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Elizabeth Boskey, Ph.D.

When Doctors Stigmatize Patients

By January 8, 2011

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A few years ago, I got an e-mail from a woman desperately looking for help for her daughter. The young woman was about to get married and, because of the stress, was having a severe and painful outbreak of herpes. She had called her doctor for help and, much to my shock, her physician had refused to treat her. He said that he was uncomfortable treating a patient with herpes and asked her to find another doctor. She told her mother, and her mother wrote to me to ask if there was anything I could do to help her daughter find care.

Although I don't normally help people find doctors, the story she told me infuriated me, and I did a little research to find a local women's health clinic in the next town over - after telling her to report her current doctor to the state's medical ethics board. She went to the clinic the next day and apparently got wonderful care. Not only was she put on suppressive therapy, but the doctors treated her kindly. They didn't make her feel sad or ashamed; they just dealt with her illness.

It's unfortunate that STDs are so thoroughly stigmatized - particularly herpes, which is one of the more difficult diseases to prevent. The stigma is so extreme that it can lead to feelings of hopelessness and worthlessness that are entirely out of proportion to the severity of the disease. It's bad enough when someone who isn't educated treats an individual poorly because they happen to have a sexually transmitted infection. It's appalling when a doctor does it.

The case I describe above is extreme, but many people have enormous amounts of difficulty discussing sexual health issues with their doctors. This is often in part because they sense, correctly, that many doctors are uncomfortable talking about sex. This mutual discomfort can then lead to a lack of appropriate screening and behavioral counseling -- which can have serious long term effects on a person's health. It's also enormously hypocritical for doctors are unwilling to have frank conversations about sex with their patients to be disappointed that their patients aren't having frank conversations about sex with their partners.

So, what can we do to improve the situation? I try to have a small impact with the sexuality course I teach to graduate public health students - who are often M.D.s. Although it's framed as a research course, my not-so-secret secondary goal is to make my students more comfortable talking about sex. I also make it a point to thank doctors and nurses whenever they are up front and positive asking sexual health questions in an exam. (I once offered to bake a nurse practitioner cookies because I was so thrilled that she asked me what gender my sexual partners were - that's a good sexual history.) And, in the opposite direction, if a doctor is negative about sex, or uncomfortable discussing it when it's appropriate, I look for a new physician and tell them why. I recently switched gynecologists because my former doctor had started bundling cosmetic procedures with her annual exams, and I found that inappropriate.

Not all of those options are open to everyone, of course, but if you have a doctor who has acted inappropriately towards you because of your sexual history - call them on it. Tell them why their attitude is problematic and discuss with them how it is affecting your willingness to seek care. Explain that their attitude and behavior could be impacting your long term health and, if it's practical, consider finding another doctor to see.

No one likes to be judged for their choices - particularly not by someone from whom they're seeking help. Although education about safe sex and risk reduction measures is an appropriate professional response to an individual who has recently been diagnosed with an STD, judgment and derision are not - not in the least because they may stop patients from coming in for help when they need it again. Doctors need to remember that they can't improve a patient's health by making that patient unwilling to come into their office.

Share your experiences with seeking sexual health care or counseling here.

Want to read more about how doctors' attitudes affect patient care? Check out the blog carnival over at the Patient Empowerment blog!

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Comments
January 10, 2011 at 4:13 pm
(1) Lisa Oldson MD says:

As a physician I cringe when I read about doctors stigmatizing patients who seek care for STD testing or treatment. We need to create an open atmosphere for our patients so they can openly and honestly bring up any health care concerns. I image it wasn’t easy for this mother to bring up the topic and then after the response she got, she’ll likely be reluctant to open up to her doctor in the future. My advice to your readers is similar to yours. It’s not okay for a physician to make you feel bad about STD testing or treatment and you should not only get a new doctor, but feel free to provide feedback to the offending physician. These days we teach medical students strategies to talk about sexuality, but some will always be more adept than others at this sort of thing. If you don’t have a physician who makes you feel comfortable, then check out a local STD clinic, department of public health, planned parenthood or even a reputable online STD testing site. There are a myriad of options out there for finding confidential, professional, expert STD counseling, screening and treatment. Dr. Boskey, you provide a great service with your blog.
Lisa Oldson MD

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