2.4.5 Respect for Difference � Sexual Orientation
Timothy F. Murphy, PhD
Updated December 1, 2013
- To identify obstacles to full disclosure by gay, lesbian, bisexual and transgender (GLBT) patients in health care relationships
- To identify the extent to which physicians can maintain confidentiality in relationships with GLBT adolescents
- To identify some strategies for securing better health care for GLBT patients
Dr. Adrienne Deutsch is a pediatrician who has become "the expert" for adolescent medicine. At least, that's the way many colleagues in her community see her: they refer all kinds of adolescents her way, whether it's for severe acne, delayed puberty, emotional problems or obesity, among other conditions. Dr. Deutsch has a special rapport with adolescents because she had some unpleasant experiences with a doctor while an adolescent herself, and, during medical school, she swore she would never make the mistakes her doctor did.
In particular, at age 16, Adrienne once developed a vaginal infection, and her doctor asked her if she was sexually active. When she said that she was, the doctor immediately turned to a discussion of contraceptives and sent her away from the office with various samples and advice to use them in every sexual encounter. In fact, Adrienne had been having sex with another young woman, her first high school crush. She kept quiet during the doctor's talk about contraception rather than bringing up the exact nature of her sexual life. Her primary question — whether she should talk to her girlfriend about the infection — went unanswered. When that relationship broke up, Adrienne fell into a depression that she could not explain to anyone. Her doctor told her mother it was probably just a teenage phase.
In her practice now, Dr. Deutsch sometimes sees teenagers who are struggling with worries about homosexuality. She assures them that it's okay to have "whatever sexual orientation you have," just so long as your doctor knows about it in order to help protect your health. She also emphasizes confidentiality as she tries to speak in plain language. Dr. Deutsch is especially happy that more and more gay and lesbian adolescents not only are open with her but also are open about their sexual identity with family and schoolmates. In all these interactions, Dr. Deutsch does not disclose her own lesbian identity to patients unless they specifically ask about her own life.
Suzanna Gowings, aged 16 years, comes to see Dr. Deutsch because her asthma seems to be getting worse. In talking with Suzanna, Dr. Deutsch learns that Suzanna had previously been seeing Dr. Gabriel Chirac, a general practitioner in the same city. Suzanna says that she had a lot of difficulty relating to Dr. Chirac. She says that she did not feel comfortable talking to him and that he sometimes said hostile things about gay people and other minorities. This is not the first time that Dr. Deutsch has heard such things about Dr. Chirac. When Dr. Deutsch assures Suzanna that she will hear no such things in her office, Suzanna mentions to Dr. Deutsch that she has a girlfriend. Almost immediately, however, she becomes very quiet, as if that disclosure has been a mistake. She then asks Dr. Deutsch not to tell anyone else about this, especially her parents.
At this point, Dr. Deutsch wonders whether she could come out to this patient as a lesbian herself, in order to build more trust in their relationship. She has never yet had a parent ask directly about a child's sexual orientation, but she wonders what she would say if Suzanna's parents did ask. She also wonders whether she should contact Dr. Chirac and advise him that some of the things he has said are having a hurtful effect on his patients.
- Dr. Deutsch takes steps in her practice to make maturing adolescents feel comfortable about disclosing their sexuality. While this is important for all teenagers, in what way is it especially important — and perhaps problematic — for adolescents maturing into gay, lesbian, bisexual and transgender (GLBT) identities?
- In this case, a patient asks the physician to keep a sexual relationship confidential as well as any treatment she might receive. Are there any circumstances under which a physician should not keep this information confidential?
- Should Dr. Deutsch disclose her own sexual orientation to her patient as a way of establishing trust?
- What, if anything, should Dr. Deutsch do after hearing that a nearby doctor may be acting inappropriately toward GLBT patients?
- Canadian Medical Association, CMA Code of Ethics (2012). Ottawa: Canadian Medical Association; 2012. Available from: http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD04-06.pdf
- American Medical Association’s Council on Ethical and Judicial Affairs. Patient-physician relationship: respect for law and human rights. Opinion E-9.12. American Medical Association; 2007. Available from: http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-9.12.HTM&&s_t=&st_p=&nth=1&prev_pol=policyfiles/HnE/E-8.21.HTM&nxt_pol=policyfiles/HnE/E-9.01.HTM
- Ginsburg KR., Winn RJ., Rudy BJ., Crawford J., Zhao H. et coll., �How to reach sexual minority youth in the health care setting: the teens offer guidance�, Journal of Adolescent Health, 2002, vol. 31, no 5, p. 407-416.
- Lehrer JA., Pantell R., Tebb K. et Shafer MA. �Forgone health care among U.S. adolescents: associations between risk characteristics and confidentiality concern�, Journal of Adolescent Health, 2007, vol. 40, no 3, p. 218-226.
- Beagan BL, Fredericks E, Goldberg L. Nurses� work with LGBTQ patients: �they�re just like everybody else, so what�s the difference?� Canadian Journal of Nursing Research 2012; 44(3): 44-63.
- Society for Adolescent Health and Medicine. Recommendations for promoting the health and well-being of lesbian, gay, bisexual, and transgender adolescents: a position paper of the society for adolescent health and medicine. Journal of Adolescent Health 2013; 52:506-510.