When to call up a colleague rather than calling them out

Editor's Note: This is a non-fiction story, with the name of the patient changed to protect his privacy. The word ally comes from the Latin word alligare, meaning "to bind to" like nations who are allies in wartime—they will act together, and protect one another; nations you can trust. Since WWII this term has expanded beyond the battlefields into the general population and medical circles. Sometimes, even in our medical settings, patients are “attacked” and don’t feel safe. And we are asked to be allies. We are compelled to be allies. It’s the right thing to do. That doesn’t mean it will be easy or come naturally. Mack: “Doc, you know I’m not a complainer, but I’ve got to tell you about a colleague of yours.” Me: “What are you talking about?” Mack: “When I was in the urgent care clinic the other day, the doctor really went out of his way to make my life miserable.” Me: “Tell me what happened.”Mack: “When he came into the exam room he literally said, “So you are Madeline, a MAN with belly pain?” He said “man” with a bit too much emphasis and caught me totally off guard. I finally said I was a trans man and my legal name was Mack. Then he said, “Yeah whatever,” rolled his eyes and said, “Why are you here anyway? It’s busy tonight.” I ignored that and tried to tell him about my abdominal pain. Me: “Wow, he really said it just like that?”Mack: “It only gets better. He thought I could be pregnant. He didn’t ask me any questions and didn’t look at my chart. I said that was impossible and he looked me right in the eye and said, “Yeah well I’ve heard that one before. Real guys can’t get pregnant, so give me a urine and we’ll check a pregnancy test first and then I’ll examine you.” Before I could tell him about my total hysterectomy he was out of the room. In the hallway, he said loudly to the nurse, for everyone to hear, “We’ve got to see if missy pretending to be mister isn’t knocked up.” Me: “I can’t believe this really happened.”Mack: “I’m not making it up.” Mack was getting red faced and bit teary, “I was so embarrassed and angry I just had to leave. As I was on my way out, he said, “Well I guess it can’t be that bad after all, if you can’t even wait a few minutes for a test result.” Me: “Do you know his name?”Mack: “I asked the nurse on the way out and she told me. She said he was just having a bad day, and not to take it personally. Well I did take it personally. How could I not?”Me: “Are you OK? What happened with the abdominal pain?” Mack: Pulling his shirt out of his pants, he showed me the scars. “A laparoscopic appendectomy. I went home, but when the pain just kept getting worse I ended up in the ER. They said a few more hours and it likely would have perforated. I’m feeling better every day now.” Me: “I am so sorry to hear what happened to you. I’m glad it turned out alright in the end. Can I help at this point?” Mack: “I don’t want to make a big deal about this. Maybe he was having a bad day. But I do want you to be an ally for me.” Me: “Of course, what do you want me to do?”Question: Which one of the following is a demonstration of medical allyship? A/ Learning more about a marginalized population your patient is part ofB/ Advocating for an appointment specifically on the only day that patient that doesn’t workC/ Actively listening to your patient’s current struggles navigating the medical system in English (not their first language) D/ Calling about a test result even when it was “normal” so that patient would not have to worry unnecessarily. E/ Declaring a war on drugsAA+BA,B,CAll of the above None of the aboveSo what does it mean to be an ally to a marginalized individual or community? Quite simply put, an ally is someone who supports and educates themselves and speaks out and advocates for a person and/or community. Answer 3 above. More formally structured, the four pillars of (medical) allyship are described asEducation and awareness, potentially special trainingActive listening and empathetic understandingAmplification and advocacy Action and accountability. In a busy medical life, all of these pillars are time-consuming and potentially challenging, especially taking decisive action. Getting into “good trouble” as some call it. Showing up and speaking up for our patients. It’s hard work being an ally. Even though I call myself one, I am not the best at it. On any given day I would much rather put my head down and get through a busy clinic day then have to call up and call out a colleague. Perhaps better stated as “gently nudging and educating” my peer as to a potentially more effective way to communicate with future patients who might fall under an umbrella of sexual or gender diversity. I try not to judge, but this behaviour was egregious and I felt it needed to be addressed. I promised Mack that I would talk to this MD, with whom I was familiar but had never met in person. I also promised that if things didn’t go well with this conversation I might have to take things further “up the chain.”So how did this conversation go?I dreaded this confrontation and each time we played telephone tag, I breathed a sigh of relief with the temporary reprieve. But we eventually did have “the talk” and it didn’t go particularly well. He agreed that he was likely abrasive and a “bit offensive, that’s my personality. It was busy and I’ve been burnt by a few patients in the past few years who couldn’t possibly be pregnant, but who were.” When I mentioned that Mack had a total hysterectomy so this was impossible, he scoffed. “Well how was I supposed to know this, that patient never told me.” “I guess you didn’t ask and when you actively dismissed their gender transition, they were definitely on the defensive.” “Noted,” he said flatly. I listened to a litany of excuses. In the end I said, “I don’t want to preach at you.” But I also told him flat out that his interaction with my patient was unacceptable and in the end he agreed to “try to be more sensitive” in the future. He didn’t come right out and apologize, but he did seem contrite after I confronted him. He was interested in whether the patient would be making a formal complaint. I feigned uncertainty, letting this possibility linger. “I would fully support them if they did, but I really think all they want is for you to understand the implications of your actions and not do it again with another patient.” “By the way, their appendectomy went well in the end. I know that CPMA would cover your medical butt in this case seeing as the patient left, but apparently it was on the verge of perforation which would certainly have been a much more complicated scenario for them . . . and potentially you.” He grunted. My points were made and he heard them loud and clear. I have yet to talk to Mack about the outcome of this discussion. He has every right to make a formal complaint, but knowing him, he likely will be satisfied with knowing that I talked to my hopefully less tone-deaf MD colleague. He trusts me as an ally, perhaps more than I trust myself to be an effective and consistent in this role. Sadly, all in a day’s work. Dr. Ted Jablonski is a performing artist and writer who has retired his family practice to focus on sexual medicine and transgender health in Southern Alberta with two feet still on the front-line trenches of acute primary care.

When to call up a colleague rather than calling them out

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