anathema in our society. Our hospital will take action when a physician acts in such a way that has or might cause harm to a patient.

You seem not to understand or accept the premise that if we chose to adopt a standard of discipline based on someone's opinions, we would be on an inappropriate slippery slope towards deciding what people are and are not allowed to say.

If you find a hospital that has a different standard, please let me know.

Liat said...

I understand that you can't play thought police. I'm not asking you to, and I don't think anyone else is either. What I don't understand is why someone can't take steps to correct this doctor's blatantly inaccurate information on homosexuality.

Homosexuality and homosexual behavior do not, in and of itself, cause any of the things to which this doctor referred. Promiscuous and dangerous behavior does. I belong to a population that's at very low risk for most STDs, but I, and other monogamous lesbians I know, have been told by medical professionals that we're in the highest-risk category, just because we're queer. That's plain incorrect.

If you had a doctor on staff who thought lung cancer was only caused by smoking and treated patients accordingly and refused to believe them if they said they didn't smoke, wouldn't someone speak to that doctor?

Of course, all organizations are liable to have bigots of one stripe or another in them, but there are places that specialize in care to oft-marginalized populations, and that increases the odds of getting a doctor who will see me as a whole person, not just another queer.

eeka said...

No one is asking you to discpline someone based on his opinions. I can only speak for myself, but I'm asking you to take action based on his behaviors. He has taken it upon himself to write to you and let you know that he wants his bigoted beliefs to be known. He has not chosen to separate his personal views from his work. He has also taken it upon himself to let you know that he has some medical facts wrong. As another commenter pointed out, there's no way to prove that a physician is brushing off a patient based on the person being queer. This physician has absolutely acted in a way that might cause harm to a patient, both by demonstrating a lack of boundaries and lack of understanding of medical facts.

For what it's worth, I've been told by two separate high-ranking docs at another facility in Boston that they would absolutely take action if such behavior happened in their facility. They also emphasized the importance of hiring practices in which applicants are required to discuss their expertise and practices used to provide culturally competent care to specific populations. This physician would have never been hired in their facility.

Your hospital already has enough of a reputation in the queer community for being homophobic. This lack of action just confirms it. I'd strongly suggest you meet ASAP with a group of experts in GLBT healthcare who can explain to you why it's so dangerous for people to be treated by a physician who is openly homophobic and who has written you a letter to inform you of this.

Oh, I might also remind you that you absolutely can decide what people are and are not allowed to say in your workplace. In my workplace, there is a policy prohibiting homophobic speech. We also have a policy that says I can't tell coworkers or patients that they have nice tits. We also have a policy that we can't make erroneous claims. Come to think of it, my professional license has a similar policy.

Quite different from thought policing.

Anonymous said...

"This is not to say that some physicians have intentionally denied treatment or provided a lower quality of treatment to homosexuals..."

--

Well, actually, I'll say it: Many physicians and other caregivers HAVE intentionally denied treatment or given sub-standard treatment to people whom they perceived to be "homosexual" (and the commenter Eeka is right in that this term smacks of a tradition of institutionalized discrmination; I assume there is a reason it's not being called "Homosexual Week"?).

As this thread has clearly illustrated, doctors and other health care practitioners can hardly be assumed to be above the fray just because of their professional status. Many gay people ask around in their communities for recommendations of medical personnel who will be responsive to their specific needs and sensitive to their issues. They know whom to seek out - and whom to avoid.

Paul Levy said...

Eeka,

"Your hospital already has enough of a reputation in the queer community for being homophobic." Wrong, wrong, wrong. You should know better than to say this.

Enough of this.

Jodie said...

While eeka could be called upon to support her claim that's she's right about her statement that your hospital has a reputation in the queer community, I'm not quite sure how you're able to refute it right now. Could you elaborate?

Paul Levy said...

First, let me just say that for anyone to make a general accusation like that about any place is really obnoxious. Imagine if I made an assertion that such-and-such hospital was racist, anti-Muslim, anti-semitic, sexist, or otherwise.

Second, on your point, BIDMC has been known for years as a place that respects and cares for people without regard to whether they are heterosexual, homosexual, or other sexual orientation. You could ask people at Fenway Community Health and Outer Cape Health Service for their views on this matter. It is no accident that those health centers have chosen to affiliate with us. If we were what eeka claimed, they would have been long gone by now.

Can you imagine that we would being sponsoring the Pride event mentioned in my posting if that were the case?

Can you imagine that I would have taken a vigorous and public position in favor of gay marriage if that were the case?

Can you imagine that we would have dozens of gay medical staff, nurses, and administrators if that were the case? And probably thousand of gay patients?

