Category Archives: Uncategorized

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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The Specialist in You

This is a finalist in the 2015 STFM Blog Competition

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Avelina Sandoval, MD

“You only see what you look for. You only recognize what you know.”

My attending’s words resonated in my mind as I stood there in my short white coat amidst the chaos of the busy trauma bay. It had been an extremely long night.

I was on my mandatory trauma call as a freshly minted third-year medical student. We had heard stories from our upper classmates about what to expect as we left our classroom nest and went off into the hospitals. We would either get to do “doctor-ly” things or we would get stuck with grunt work depending on who was on our team and how busy the service was.

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