Medical Anecdotal Report
Indexing Title: LBBERSAMIN’S MAR [15-04]
MAR Title: My Hesitation in an Awkward Moment
Date of Medical Observation: May 2015
Tag: Avoiding any hesitation to an awkward moment
Category: Professiona/Ethicall– Reinforcement
I never knew then that it could happen. Of how a delicate matter, of its international significance and its sensitivity as an issue, would present to me. I had received an endorsement from my junior resident in the emergency room, of a 24-year-old male patient suffering to have scrotal abscess for a couple of weeks now. I, together with my team of surgery residents, then went on to hear about the case of this patient. As we moved towards his bed in the emergency department, we saw the patient, lying still as if movement had caused some sort of friction to his inguinal area ample enough to give pain and discomfort. He was accompanied by another male individual and was said to be his partner. The patient was already anxious about his situation and he was a bit mortified by what condition he had. Generally, as I had the information of this case, I introduced myself to the patient and his partner. I initially asked the more relevant questions for my medical history of when his abscess had started and its presentation. I also asked about other illnesses such as a pulmonary problem or diabetes mellitus. But somehow, after inching in with the idea of my patient’s profile, I hesitated to ask the more sensitive questions about his sexual practices. After a brief pause, I went on to ask the patient: “Are you having sexual relations with your partner”; and followed it up with “How many sexual partners did you have”. The patient, ill at ease, claimed to have had only his partner as his only sexual partner. He also claimed that he did not have any other sexual relations with other men. After giving this question and receiving a response, I explained the propensity of his illness from an immune-compromised state of a patient that may come from sexually transmitted diseases. I also asked for them to forgive me as I have been forthcoming with my questions. In my mind, I thought that I was in an awkward moment given the personalities involved and their sexual orientation. But despite the awkwardness, I had to ask. After all this, I informed him of the procedure and how it may give a defect. But with the completeness of surgery, medical management, proper wound care, and the absence of other complications; we saw him ready for discharge. The patient and his partner then warmed up to us with the gratitude of what we have given them and thanked us upon discharge.
(Physical, Professional/Ethical, Psychosocial)
(Discovery, Stimulus, Reinforcement)
Coming to the process of consultation, we get to know about our patient and tread further with relevant questions to understand their illnesses. When we find a patient, ill and uneasy, we already try hard to avoid further discomfort with our physical examination and aggravate the anxiousness of our patients with our questioning. In this situation, we are faced with a homosexual individual with an illness that warrants further questioning with regards to the sexual history of our patient. At this moment, we are put in a situation that places us to ask them straight forward questions about their sexual practices as they are in that orientation. This is was my dilemma then, that in my required questioning for the patient’s history, do I alienate my patient? Do we feel awkward because we are asking these questions to our patient, or because we are asking these questions to a homosexual individual? Before, these questions may seem offensive and unacceptable especially in the culture of a Christian conservative community. But in modern times, it has become more open as an accepted fact about the existence of this third gender. I asked a close friend of mine, a homosexual individual, of the situation I was in then because I did not want to hesitate again and feel impolite the next time I will be in this same situation as it is not far from happening again. I wanted to have that level of sensitivity and understanding to my patient’s point of view. He said that in giving sensitive but relevant questions about homosexual sexual practices, I should treat it objectively. What difference does it employ to ask a homosexual individual and heterosexual individual with the same sex practices. If we think objectively, then we act objectively. We get to complete our patient management, guide them accordingly to treatment, and openly recommend VDRL testing. I wanted to be informed and reinforce myself so I can counsel and guide them accordingly. I want to be able to help them not only as a surgeon, but as a complete physician. I want to reinforce myself with the right practice of being sensible to my patients in general. If in their own person, a gay individual is not ashamed of his nature, then why would we?
ROJoson’s Notes (17feb2):
A lot of times physicians are caught in a situation deciding whether to ask sensitive questions or not. General guides: do so when needed in the patient management and do it in a professional non-offensive way when needed.