I do not mind and indeed welcome points of view opposing mine on the issues of the day, but this comment went over the line in terms of being mean-spirited and inaccurate. It is a kind of talk that eeka otherwise argues so strenuously against, in that it only seeks to demean the reputation of a place and thereby everybody who works there.

Jodie said...

I can imagine that there is more than one way to be homophobic. While well-meaning people might truly want to support the GLBT community, they might unwittingly support behavior that is to the contrary. I think that's exactly what happened here. Of course, as an employer, you can't fire or discipline people because they don't agree with you or patients. On the other hand, it hurts your cause when you don't act on a letter that contains clearly medically inaccurate information from a doctor at your facility. You don't need a patient complaint in this case; this doctor has personally written to you that they don't understand the basics of STI transmission. "Homosexual behavior" encompasses many things, most of which do not result in disease transmission. Of course, unprotected anal sex with multiple partners does increase this risk, regardless if it's practiced by gay men or straight women.

When a hospital chooses not to act when this is presented to them in writing and publishes the letter in a public blog, it most certainly contributes to homophobia. It doesn't matter so much that you have Pride events when physicians on your staff are spreading inaccurate medical information about "homosexual behavior." Personally, I think it's even more damaging to be coming from your hospital. If people believe that BIDMC is a place that cares about the GLBT community, the general public may be more apt to believe inaccurate statements regarding health risks for members of the GLBT community that come from your staff.

I believe you care. I also believe that you're unwittingly contributing to the problem.

Liat said...

Eeka didn't say that BIDMC is homophobic. She said there's a perception in the queer community that it's homophobic. Subtly different concepts there. You've had a couple people come in and tell you about negative experiences that may have been caused by homophobia (or they may not).

You're still not addressing the issue that Jodie so eloquently mentioned about a doctor disseminating incorrect health information. That worries me more than any rumors possibly could.

Paul Levy said...

It is really interesting to me that you think publishing the letter contributes to homophobia, when I used it precisely to show the opposite -- the positive response, by the way, of several gay people on the staff.

I don't think anyone reading the blog could conclude that the sentiments in the letter reflect mine or that of other people here.

As mentioned, I also reviewed the actual record of this doctor with regard to patient care with his chief.

Yet, you ask for something else. You ask me to conclude that this doctor is hurting patients in the face of no evidence that he is. "You don't need a patient complaint", you say. I say I need evidence of harm or likelihood to cause harm. A stated opinion -- wrong, stupid, or misinformed -- is not evidence of that.

Liat said...

Also, you talk a lot about respect and caring for the GLBT community, but you persist in using words like "homosexual" and "gay" to encompass the entire community.

You also, in your original post, used the phrase "gay and lesbian agenda", which is really very disrespectful, since that's the exact language used by homophobes to attack GLBT people and their ideas and actions.

Mind you, I don't believe that you intended any disrespect. I'm sure that you are, on a personal level, respectful to all your patients and staff.

I do wonder what your response would be if you received a similar letter criticizing the hospital's choice to observe Black History Month.

Paul Levy said...

Liat,

You are splitting hairs about what she was saying and what she meant to connote.

Have a good weekend. I am off duty now.

Jodie said...

See, but the doctor who wrote a letter did not express an opinion; he stated a "fact:"

. . . the fact that homosexual behavior involves well recognized higher risks of STD's, HIV and AIDS, anal cancer, hepatitis, parasitic intestinal infections, and psychiatric disorders.

This person is very clearly saying that this is not an opinion. I believe that everyone should be entitled to their opinion. Spouting opinion as "fact" is another matter entirely. That's what makes this a problem. It seems clear to me that this person needs further education on STI transmission, because they are generalizing an entire population's risk factor based on very specific behaviors that many in the community do not engage in, and stating it as FACT, not opinion.

Liat said...

You may be splitting hairs as well here.

I'm glad your gay staff was reassured by the hospital's response. There are queer potential patients in here right now telling you that we no longer feel safe going to your hospital for treatment because of the refusal, not to discipline this doctor, but to make sure he or she has basic medical information correct. This is a point that has been brought up by at least three different people and which you have not addressed.

I don't feel any better knowing that a doctor can be plain wrong and demonstrate that he or she is plain wrong and not have to be re-educated. What else might this doctor not know that he or she should?

eeka said...

Hi, I thought I'd insert myself into the debate on what I did or did not mean by my comment.

I did not mean that the hospital in its entirety is homophobic, no. I recognize that the hospital and its affiliates have done positive things for members of the GLBT community at times. This does not exempt the institution from homophobia, and it's frankly silly that you'd give these examples as reasons why the place can't possibly have a reputation for homophobic practices.

