November 6th, 2016

Do ID Clinicians Perpetuate Our Own Stigma?

Infectious Diseases doctors will find this exchange familiar:

New person you’re meeting:  What to do you do?
ID Doc:  I’m a doctor.
New person:  Oh — what kind?
ID Doc:  A specialist in Infectious Diseases.
New person (making a face, or moving a few feet back, either to be humorous or truly frightened, or both):  Yuck! Well I guess someone has to do it …

The stigma associated with Infectious Diseases is as much a part of the field as knowing why Pneumocystis carinii is now Pneumocystis jirovecii, and how to pronounce the drug class that includes linezolid and tedizolid. (Oxazolidinone.)

I mention this aspect of ID as it came 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 generate letters to patients to notify them of their lab results.

Here’s what the header to those letters looks like; I highlighted the key problems:


There are four issues with this image, three small, one big. The three small items first:

  1. That’s the old hospital insignia. Here’s the new one.
  2. The lower-case “b” in BWH. Hello, can we get a proofreader in here?
  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.

None of these is a big deal (though it is kind of ironic to see what you get for your billion dollars).

What is a big deal, however, is that many of our patients have made it abundantly clear to us that they don’t want any references to “Infectious Diseases” on materials mailed to them.

Worse would be “Infectious Diseases” on the envelope return address — gosh, anyone could see that — but mentioning it at the top of a letter 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.)

We’re also not supposed to say we’re calling from “Infectious Diseases” when leaving appointment reminders or other voicemail messages. So we don’t.

And there’s more.

I’ve had patients tell me that they don’t like the fact that our practice is called “Infectious Diseases” in the hospital directory, preferring that we be listed by some generic term — one suggested we go back to the plural, “Medical Specialties”, which is what our office used 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?”.

Some don’t even like sitting in our waiting room — this is very sad, when you think about it — even though they are coming to us for their own ID problem.

But think of how we’ve responded to our patients’ concerns:

  • Many ID/HIV practices or inpatient services have various euphemisms that say nothing about the mission of the clinicians — Ward 86, the Moore Clinic, the 1917 Clinic are three famous examples.
  • A terrific group of HIV/ID nurses I’ve worked with for over 20 years calls themselves “The Resource Team.”
  • I know a famous hospital (yes, again that other one in Boston abbreviated with 3 letters) that frequently refers to HIV as “Z virus” — a longstanding tradition that greatly precedes (and has nothing to do with) Zika.

So back to our patient letters:  I contacted our excellent IT liaison to see if we could change the letterhead back to something that doesn’t say “Infectious Diseases”, and included our HIV social workers in the email thread, thinking they would certainly amplify the importance of this change to our patients.

Surprisingly, I got this back from one of them:

Does any other department need to protect their patients by disguising the name of where they work? It’s as if we own stigma like our patients. In Social Work they call that “the parallel process”. It’s kind of a part of our own identity, our reality, and for some of us our pride in our specialization. I’ve been changed as a person because of it. Wow, really getting deep this morning!

Susan has a point. Imagine if “Dana-Farber Cancer Institute” or “Memorial Sloan Kettering Cancer Center” were asked by their patients not to include the word “Cancer” in their names. Or if a Cardiologist asked to remove his or her specialty from their hospital identification badge — I know one ID doctor who actually did this, as he didn’t want to make patients or hospital coworkers uncomfortable.

Makes you think. Are we doing more harm than good in treating our field with such exceptionalism?

12 Responses to “Do ID Clinicians Perpetuate Our Own Stigma?”

  1. Simon says:

    Great post – we are debating the same thing. Its the word infectious that seems to get people. We will likely change from Infectious Diseases Department to “Infection Management Services”
    For you instead of changing a letter head, why not the division? “Division of Infection Management” perhaps.

  2. Loretta S says:

    Wow, I had no idea you extremely smart ID folks use various methods of subterfuge to hide what you do. I find this kind of sad, both that patients feel stigmatized and that the docs also feel stigmatized. I’ll bet if there were a new infectious disease that became pandemic, ID docs would be lionized. Maybe we would even have a comic book super hero created who was an ID specialist. (Maybe your sister can draw an ID super hero and you can have a naming contest, Paul.)

    Not 2 weeks ago, I had a long talk with a former student who is trying to decide what kind of NP specialty he should go for. He is extremely bright, detail-oriented, plenty of science background, holistic in his thinking… I told him to think about working with an ID group!

  3. Gillian Arsenault says:

    How about
    Department of Microbiology
    Division of Human Microbiome Management
    Pathogen Response Team
    There must be lots of other possibilities.
    When you think about it, pathogens tend to get their names changed from time to time, so why not the pathogen wranglers?

  4. Liz Gabay says:

    When patients seem taken aback (or make a joke) about the field of Infectious Disease, I say “I cure them, I don’t spread them around.”

  5. IDMD says:

    I also regularly get asked if I’m afraid of catching my patients’ illness. (FYI, I’m not.)

  6. Joel Gallant says:

    Because to most people “infectious” is synonymous with “contagious,” we have an inherent problem not shared by any other specialty, and one that will probably always be with us. (In fact it will only get worse when our antibiotics stop working!)

  7. Cedric says:

    Great post,
    In my residency, the HIV ward was called “Viro”.
    In ID fellowship, HIV clinic was called “Center for Positive Living”
    My first attending position it was called “the DAC” (Designated AIDS Center)
    In China, the HIV hospital where I currently work is called “Red Ribbon Antiviral Care Center”

  8. Jim Greig says:

    GUMed are even worse, when was the last time you saw the Department of the Diseases of Venus. Use to be in the Military, a senior Officer was inspecting the hospital and chanced upon the GUMed waiting room. His aides (sic) told him they were waiting to give blood, his loud response was ‘well done men, proud of you, never had the nerve to do it myself’ and he left.

  9. David K says:

    Just this week, some cardiologists tried to tell me that my patients would have to walk around and come in the back of the office pod we are in. “We have patients with prosthetic valves,” they said. “Your patients could give them C. diff.”

    They tried to turf the blame to an Infection Control policy, and fortunately I am also the chair of that department (it’s a small hospital), so we had a nice teachable moment.

  10. Ansal says:

    I can relate to this as an ID doc. We call our practice ” Immunology Center”!

  11. Rossana says:

    Where I trained we called the HIV service “Special Immunology” and HIV was referred as “High Five”.

    As a fellow I once deeply offended a patient by introducing myself as part of the Infectious Diseases team. He had diarrhea… He demanded my attending and I concealed our specialty.
    My attending’s reply: “Sir, your request is most unreasonable”.

  12. Ben S says:

    As a military physician, I can’t change my duty title from Infectious Disease Physician, but we’ve rebranded our clinic as the Infectiology Service and all of my signature blocks say Infectiologist. I’ve been partial to the term since I came across it in a European journal during fellowship. We don’t call cardiologists cardiovascular disease specialists, why should we be different? Patients seem to prefer it as well.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

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