November 6, 2016
Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.
Infectious Diseases doctors will find this exchange familiar:
New person you're meeting: What to do you do?
ID Doc: I'm a doctor.
New person: Oh -- what kind?
ID Doc: A specialist in Infectious Diseases.
New person (making a face, or moving a few feet back, either to be humorous or truly frightened, or both): Yuck! Well I guess someone has to do it ...
The stigma associated with Infectious Diseases is as much a part of the field as knowing why Pneumocystis carinii is now Pneumocystis jirovecii, and how to pronounce the drug class that includes linezolid and tedizolid. (Oxazolidinone.)
I mention this aspect of ID as it came up recently in the context of our shiny bells and whistles electronic health record. One of its many features (common to most EHRs) is that you can generate letters to patients to notify them of their lab results.
Here's what the header to those letters looks like; I highlighted the key problems:
There are four issues with this image, three small, one big. The three small items first:
None of these is a big deal (though it is kind of ironic to see what you get for your billion dollars).
What is a big deal, however, is that many of our patients have made it abundantly clear to us that they don't want any references to "Infectious Diseases" on materials mailed to them. Worse would be "Infectious Diseases" on the envelope's return address -- gosh, anyone could see that -- but mentioning it at the top of a letter is also off limits. (For the record, our old EHR had an option to choose "generic BWH letterhead", and we went with that as the default.) We're also not supposed to say we're calling from "Infectious Diseases" when leaving appointment reminders or other voicemail messages, so we don't.
Non-ID clinicians might think this is an exaggeration, but I assure you it's really the tip of the iceberg. I've had patients tell me that they don't like the fact that our practice is called "Infectious Diseases" in the hospital directory, preferring that we be listed by some generic term -- one suggested we go back to the plural, "Medical Specialties", which is what our office used to be called when we shared clinical space with Renal, Pulmonary, and GI; another wanted the bland moniker "Brigham Associates" (to which I would always wonder, "associates with what?"). Some don't even like sitting in our waiting room -- this is very sad, when you think about it -- even though they are coming to us for their own ID problem.
But think of how we've responded to our patients' concerns:
So back to our patient letters: I contacted our excellent IT liason to see if we could change the letterhead back to something that doesn't say "Infectious Diseases", and included our HIV Social workers in the email thread, thinking they would certainly amplify the importance of this change to our patients.
Surprisingly, I got this back from one of them:
Does any other department need to protect their patients by disguising the name of where they work? It's as if we own stigma like our patients. In Social Work they call that "the parallel process". It's kind of a part of our own identity, our reality, and for some of us our pride in our specialization. I've been changed as a person because of it. Wow, really getting deep this morning!
Susan has a point. Imagine if "Dana-Farber Cancer Institute" or "Memorial Sloan Kettering Cancer Center" were asked by their patients not to include the word "Cancer" in their names. Or if a Cardiologist asked to remove his or her specialty from their hospital identification badge -- I know one ID doctor who actually did this, as he didn't want to make patients or hospital coworkers uncomfortable.
Makes you think. Are we doing more harm than good in treating our field with such exceptionalism?
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