I've heard from many clients, colleagues, and friends that they avoid the place due to homophobic treatment (and nonresolution in the case of people who've complained). And yes, this includes providers affiliated with the two health centers you've mentioned. The queer health centers may value the affiliation enough to keep it, but this doesn't mean that there aren't providers at those health centers who have experienced homophobia and transphobia when collaborating with BIDMC specialists on patient care.

No, I have no way of proving that people in the GLBT community have reported these things to me, 'tis true, but you certainly don't have any grounds for telling me I'm "wrong" about my experiences or perceptions. My personal and professional identity are easy to figure out from my blog -- if I were making things up, I wouldn't be posting in a way that's easily traceable to my business and my professonal license. I wouldn't be very credible as a GLBT healthcare trainer or a provider if I were going around inventing homophobia. No reason whatsoever for me to do so.

Anonymous said...

Great post, Paul.

I hope you are not dissuaded from your candid approach to this blog by commenters who -- once they've received reasonable responses to their very appropriate queries -- shift into "aggrieved" mode and impugn your institution's credibility.

Most readers roll their eyes, I suspect.

Anonymous said...

Wow, a couple days ago when I was counting comments on Paul's posts, we were at 52. Clearly things have escalated since then. I was wondering why Paul had not submitted a post today; now I know he was busy arguing with you guys. I miss the post that he would have submitted.
I would like everyone involved here to step back a little and look at the real issues.
Paul started this whole thing by mentioning that his hospital was having an event positively acknowledging the GLBT community (I just backspaced to make sure I am using the correct terminology here; I can learn). He then published a private letter to him from a member of his medical staff, in order to make the point that this doctor's view had NOT changed his support of this event. (contrary to eeka's statement on her blog, there is no evidence that this doctor "circulated it around the hospital.") What is the result of his action intending to support the GLBT community? He gets roundly castigated by that community, both in this and in eeka's blog and wherever else I do not know, along with barely disguised calls for boycotting BIDMC, apparently inaccurate statements regarding BICMC's attitude toward the aforementioned community, accusations of professional incompetence, etc. - because he has not done ENOUGH!!
And you commenters make a big deal about the inaccurate information of the doctor; look to your own statements.

I agree the doctor made medically inaccurate statements, and I have made at least 5 previous comments here supporting that fact. Commenters must understand that all peer review activities in a hospital are confidential; therefore if Paul has taken some action, through the dept. chair or medical executive committee, against this physician, such as counseling him regarding correct information, he couldn't tell you he did it anyway.

In addition, it is my personal opinion that excessive militancy on any issue tends to turn otherwise supportive people against that issue; witness the bombing of abortion clinics, murder of physicians performing abortions, and other extremist actions on issues on which people vehemently disagree.
If anyone hopes to achieve tolerance of whatever issue you are trying to advance, they must exhibit some tolerance themselves. You are forgetting that Paul put himself out there acknowledging that this attitude exists within one physician at his hospital, and I am sure you will find at least one physician with exactly the same attitudes at any other hospital in the country. I worked as a hospital-based physician for 21 years and I can tell you that physicians have just as many weird ideas on a number of subjects as anyone else.

eeka, your suggestion that this physician's "supervisor" sit in on his patient interactions is naive; the physician would just modify his history-taking to make it politically correct for his audience. Patient or staff complaints are the only, and I mean the only, way this prejudice would be uncovered.

Finally, I think the unspoken standard of civility and intellectual debate represented by this blog has been soundly violated, and I for one am offended. Back off.

Anonymous said...

I understand why it is outside your jurisdiction to take certain actions against this doctor, but I wonder if anyone has simply educated him about the medical inaccuracies in his letter.

Liat said...

Anonymi:

First, it would be useful if you could each choose another name, since everyone's being anonymous makes it a little difficult to track who's saying what.

You're correct that it wasn't said that the doctor circulated it through the hospital, but Paul refers to gay staff members who approved of his response, therefore it had a wider audience than just the doctor and Paul.

I understand the concept of confidentiality, of course, but there's not been any indication that anything at all was done other than a written response that this event will continue. I can't speak for other commenters but I'm less concerned about this doctor being disciplined and more concerned that he's disseminating inaccurate medical information. If I can't trust my doctor to know how STDs are transmitted, how can I trust him/her with any of the rest of my health?

Anon 7:17, are you yourself in a marginalized population? I mentioned that we feel my partner got substandard care from one physician, but we have no way of knowing if it was due to homophobia or if s/he just has poor people skills in general. How should we complain? "Dr. X seemed cranky, make hir be nicer"?

