The Great Hippo wrote:Oh, pardon, I missed that you already answered this question! I think you're off base, though -- we don't think of things as social identity as being medically relevant, do we? The stress caused by those identities might be medically relevant, sure -- but I wouldn't expect the word 'lesbian' on a medical chart anymore than I'd expect the word 'poor'. I'm not saying let's go grab pitchforks, but I am saying that my sexual orientation probably isn't any of my doctor's business.
(My sexual behavior might be, sure -- but not my sexual orientation!)
Just to reiterate, the article that inspired this discussion no longer exists at the end of that link. I didn't get to read it. Maybe it was mistaken to begin with.
I think important possible explanations are either a dictation error (which happened on a chart of a patient who happened to BE a lesbian), or they recorded the information in the wrong section of the chart. I have also noticed, more recently, the kids using problem lists to flag anything they might want to remember, such as critical medications needing monitoring (digoxin, coumadin) a plan for a chronic pain or psych patient (they get one shot of medicine and then if nothing is found, a security escort out of the ED as they have a history of attacking staff when discharged), etc. That's a bad habit but it's increasingly common as chart bloat makes it harder and harder to read a chart from beginning to end. So it may have been done deliberately, but foolishly, to flag someone as a lesbian so that the provider doesn't bug them about contraception, etc.
If this was done deliberately, that person needs some counseling about how to document. You're right, it's typically recommended to frame these things in the more detached language of sexual behavior ("has sex only with women") rather than sexual orientation. That's a rhetorical flourish, though, and it's not necessarily a mark of bigotry to call things by their commonly used non-derogatory names.
I do want to emphasize, though, that what a physician is interested in, in terms of a patient's life and choices, is very broad. (Of course "interested in" should not mean "judging you for.") I have ABSOLUTELY described a patient as poor. That is one of the MOST relevant facts impacting their treatment and recovery.
I remember a recent case, facial abscess & cellulitis, PA discharged them with a plan to put a hot compress on it three times a a day plus antibiotics. She came back, worse despite the antibiotics, and admitted to me (after careful & hopefully sensitive questions on my part) she couldn't put compresses on it because she was living out of her car. No hot water. She was living out of her car because she had finally left her abusive husband of 20 years. Really.
That was an admission to the hospital (with social work consulting) because her circumstances made it unsafe to treat her as an output. Sometimes I have to chose a cheaper antibiotic that the one I would prefer, rather than a perfect $70 prescription that will go unfilled. We help people connect with shelter beds and substance abuse treatment routinely. And so on. Health is connected to everything, and we don't get to ignore the non-biological issues. And this is not a new or modern/progressive "social justice" account of the physician's role. As per Hippocrates:
1. Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate.
"Reasonable – that is, human – men will always be capable of compromise, but men who have dehumanized themselves by becoming the blind worshipers of an idea or an ideal are fanatics whose devotion to abstractions makes them the enemies of life."
-- Alan Watts, "The Way of Zen"