The next time your physician peppers you with questions about your sex life, your religious affiliations, your modus vivandi, turn around and ask him those same questions.
The questions he asks bear directly on your medical treatment. Do you have multiple sexual partners? That answer may lead to a diagnosis of a sexually transmitted disease. How much do you drink? Heavy drinkers may be at risk for cirrhosis. What do you do for fun &endash; cheer on chickens at cock-fights (a possible source of bird flu), bicycle without a helmet (you're at risk for a head injury), or watch television (a sedentary lifestyle might figure into hypertension)? Are you religious? The strength of your faith may tell him whether you can marshal support for a rigorous treatment regimen. The questions, however intrusive, are germane to the clinician's ability to treat you.
Besides, ethical strictures guide physicians. Hippocrates advised: "keep the good of the patient as the highest priority" and "do not harm." Maimonides' oath promised: "May I never see in the patient anything but a fellow creature in pain." Amatus's 16th century promise held: "I have given my services in equal manner to all, to Hebrews, Christians and Muslims."
Physicians are supposed to separate their feelings from their analyses. If you tell your doctor that you train cock-fighting chickens, he is not supposed to respond "yetch." If you admit you shoot, and eat, squirrels, the vegetarian clinician is not supposed to grimace. Ditto for sexual practices. The careful physician hides his gut-reactions. If the clinician finds you as a patient too distasteful to treat, he is obliged to refer you to a colleague. The American Medical Association is explicit: if a physician cannot treat a patient because of the physician's "personal, religious or moral beliefs," the physician should help the patient get care elsewhere.
The ethical underpinning of the clinician's craft gives you, the patient, the assurance that however you answer the questions, the clinician wants to alleviate your pain, treat your symptoms, "to do no harm."
You, the patient, though, don't know much about your physician's sex life, religious affiliation, or modus vivandi. On the wall you can see the degrees; note the certification in a specialty; mark where the physician trained. Through your state's licensing board, you can learn whether your physician has been reprimanded, or had his license suspended.
But is he, or she, gay? Bisexual? Has she had an abortion? Has he paid for a partner to have one? Has your doctor been born again? If so, as what? What does your physician think about contraception? About abortion? About euthanasia?
These questions may be germane. University of Chicago researchers polled 1,144 physicians on the impact of their values on their treatment plans [Feb. 8, 2007 New England Journal of Medicine]. The researchers measured physicians' responses to hypothetical patient-requests. Would the clinician give terminal sedation to a dying patient? Would s/he sanction abortion for failed contraception? Would s/he prescribe birth control to an adolescent without parental consent? Sixty-three percent of clinicians would explain their moral objections. But 14% of respondents would not tell patients all their options. Furthermore, only 71% of physicians said they would refer patients to physicians who would meet their requests. The remaining 29% either would not, or were undecided.
In this brave new world of values, the physicians' own religious/moral values may trump the oaths that mark medical practice.
So, after the intake history, with its myriad questions, the prudent patient might ask a few questions back.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email firstname.lastname@example.org.
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