I doubt any physician is going to be careless enough to make overtly phobic statements to a patient. That leaves us to speculate, "Is this doctor saying this because s/he doesn't want to treat us, or because there's actually not a problem or what?"

It's annoying enough to be asked by medical professionals (not just at BIDMC, for the record) what my husband does for a living. It's very annoying to have to convince anyone that we are actually legally married in this state. It's downright dangerous to have a doctor out there claiming incorrect facts about homosexuality.

I'm not sure why you don't seem to understand that cerdmonially recognizing the GLBT community is all well and good, but at this point, it seems like merely lip service.

No, of course Paul can't regulate a doctor's thoughts. But this doctor has gone beyond thoughts to speech. Of course s/he is going to say s/he wouldn't treat a queer patient any differently. S/he wants to keep hir job.

I just wish I could get people to understand that we (meaning a small segment of the queer community) don't think Paul is prejudiced, but we don't currently feel particularly safe choosing BIDMC for our medical needs right now.

eeka said...

Anon 7:17, have you had a situation in which you've provided a provider with additional training on how to address prejudices and work more sensitively with individuals? It can be quite effective, if the provider is willing to learn. And if the provider behaves in a manner that indicates s/he is not, then s/he can be disciplined according to nondiscrimination policies. This is what we do in my workplace.

I worked with a provider who was insisting on calling a transgendered individual by her legal name because "this is a place of business and I'm going to be professional." This became apparent during various consultations in which the provider used the legal name, was asked by others to use the preferred name, and continued to choose not to.

So, we first gave the provider the correct information, that individuals have the right to be addressed how they prefer, and that this is required by the city nondiscrimination law, the facility's nondiscrmination policy, and the GLBT standards of care from the Massachusetts Health Access Project. The provider continued to state that he does not agree and "I'm not going to call a man a woman." He was told that he does not have to agree, but he does need to abide by policies of competent care. He agreed to have additional training and supervision on the issue.

So, this provider went to various trainings on understanding and being sensitive to trans individuals. He then observed a senior member of the team modeling an interaction in which the senior member apologized to this woman about inconsistencies, assured her we were working to be more sensitive, asked what name this woman wanted to be called, what pronouns she prefers, whether she has a preference in terms of "trans," "transgender," "transsexual," etc. The senior member then observed some of this provider's interactions with her and provided feedback later. The senior member had a few followup meetings in which the provider indicated that he still doesn't agree, but understands that the facility sees it as a patient right to be called by preferred name, and he plans to do so.

This was sufficient for us -- ideally, he would understand that she has the same rights he does to be addressed in a comfortable manner, but this goes beyond the organization's role -- we can only control how he does his job. If he were to continue to refer to her as "a man" or address her as her legal name after having been taught why this is discriminatory, he would be dealt with according to the HR policies on discrimination. It wouldn't matter to us whether this had been in her presence or not. We continue to send providers to conferences on working with trans individuals (among other marginalized groups), because we see that there's still a need, but we don't mandate that people change their beliefs beyond what comes out in the workplace.

ad said...

Wow, this is really outrageous.

Honest question: Do you think a doctor displaying such actions would be allowed to stay at FCHC with no consequences?

Anonymous said...

No one is gay. No one is straight. We are PEOPLE. We have thoughts and feelings. We have opinions. We love other PEOPLE, whether or not they be of the "correct" sex.
I'm seventeen years old. My parents have never really presented any kind of view about gay people, and somehow I have come to form my own opinion, which is that they are simply people like me.
I am not a staunch advocate of either "lifestyle", if being gay or straight can be grouped as seperate lifestyles. I do believe that every person, every couple, deserves respect. There have been some nasty words and accusations thrown around in these comments, and no person on this wall deserves to be disrespected.
In response to some of the comments on this page, I do have some strong opinions.
As for boycotting the hospital: that is absolutely ridiculous. Maybe if it were a hair salon or something that would work, but a hospital is meant for patient care and treatment of those in need, not a tool to promote a certain viewpoint.
As for picking on homophobic doctors: it is unrealistic to think that all the doctors in the world are not going to be homophobic. The ratio of homophobes to non-homophobes is probably not small enough to ensure that every doctor is not going to be homophobic.
Solution? If you are worried about it, don't broadcast do your doctor that you are gay. While I admit it is sad to have to deny who you are in order to feel that you are getting unbaised medical treatment, that's the way it will have to be until we all realize that there are bigger issues than who is gay and who is straight.

Anonymous said...

The Beth Israel Deaconess Medical Center Policy on Harassment and Discrimination states that "inappropriate behavior includes unsolicited remarks, gestures, or physical contact, display, or circulation of written materials or pictures which has the purpose or effect of creating an environment which is hostile, offensive, coercive, or humiliating based on race, color, religion, national origin, age, sex, sexual orientation (gay, lesbian, bisexual, or heterosexual), disability, or veteran status".

