The nature of an intimate relationship is, according to dictionary.com, “very private” and “closely personal”. Both parties must be open and honest for it to work. If one of those is a doctor, most importantly a primary care physician, or any member of that team of professionals, and the other is a patient, they both must feel comfortable with sensitive information as it passes back and forth in the seclusion of the examination room.
Certain temperaments in either party can nourish this necessary sharing. Some may be innate; others may be cultivated. The right combination of personalities can lead to a dynamic and healthy affair, certain to be of benefit to both.
I had met Dr. Tamara Odell when she was a primary care physician in Middletown. She’s now a family medicine specialist at Odell Family Practice in Oceanport and mostly helps those with Lyme Disease. She invited me to talk to her in her backyard, where we sipped iced tea as I marveled at her disarming charisma. I asked her what made it so easy to talk to her. She said, “I try to speak commonly. You’re more apt to have a conversation with a friend. I try to convey that I’m approachable, less buttoned-up, less of a white-coat person.”
We talked about the things a patient needs to tell a doctor, like past medical history, social history, sexual activity, and weight. We discussed the ways a physician can gather any important information, even if the patient is reluctant to share. “You have to establish a rapport,” she said, then added, “Lack of shame goes a long way on both parts.”
When we delved into the kinds of important things patients might not want to talk about, she told me, “When you voice the scary thing, it takes the power away from it.” She stressed that ultimately, the onus is on the physician to evoke the crucial information from the patient, but that the patient needs to enter the relationship with a “what have I got to lose” attitude. “The thing that is at risk of being lost is a relationship that isn’t worth keeping,” she advised.
I sat with Dr. Salvatore Prainito a New Jersey resident with a family practice on Staten Island. When I asked him what he does when a patient seems to be shy or embarrassed to talk about something, he answered, “I assure them that this discussion is private, and they can let me know when they are ready to talk about it.” He added that a patient shouldn’t assume that a doctor knows something or sees something and that a doctor, likewise, shouldn’t assume anything about the patient’s sexuality, gender, or sexual history.
Before a patient goes to see a doctor, particularly a new doctor, the patient should write down three questions that help the doctor to know what the patient wants to get out of the visit said Dr. Prainito. If the patient is there for a yearly health visit and is having bloodwork done, the doctor might say, “Often we test for STDs or HIV…” if that issue hasn’t yet come up.
Dr Prainito said, “You’re building a relationship. Educate kindly.”
When I spoke to Michael Zito-Govert, the Ryan White Clinical Manager at the Visiting Nurse Association of Central Jersey, and Primary Care Practitioner at the LGBTQ Center for Health and Wellness in Asbury Park, he told me, “It’s about building trust. Having a conversation. I’m not here to judge you. Tell me what’s going on in your life. How is work? School? I try to understand the person and make them feel that I’m interested. I am. These things guide me. The more information they give me up front encourages additional questions from me.”
He said that where he works, the intake form addresses sexuality, gender identity, significant other information, preferred pronouns, sexual history, and the like that other facilities’ forms may not cover. He said, “Everyone should ask ‘Who are you attracted to? What kind of sex are you having?’ A provider may have to tease away what the problems are. It’s up to the provider to get to what the issues are.”
The responsibilities are clearly on both parties in this relationship. Both can maximize their inherent qualities that may make discussing sensitive topics much easier. Both can also enhance their skills at honest conversation and increasing comfort in them. In Dr. Odell’s words, “Nothing shocks me.”
“…[the doctor-patient relationship is] about building trust. Having a conversation. I’m not here to judge you…”
~ Dr. Michael Zito-Govert.
As patients we should assume medical professionals have heard just about everything and that they are equipped with the tools to help us. It would be helpful for physicians not to assume anything about patients and to treat all equally. A doctor-patient relationship isn’t the same as a friendship.
We will most likely tell our doctors things we wouldn’t tell our friends or our lovers. However, we can foster a friend-like relationship that makes the scary things easier to talk about and makes managing our health more effective.