BIDMC CEO receives communication from a BIDMC physician representing an anti-GLBT hate group, blogs it, takes no real action

Paul Levy, the CEO of Beth Israel Deaconess Medical Center, posts a letter on his blog that he received, which states that the author is opposed to BIDMC validating the GLBT community, because the committee feels that "homosexuality is immoral, ungodly, unnatural, and of course unhealthy." The letter further states that "the health risks of homosexual behavior are well known and incontrovertible," and "It is all together inappropriate for BIDMC to endorse, affirm, or encourage these behaviors."

The letter orginated from a physician at the institution and is written in the first-person plural, claiming to be from "The Committee to Restore Sensible Values and Perspective."

While I enjoy reading Mr. Levy's blog and very much respect him, I find his lack of action on this letter quite disturbing, especially given that the letter is now available to staff and patients by virtue of being posted on his blog.

If you read the comments thread, you'll see Mr. Levy's descriptions of the action he has taken in response to the letter. He describes having done the following:
  • Wrote back to the physician, assuring him/her that BIDMC is somewhere where all values can be expressed and respected (we'll get to how the BIDMC anti-discrimination policy doesn't necessarily agree in a moment)
  • Asked the physician to consider whether s/he is able to separate these beliefs from his/her work with patients (the physician reportedly ensured Mr. Levy that s/he is able to)

  • Mentioned the letter to the physician's supervisor (the supervisor reportedly assured Mr. Levy that "there had been no indication of improper behavior by this doctor in the presence of patients")

I appreciate that he spoke to the person in question and posted on his blog expressing his disagreement. This is appropriate. What's troublesome is all of the actions he hasn't taken, and which he defends throughout the comments thread. He seems to be focused on how he can't discipline someone or take away privileges when the person has not given evidence of harming patients. This is correct, of course, and we don't want to ruin a good cause by violating this physician's rights in the process. We also don't want to overlook that the individual who signed the letter has some basic medical facts wrong, which is grounds for taking many actions that don't necessarily involve removing privileges.

Why this lack of action troubles me:

  • This physician has some medical facts wrong regarding STD risk, the idea that GLBT identity is inherently unhealthy, and the idea that GLBT identity should not be affirmed or encouraged (the AMA has released position statements regarding the harm caused by encouraging people to deny or change their sexual orientation). This physician took it upon him/herself to alert Mr. Levy to this lack of education. Mr. Levy should thank him/her for being so upfront in disclosing these deficits in this matter and see to it that s/he receive appropriate training. (Which, in the healthcare field, involves being observed by another provider to ensure that the skills are being applied appropriately.)
  • Disparities in healthcare between GLBT individuals and non-GLBT individuals are not generally caused by outright "mistreatment" by providers, but rather by providers whose own biases prevent them from taking accurate sexual histories, from encouraging patients to be open and honest about their lives and behavior, and from accurately assessing the mental and emotional health of patients. A physician with good boundaries between personal beliefs and professional practice would not typically take the time to state, in writing, at his/her workplace, that s/he believes GLBT individuals are immoral and unhealthy. This letter is evidence of a serious potential to harm patients. "No evidence of improper behavior" is not a sufficient indication that this person can really work effectively with GLBT individuals. At every one of the GLBT healthcare trainings I do, I hear from dozens of people who have encountered homophobia in healthcare but did not complain.

  • Remember, this wasn't just a comment that this doctor muttered after seeing an announcement. This was a letter the doctor has written every year, while purporting to be part of a committee. The AMA has made statements that GLBT identity must be affirmed and disparities must be addressed, yet this physician clearly feels differently. It is important that all staff at the institution are working from the same standards, and if an alleged committee is advocating for different practices from the standard ones, an appropriate response is either to take action to ask that s/he stop, or to make the committee's statement available for all staff to discuss in order to arrive at an official hospital policy.
  • The Beth Israel Deaconess Medical Center Policy on Harassment and Discrimination states that inappropriate behavior includes unsolicited remarks, gestures, or physical contact, display, or circulation of written materials or pictures which has the purpose or effect of creating an environment which is hostile, offensive, coercive, or humiliating based on race, color, religion, national origin, age, sex, sexual orientation (gay, lesbian, bisexual, or heterosexual), disability, or veteran status. This individual clearly circulated written materials that are offensive to GLB individuals. [Notice that their policies don't cover trans folks, even though the City of Boston Municipal Code covers gender identity and gender expression]. Thanks to Mr. Levy's blog, this material has now been circulated to all staff, patients, and community members who come across the letter. Additionally, the letter does not purport to be the opinion of one person, but rather, of a committee operating within the hospital.