I believe this doctor has violated this policy. They have circulated written materials. I find hard to believe that such an individual can divorce their feelings about homosexuality from their treatment provided their patients.

I will _never_ go to BIDH hospital and as a lesbian I will let everyone I know about this situation, gay and straight.

eeka said...

No, it's not the way it has to be.

Why not just go to a physician who I know goes to all the GLBT healthcare conferences and writes articles about GLBT healthcare? It's working quite well for me.

Also, if people are referring to me in terms of "boycotting" the hospital, I choose to go somewhere else where I get culturally appropriate care. I go to hospitals to get care; it isn't like it's my responsibility to provide them with business.

(BTW, how would pretending to have no sexuality work when receiving healthcare? A good physician asks patients about living situation, relationships, and sexual activities. Mine does, and I need to provide her with honest answers in order for her to best assess my health and offer appropriate treatment.)

Liat said...

Anon 12:35

Do not tell my doctor I'm gay? What? How is secrecy not going to harm me?

How can a doctor who does not know his or her patients' sexual history provide sufficient and accurate treatment? STD risk is, as has been mentioned here, predicted by sexual behavior, and if someone has had sex with 100 men or has only had sex with 1 woman, that's important for a doctor to know. If I present with symptoms that could be an STD or could be something else, who I've had sex with is something I need to tell my doctor.

How can I let my physician know that there's no possibility that I could be pregnant but that I could have an STD and be believed without telling him or her that I only have sex with other women? (Hypothetically speaking.)

How should I introduce my wife when she accompanies me to the doctor? If my sister can talk about her husband, why can't I talk about my wife?

Am I supposed to claim to not be married to my wife, when I have a marriage license, wedding pictures, and a chunk of credit card debt to prove it? When my doctor asks if I live with anyone in order to make sure someone can keep an eye on me if necessary when I go home, what should I say?

Nobody's calling for a boycott, I don't think. We're suggesting that people have the information they need to make the right decision for themselves. The right decision for me and my family at the moment is to avoid BIDMC if at all possible. The right decision for other queer people might be different for other reasons.

(Incidentally, if you can define an LGBT lifestyle as opposed to a straight one, do let me know. Nobody else I've ever asked has been able to.)

Anonymous said...

Liat;

I am anon 7:17. I prefer anon for a number of reasons, but I am the one with the gay nephew and I am thoroughly on your side on the basic principles. Way back on comment number 10 or so, I said I wouldn't send him to BIDMC, but I rethought that position, since it's really stupid if they are a good hospital (I do not live in NE); for reasons I've already cited above and more below.(What DON'T you know about all the other hospitals in Boston?)

I an not a member of a marginalized population, the closest I can (admittedly inadequately) come is that I am an older female physician and was often in the postion of wondering whether the other docs were treating me in a certain way because I was female, or just because I have a big mouth, etc. (:

I do have experience in reviewing patient/staff complaints as former dept. chair in a hospital and med executive committee member. I would recommend your partner (as the patient) complain in writing to the hospital administration (Paul or whomever the designated complaint receiver is), with a description of the facts of the encounter and in what way you thought his/her treatment of you was substandard. For example, didn't listen to your concerns, didn't do a proper physical exam, hurried through the appointment, seemed dismissive, etc. After that, I would politely mention your social status and simply raise the question as to whether you may have been treated that way because of it. I think it's worth raising because say, for instance, the complaint reviewer has received 3 previous complaints from patients in identical social situations - that would raise a red flag and provide some evidence for further action.
That's just how I would approach it, if this helps.

As to lip service, I am not qualified to answer since I do not have any evidence except this incident. However, since I've been reading this blog I have formed the opinion that Paul goes out of his way to address issues of discrimination of any type (witness some of his previous posts.) Frankly, if I were in his position, I would just quietly drop this event next year because who needs the hassle and bad publicity? But I bet he won't.

Also see my comments to eeka below. I wish we could all sit down and discuss this face to face; this medium is more conducive to misunderstanding.

Anonymous said...

eeka;

I am anon 7:17. First, let me reiterate for all that there is no evidence the physician "circulated" this material. This assertion first appeared on eeka's blog and has been picked up by everyone else.
In my hospital, physicians are not employees of the hospital. I do not know how this would affect the policy cited above or how it affects BIDMC physicians.

eeka, your point about sensitivity training is well taken, but I think it has the most utility for those who are ill informed or uneducated on this issue. This physician appears to be one of those "religious persons" (I am following the civility rule and refraining from using a more pejorative term) who believes the bible specifically forbids homosexuality, so no discussion is allowable in his mind. That still does not mean he actually renders different care to GLBT individuals and indeed, for all we know he is in a medical specialty such as pathology which does not see patients at all.

