Author Archives: STFM News

Just Ask

Amber Cadick, PhD, HSPP

Amber Cadick, PhD, HSPP

A 24-year-old male presents to your office with complaints of fatigue and pain. When you go to listen to his heart you notice some red marks on his chest. When inquiring about this he breaks down crying and unbuttons his shirt to reveal claw marks across his torso. He quietly confesses through sobs that his girlfriend has been physically abusing him for some time, and he doesn’t know how to exit the relationship.

During didactics you notice that one of your star residents is sleeping. She has moved her typical seat with her peers to alone on the side of the room. The next 3 weeks you notice her dozing often during the lectures. What should you attribute this to—laziness, fatigue, apathy? Other faculty have noticed, and some are thinking about talking to her concerning professionalism. Thinking back, you realize that she has been lingering by your office but not saying much. One day she comes into your office, closes the door, and begins to cry. She shares that she hasn’t been able to sleep at night due to a fear for her safety. She thought this change in her partner’s behavior would be temporary, but now she doesn’t know how to stop it. She feels trapped, isolated, and lonely. She notes it is hard to perform her job as a resident with this stress at home.

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Notes on the Ethics of Reflection

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Sharon A. Dobie MCP, MD

It is important that we reflect and write about the work we do with patients. As we reflect, we create a narrative that sometimes becomes a written piece. We cannot really tell our stories without including the patients because it is actually our perception of the patients and their stories. And yet, we also have a covenant of confidentiality with our patients. Beyond what HIPAA says, we live within ethical considerations that must protect our patients.

What then can we do when we write and then want to share that writing with a friend, in a blog, or for a journal submission?

When writing about patients, we must respect these ethical considerations. In an evolving set of guidelines, the best practice remains to show what we write to the person about whom we wrote. That is what I encourage writers to do whenever possible. It can be scary and it is always fruitful. You might learn more about the story, about the person, about yourself, and the bias inherent in your viewpoint. That information might lead you to add to or edit your reflection. Then what you have is a co-creation, and your patients will feel valued and respected. Alternatively, these conversations may also clarify reasons to not publish the piece.

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Clinical Teaching for LGBT Health at the Point of Care

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Sarah E. Stumbar, MD, MPH

“Do you live with your husband, too?” the second-year medical student asked, innocently enough. It was our first visit with this patient, a healthy middle-aged African American woman. We were just chatting, trying to get to know her, and I had picked up on little clues in our conversation that had already led me to conclude that there was no husband in the picture. The medical student, though, didn’t seem to have picked up on this and, I thought, was trying to get at her sexual history by asking, instead, about her husband.

A few seconds of an awkward, heavy silence followed his question, until the patient forcefully said, “I’m an independent woman.” There was no room left open in her tone for further discussion, and our conversation quickly moved onto other topics.

Later, after the visit, I challenged the medical student to go back to that question and think of all of its assumptions: a heterosexual relationship, the need for a husband to have a child, the assumption that asking about a husband equated to asking a sexual history. I could see the student processing all of this, as he squinted his eyes and stated, “I come from a very conservative family.”

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