  • I find it hard to believe that this doesn't violate some sort of policies regarding organizing (or using company time, or using company computers...) for purposes that are not directly related to their mission. At my workplace, which is quite progressive, there would be consequences for forming a committee inside the workplace without clearing it with administration, regardless of the message of the committee. This is mostly just for reasons of practicality, but also to ensure that staff are not sending messages that go against the mission of the company.

What I'm doing to address this:

  • Writing to everyone I can at BIDMC (patientrelations@bidmc.harvard.edu or conduct_c@bidmc.harvard.edu seem like good places to start) to tell them how I feel. I'm expressing that as a patient, I feel scared and threatened that this letter was circulated at the hospital with no consequences, and I'm letting them know that I am not comfortable returning to a hospital that tolerates such things. I'm outlining how the letter seems to violate their harassment policy (especially since it is in the hands of staff and patients) and explaining why I believe additional action needs to be taken to truly assess this person's professional boundaries and skills.
  • I'm encouraging everyone we know who works at BIDMC to take action if they feel the letter affects them as an employee there.
  • I'm writing to Fenway Community Health Center, where my PCP is, explaining to them that I feel uncomfortable that they typically refer patients to BIDMC for specialty care, given that BIDMC is allowing physicians to spread anti-GLBT sentiments throughout the hospital (and now into the community) with little consequence. I am asking them if they plan to give any sort of statement in response to the letter.
  • I plan to conduct more GLBT healthcare trainings this year than I had previously planned to, and to offer these to agencies at a reduced rate. I am also looking into writing articles that I had not previously planned to write.

If the events that have taken place ad BIDMC are bothersome to you as well, please consider sending a few e-mails.



3 comments:

Jodie said...

You note that when you do trainings, you run across people who don't complain when they've not been treated appropriately. All the things that you've mentioned here are great, but people should be encouraged to complain. Of course it's uncomfortable, but there are obviously physicians out there who don't understnad that

Disparities in healthcare between GLBT individuals and non-GLBT individuals are not generally caused by outright "mistreatment" by providers, but rather by providers whose own biases prevent them from taking accurate sexual histories, from encouraging patients to be open and honest about their lives and behavior, and from accurately assessing the mental and emotional health of patients.

We all need to be proactive in our health care. Physicians who don't do the above probably aren't going to change if no one points it out to them that what they're doing is wrong. I would imagine that not so many of them are as dumb as this particular physician to put their views down of paper, so it is left to the people who s/he treats to speak up. It's great if there's a nurse in the room or something that notices that the doctor never takes a sexual history or that they always assume that the patient is heterosexual, but that's often not possible (and the nurse might not even notice!).

I'm rambling. I guess when it come to health care, we all have to speak up, most especially when we feel that physicians aren't meeting our needs (whatever those may be).

eeka said...

Oh, yeah, that's a great point. A big part of the problem is that people don't speak up. This is why I wouldn't encourage Mr. Levy to single out a physician just for being untrained, because most of these oversights are due to lack of training and lack of feedback. This needs to be addressed by continual training for all -- and by people complaining.

But I do encourage him to do a lot more when someone is circulating hate speech in his hospital -- clearly the person knows that this violates HR policies, but since they aren't enforced, it creates a culture where the policies mean nothing.

FWIW, complaining specifically about staff at BIDMC doesn't seem to go very far -- they send form letters stating how much they value diversity.

Anonymous said...

As a physician at BIDMC I am amazed to read this as I have always felt that the physicians I work with daily were more enlightened. Very interesting Blog, thank you for this. I will keep my ears open for anti-GLBT sentiment.