What sets me off, eeka, is that while you maintain a veneer of professionalism on this blog, I saw the following posts on your own blog. Forgive me, Paul, for giving these comments undeserved publicity but they should not go unexposed: (parentheses mine):

(headline) "The latest on condoning homophobia at BIDMC"

"He (Paul) is blaming the victims".

.....(she is telling the Fenway clinic that) "I feel uncomfortable that they typically refer patients to BIDMC for specialty care given that BIDMC is allowing physicians to spread anti-GLBT sentiments through the hospital....with little consequence." (factually inaccurate and can be interpreted as calling for boycott)

Then in your profile, you request that if you are quoted, it should be on something you actually said.
Perhaps you could treat Paul with the same courtesy - and BTW, the "nice tits" comment was not worthy of this blog, coming from either gender. I can get that in the local bar.

I did remember something illustrating my previous comment that there is probably at least one anti-GLBT (and racist, anti-semitic, anti-Muslim,etc.) physician on every hospital's staff. After I retired, I found on the net an incident in which a Mormon physician I knew well at my hospital had basicaly tricked her colleagues into siging a petition to the state legislature which contained, buried in the fine print, the phrase "homosexuality is unnatural". Several physicians wrote to the legislature retracting their signatures. She is still on the hospital's staff. Although I do not know if there were any official consequences for her, I do know she has basically been marginalized by her colleagues. That, I suspect, is what happens to most of these people eventually, and that's the most appropriate retribution for them.

Anonymous said...

this is anon 12:35... I purposely did not make my position on homosexuality clear, considering that if I said I was against homosexuality I would probably be shot down for saying that. In reality, I completely support it and I have many friends and a family member who are gay. Obviously, the point of my post was completely missed and rather picked apart and argued with. Let me make myself clear: this argument is becoming a bit ridiculous. While it is a controversial issue and not one which should be ignored, I do not think Mr. Levy deserves for people to come back and try to ruin the reputation of his hospital among a certain community because of one "bad apple". There are bigger things than that. He obviously shows compassion about the issue and is trying to be accepting.
If you truly wish to aviod BIDMC, then maybe you should not comment on this blog anymore rather than disrespecting the hosptial, which has probably not done anything to you personally. I remind everyone that this letter was not a personal attack on any specific person but rather an opinion expressed by someone who certainly has the right to, although I neither support his way of thinking or the way in which he (or she) chose to express that opinion.
Finally, in response to liat, "(Incidentally, if you can define an LGBT lifestyle as opposed to a straight one, do let me know. Nobody else I've ever asked has been able to.)", if you had read my post carefully, I did in fact say that "I am not a staunch advocate of either "lifestyle", if being gay or straight can be grouped as seperate lifestyles", meaning that no, there is not a way to define either lifestlye. I apologize if my wording was confusing.

Liat said...

Anon w/gay nephew, for want of a better name:

eeka did not actually say anyone here or elsewhere has nice tits. She didn't say Paul said anyone had nice tits. She was making an analogy to a hypothetical similar situation. The physician who wrote this letter did actually say that GLBT folks are at higher risk for various ailments, but s/he was wrong about the reasons.

Why can't people grasp that some of us are far more concerned about the INCORRECT HEALTH INFORMATION BEING DISSEMINATED BY A DOCTOR than we are about the doctor's personal views?

And perhaps the physician didn't circulate the material...but Paul did. He thought it was significant enough to post to the general public, and frankly, I'm surprised that people are surprised that GLBT folks are having a bad reaction to the letter and its repercussions or lack thereof.

My partner's less-than-stellar experience happened a few years ago; complaining now would really look like sour grapes, don't you think?

17-year-old anon, again for want of a better name:

I thought the point of your post was that gay people shouldn't tell their doctors they're gay, since that's what you said. The "lifestyle" thing is admittedly a nitpick, but that word is tossed about so casually in condemnation and nobody who uses it as such has any idea how to define the "gay lifestyle". I realize you weren't personally using it in a pejorative manner; I just think some caution in word choice is polite, in much the same way I was surprised that Paul used the phrase "gay and lesbian agenda".

If you had read my posts carefully, you would perhaps remember that a physician at BIDMC did have a negative effect on my family, but I can't prove why.

eeka said...

As I've mentioned before, it wouldn't serve me well professionally (or karmically...) to create problems where there are none.

