The Right to Do the Right Thing

As I practiced what I would say under my breath, I walked slowly toward the unit’s nursing station, clenching my fists and taking deep breaths to calm myself. It was spring 1996, and I was an Internal Medicine intern in Massachusetts, struggling with how to navigate the conversation I was about to have. I had been caring for a man who was obtunded and clinically deteriorating from sepsis. The only person who had been regularly calling and visiting my patient now stood at the nursing station anxiously waiting to hear an update. This man wanted desperately to understand why the man he loved and lived with for more than 20 years was dying. At that point in my career, I had a few occasions where I was able to discuss a patient’s disease course and prognosis with their spouse in the absence of having a documented health care proxy (HCP). But this time was different. Our hospital ethicist, who was seemingly as troubled as me by the disconnect between our procedures and our values, had just explained to me that I can only share news about my patient’s condition with his legal spouse, children, or parents in the absence of an HCP. Faced with the fact that my patient clearly made a life with the man standing before me, I struggled with being advised to limit communication about my patient’s care to the one person with whom he clearly chose to live his life. I felt as if I were contributing to stigmatizing their love, contributing further to the heartbreak of a man struggling with the loss of his partner, and that I was being unfair. I was devastated because that feeling was true; I had become part of a system that was reinforcing stigma and causing pain.

In 2003, seven years after caring for my dying patient, the Massachusetts Supreme Judicial Court allowed same-sex couples the right to civil marriage, helping to clear the path toward guaranteeing same-sex couples the fundamental right to marry.¹ As I thought about the theme for this issue of the Forum, I reflected on the time prior to marriage equality and my personal experiences caring for patients in a system that asked physicians to provide inequitable care that dehumanized and marginalized patients. To be clear, SGIM has a commitment to assuring that all our members feel supported in their ability to practice medicine in an equitable fashion for all populations they serve.

Recognizing that LGBTQ populations are: (1) at increased risk of victimization through interpersonal violence, (2) more likely to report suicidality and a higher prevalence of poor mental health, (3) at a higher risk of cardiovascular disease and obesity, (4) disproportionately impacted from several forms of cancer and (5) more likely to report experiencing health care-related discrimination and delays in care, I am concerned about consistent, increasing political efforts that may further exacerbate these disparities.^2-5 As physicians, we cannot be complicit in perpetuating injustice. SGIM must also support our providers to do what is right for their patients.

I am proud of the SGIM membership and believe we are a professional society full of doctors who must have the autonomy to provide equitable care for their patients and improve the health and wellness of all we serve, regardless of how they identify or whom they love. I also support the many SGIM members who advocate for equity in career advancement opportunities for LGBTQ physicians. As SGIM President, I believe it is imperative that we do all we can as a society to support our community of clinicians, educators, researchers, public health advocates, and health system administrators promoting work to address the differential treatment and outcomes for members of the LGBTQ community. This issue of Forum represents and example of why our members make me proud.