Day 29: Treating Gay Patients

Today, I took time out from the studying to attend the "Cultural Humility Series" lecture on "Treating Gay, Lesbian, Bisexual and Transgender Patients." I love this cultural humility class thing. We get "blue book" credit for going to a certain percentage of them, but even without that, I'd still go. Why? Because it gets me to constantly reevaluate and assess my existence.

Last week's topic on Southeast Asian patients was interesting because I am so intimately involved with the Vietnamese population here and in Vietnam. Today was a different kind of interesting.

Honestly, I've never thought about homosexual patients, or doctors for that matter. It's never crossed my mind. I just lived my life, day after day, not thinking that there could be issues regarding sexuality, besides your doc asking "are you sexually active?"

Dr. Bockmon gave a good seminar on the issues that GLBT patients deal with and what physicians who treat them deal with. I did not care for the loads of time he spent trying to tell us why people are gay.

You see, I'm a Mormon. I come from a pretty conservative christian church. I have personal religious beliefs that deal with sexuality of all forms. Naturally, as we've all seen in the public forum debates today, people's beliefs run head-on into each other when discussing homosexuality, specifically homosexual marriage.

How should I feel about this issue, as a person? As a doctor? Religiously, I believe that there is a God, who is our spiritual father, and he's given us commandments. If we follow them, we are worthy to return and live with him forever. Most of these commandments deal with controlling the natural body -- putting the spirit in charge -- and ordering society. "Thou shalt have no other god before me..." etc. One of God's big commandments, is "Thou shalt not commit adultery." It's obviously elaborated further in the scriptures, but I believe that a person should abstain from sexual activities (not just intercourse, but felatio, etc.) until marriage, and should be monogamous after. Marriage is defined in the scriptures as a man and a woman. So I have a deep religious belief that homosexuals are breaking this commandment. It's a religious belief, and I do not feel any need to change it or apologize because the prevaling social norms are different.

Nevertheless, I live in a country where nobody is allowed to impose their beliefs on others. So I cannot stand on my horse and judge or meet out judgement on homosexuals because I feel they are breaking God's law. God, Himself, says that we should treat everyone with love and be subject to the laws of the land. As a doctor, I am required (and would feel awkward doing otherwise) to put aside my personal feelings about anyone, whether it be race, sexuality, religion, creed, gender, etc. and make sure that patient gets the best possible heathcare. I feel extremely strong on this point. No matter what my personal beliefs are on homosexuality and eternal salvation, there is no question about homosexuality and temporal healthcare. Everyone gets the same healthcare. I do my best for all.

I liked that about the talk. It was very eye opening. But then the question was asked, should physicians be required to treat LGBT patients (or any patient for that matter)? This gave me fits for quite awhile, but I think I've decided NO. The physician-patient relationship is special, because it is so contractual, yet the employee is the boss of the employer. Technically, the patient walking into my office is the boss. He or she decides to spend his or her hard-earned money on me, to achieve the outcome (better health, bigger boobs, etc.). However, part of that contract is that the patient basically relinquishes power to the doctor because the doctor has the knowledge and expertise. You let a lawyer draw up merger plans for your company because you have no clue how to do so. Same thing with a doctor, only the outcome of this "merger" really is life or death.

So, being a contractual relationship, I think the doctor has the right to say, no, I don't want to treat such and such patient, no reason necessary. On the other hand, a patient has the right to choose whatever doctor he or she thinks is best for him or her, even mid-treatment. Now, caveats. Today's HMO/PPO junk has limited the number of doctors people can see, true, but there are still many doctors out there so I don't think this is a valid argument against my point. The other caveat is that a doctor is oath-bound to save lives, and if there is not a reasonable alternative, I don't think any doctor can ethically turn away any patient.

Example: if you're the only doctor in a small town, you can't turn away townsfolk who have nobody else to go to. Or, if you come across a motor vehicle accident, you cannot ethically excuse yourself from giving aid to hurt passengers. But for standard, walk in patients with cuts, bruises, viruses, or chronic diseases, where there are other alternatives available, I think a physician is well within his or her right to refuse services just as a patient can stop services that he or she deems unneccesary or ineffective.