I haven't gone into detail here about the homophobic treatment I've received at the hospital or the stories I've heard at GLBT healthcare conferences, because Paul has asked me not to discuss my medical information on his public blog, and it would be unprofessional of me to repeat what clients and colleagues have told me in confidence about their experiences consulting with folks at BIDMC, being a patient there, and presenting trans healthcare trainings there. I can definitely tell you (and really should, for the sake of perspective) that I've experienced quite a bit of personal homophobic treatment at BIDMC, and actually haven't at other hospitals. I'm only counting instances in which providers were derogatory or uninformed, or support staff told me my spouse was not "an immediate family member." I've also heard numerous stories from clients and colleagues about similar attitudes at the facility. My views about the hospital have not been formed based on this letter and the responses; this thread has just served to confirm more of the the attitude I've previously perceived, i.e., "thanks, but we don't need to learn how to be sensitive to your needs, because we're very proud to treat everyone equally" (which means they treat everyone straight, of course).

I'm also interested to hear thoughts on the previous commenter's question about whether Fenway would tolerate such behavior from one of their physicians. Does anyone associated with Fenway (or BIDMC) feel they can address this?

Liat said...

Missed this:

"Frankly, if I were in his position, I would just quietly drop this event next year because who needs the hassle and bad publicity? But I bet he won't."

Again, nobody's accusing Paul of discrimination on a personal level, but any hassle and bad publicity that might happen has come about due to his choice to publish the letter and to not take steps to ensure this physician is educated.

I seem to be unable to emphasize strongly enough that I understand this doctor's values and opinions may not be changeable. S/he has a right to hir views. That's not why we're calling for education.

Even if s/he believes for the rest of hir life that homosexuality is immoral and unnatural, it's dangerous to allow hir or anyone else to spread misinformation about STD risk. A straight woman who has unprotected anal sex with twelve men is at greater risk for all kinds of diseases than a gay man who has had protected oral sex with twelve men.

Sexual orientation does not create a high risk for STDs; engaging in unprotected sex does. Sexual orientation does not create a higher risk for depression; society's reaction to queer people does.

We're just asking to know that someone has spoken to this person about spreading pseudoscience. That's all. Is that so much to ask?

Anonymous said...

eeka;

I'm glad I managed to enable you to spread even more unsubstantiated gossip about BIDMC. Since there is clearly a not-so-hidden agenda here, I choose to end this discussion. Just know that you have not further educated me in a positive way about GLBT issues, except for the preferred terminology to use.

Liat; we are just repeating ourselves.

I wish you all well.

eeka said...

Everything on blogs all really comes down to "unsubstantiated gossip." I have no way of knowing that Paul actually received this letter from an employee. I have no way of knowing that you're a doctor.

As I said before, I'm not going to go into specifics on a public blog about things that I've heard from clients or colleagues or at trainings or conferences. It WOULD be gossip for me to repeat things that were told to me in confidence as a professional. But the other side of my professional obligations is that I'm not going to make things up. You're posting anonymous accusations about me, but I'm posting in connection with my blog, where you can easily find my name and could get to my license if you wanted to formally accuse me of being unprofessional. Like I said, it would be a really bad professional move for me to make unsubstantiated comments about anything going on in the healthcare field.

If anyone here is actually interested in becoming more educated about how BIDMC has come up in various trainings and conferences about GLBT healthcare, please feel free to contact me in private, where I can provide you with more information than I can on a public blog. I still won't breach confidentiality of course, but I can give you much more detailed anecdotal accounts than I can here. The invitation is open, in the event that anyone here is actually interested in improving healthcare for GLBT folks.

Eve said...

I think the concerns Eeka and Jodie and Liat have all mentioned here boil down to this:

How can I, as a patient, be assured that I will not get the doctor who wrote the letter as my doctor? Because I would feel very uncomfortable, as a queer woman, knowing that my doctor had such ignorant, hateful beliefs, and I would find it hard to trust that he or she had my best interests in mind.

I am not sure what the answer is - that's why I'm not a hospital administrator - but I do know that there is a fundamental ethical problem allowing this doctor to treat lgbt people, or even straight people with "untraditional" sex lives (bdsm community, polyamorous community, etc).

In the same way, I think it's unethical for Catholic hospitals to counsel pregnant women, if they won't be honest and straightforward about their options (including abortion). Not that this doesn't happen ALL THE TIME, but that doesn't mean it's right.

So like I said, I don't know what the answer is, but I am very concerned, as a potential patient.

