{"id":8227,"date":"2016-11-06T14:17:54","date_gmt":"2016-11-06T19:17:54","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8227"},"modified":"2018-04-19T22:21:17","modified_gmt":"2018-04-20T02:21:17","slug":"id-doctors-stigma","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/id-doctors-stigma\/2016\/11\/06\/","title":{"rendered":"Do ID Clinicians Perpetuate Our Own Stigma?"},"content":{"rendered":"

Infectious Diseases doctors will find this exchange familiar:<\/p>\n

New person you’re meeting:<\/em><\/strong> \u00a0What to do you do?
\nID Doc:<\/em><\/strong>\u00a0 I’m a doctor.
\nNew person:<\/em><\/strong> \u00a0Oh — what kind?
\nID Doc:<\/em><\/strong>\u00a0 A specialist in Infectious Diseases.
\nNew person (making a face, or moving a few feet back, either to be humorous or truly frightened, or both):<\/em><\/strong> \u00a0Yuck! Well I guess someone has to do it …<\/p>\n

The stigma associated with Infectious Diseases\u00a0is as much a part of the field as knowing why\u00a0Pneumocystis carinii<\/em>\u00a0is now\u00a0Pneumocystis jirovecii,<\/em> and how to pronounce the drug class that includes linezolid and tedizolid. (Oxazolidinone.)<\/a><\/p>\n

I mention this aspect of ID as it\u00a0came up recently in the context of our shiny bells and whistles electronic medical record. One of its many features (common to most EMRs) is that you can\u00a0generate letters to patients to notify them of their lab results.<\/p>\n

Here’s what the header to those letters looks like; I highlighted the key problems:<\/p>\n

\"letterhead4\"<\/a><\/p>\n

There are four issues\u00a0with this image,\u00a0three\u00a0small, one big. The three small items\u00a0first:<\/p>\n

    \n
  1. That’s the old hospital insignia. Here’s the new one.<\/a><\/strong><\/li>\n
  2. The lower-case “b” in BWH. Hello, can we get a proofreader in here?<\/li>\n
  3. For some reason it’s calling our practice “bWH Infectious Diseases Medicine”, which is a term used literally nowhere else — we’re the “Division of Infectious Diseases” to the rest of the world.<\/li>\n<\/ol>\n

    None of these is a big deal (though it is kind of ironic to see what you get for your billion dollars).<\/a><\/p>\n

    What is<\/em> a big deal, however,\u00a0is that many of our patients have made it abundantly\u00a0clear to us that they don’t want any references to “Infectious Diseases” on materials mailed to them.<\/p>\n

    Worse would be “Infectious Diseases” on the envelope return address\u00a0— gosh, anyone<\/em> could see that — but mentioning it at the top of a\u00a0letter is also off limits. (For the record, our old EMR had an option to choose “generic BWH letterhead”, and we went with that as the default.)<\/p>\n

    We’re also not supposed to say we’re calling from “Infectious Diseases” when leaving appointment reminders or other voicemail messages. So\u00a0we don’t.<\/p>\n

    And there’s more.<\/p>\n

    I’ve had patients tell me that they don’t like the fact that our practice is\u00a0called “Infectious Diseases” in the hospital directory, preferring\u00a0that we be listed by some generic term — one suggested we go back to the plural, “Medical Specialties”, which is what our office\u00a0used to be called when we shared clinical space with Renal, Pulmonary, and GI. Another wanted the bland moniker “Brigham Associates” — to which I would always wonder, “associates with what?”.<\/p>\n

    Some don’t even like sitting\u00a0in our waiting room — this is very sad, when you think about it — even though they are coming to us for their own<\/em> ID problem.<\/p>\n

    But think of how we’ve responded to our patients’ concerns:<\/p>\n