I go to Harvard Vanguard, and I adore my doctor (Leann Canty). I can speak openly and honestly with her about anything, and I feel like she gets me and respects me. Yet, I have no idea how Harvard Vanguard ranks in general when it comes to lgbt issues. So, maybe I would just KNOW if I was inadvertantly assigned to this homophobe doctor, and promptly fire him. But I'm a pretty assertive, savvy patient, and I wonder about patients who are less so.

Jodie said...

Actually Eve, I never said or implied I was a queer woman. I'm straight. That said, as a straight woman, I'm part of a higher risk group for STI transmission that Liat or eeka are. I'm most concerned that this doctor doesn't understand sexual health risks, and that nothing is being done about that. That should concern everyone equally.

Liat said...

Ah, finally someone discovered our "not-so-hidden agenda".

Let me spell it out for you so we're all on the same page:

We want fair and unbiased health care.

That's it. That's our "agenda". I know it's radical, and it may take some time to come to terms with, but just sit quietly with it a while and see.

Otherwise, I finally put my finger on what's bugging me.

Y'all may well be correct that homophobic doctors exist at all medical centers. But you know what? Just because they exist doesn't make it OK to shrug them off.

I can't imagine most of you would say a black person should go to a possibly racist doctor or that a Jewish person should see a possibly anti-Semitic doctor for care. I don't understand why you're (general you) persisting in saying queer people should just be quiet, stop bothering the nice CEO (sorry, Paul; I think you probably really are a nice CEO) and take the chance of seeing homophobic doctors.

Injustice and unfairness run rampant in this world. I don't see why we have to perpetuate this.

Anonymous said...

Paul:
Will you post the winners of your award on the blog and give a summary of their contribution/accomplishment? I think the winners themselves can show that this is about service to patients and community not a gay vs. straight debate.

Paul Levy said...

Thanks very much for the idea. I did.

Dave said...

Wow - this one was out of control. I am glad you stayed out of the fray once it got nasty, Paul. I do think you flamed the fires by getting too sensitive, however. You did that a few weeks later with the anon person who wrote about something else that bothered you about managers and soccer and the potential sexism beneath that.

I don't think any even-headed reader could possibly interpret you as anything other than open-minded and well-meaning. I do think that when you get into the fray and try to defend yourself you do yourself a disservice (e.g., when you put together the list way back in these responses about "why you're not a homophobic hospital"). You can't possibly win the argument and when you attempt to get into it you just dig a deeper hole. You realized this, of course, when you appropriately bid farewell earlier in this "discussion". You then got defensive on the aforementioned other post response, however.

Unfortunately, Eena did a great disservice to her cause by being so unreasonable on here. I also would draw a great distinction between Eena and Liat in that regard; the latter was making valid arguments without histrionics and the former was an embarrassing pest. Gay, straight, transgendered, white, black, hispanic, human or martian, a jerk is a jerk.

And talk about thought police, the person who took issue with your phrases and language (e.g. "gay agenda") and not the goodness of what you're doing is so insular and myopic in his/her thinking that their line of reasoning only serves to worsen their cause by further dividing us rather than uniting us in civility and common sense.

On behalf of my many gay friends, I would ask anyone reading the above to understand that Eena is the outlier, both in her own "community" and in the larger world. She should try to walk a day as a human being rather than in her own self-defined isolation.

Finally, an unrequested piece of advice to her: when you're trying to climb a mountain (i.e., overcome homophobia) be sure to distinguish between the avalanche that is out to destroy you (i.e. homophobes) and the rock that may not be sturdy enough but is well-positioned (i.e., Paul and the physician with the gay nephew). By throwing us all together you just disrespect us and run the risk of creating a less vigorous ally. You don't need that, now do you?

Anonymous said...

Hey Dave, are you the "dave" with the investment industry who was afraid to be caught reading this blog?!! Sounds like Paul has another addict besides me! (: When are you going to start your blog about your industry? You could be anonymous like Mr. HIStalk.
ps I liked your comment above, since I'm the doc with the gay nephew. I agree with you about the ladies - but let Paul be himself; it keeps it interesting!

Dave said...

hey anon - yep that's me! dave

joe said...

here's a link that posts some findings relevant to this discussion:

http://www.fda.gov/cber/faq/msmdonor.htm

Anonymous said...

Sir,

I didnt know you until i started working for this hospital. Ive heard of stories of how good you are and what you have done to turn around this dying institution when it merged. As, i google your name and that of the hospital, i've read enough to come to the conclusion that what i heard from my colleagues are true. I just started reading your blogs, its very fascinating and very interesting to get to know how my boss thinks, his views, beliefs etc. Though i may not know you personally, your blog serves as a venue for us to get to know you.

If only the whitehouse could be as transparent as you are and how you run this institution think things will be better...Any plans of running for the presidency?:-)

inspired