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Reflections

A Lie by Omission?

Yingling, Charles DNP, FNP-BC, FAANP

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AJN, American Journal of Nursing: January 2019 - Volume 119 - Issue 1 - p 72
doi: 10.1097/01.NAJ.0000552618.98438.25
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Figure:
Illustration by Jennifer Rodgers

As a family NP, I develop long-term clinical relationships with my patients and their families. My patients invite me to celebrate their joys and allow me to empathize with their sorrows. Despite being allowed into the private lives of my patients, I have always maintained professional boundaries. My family life has never seemed germane to the clinical care I provide my patients.

When my son was born, I took leave from work. Upon returning, I was greeted by gifts from my patients for my son and warm congratulations for me and… my wife. Grateful for the kindness of my patients, I felt disinclined to correct their not unreasonable assumption that my son's other parent was a woman. In fact, my son has two dads.

In my professional and personal life, it is no secret that I am a gay man. My clinical scholarship is built around improving health care for sexual and gender minority people. While I don't wear my sexual orientation on my sleeve, I am not ashamed of it. So, why didn't I correct my patients’ perceptions after my son's birth?

Preceding the Christmas holiday, two patients concluded their visits by wishing me and my wife a merry Christmas. Hand on doorknob, I paused and considered whether I should correct them. I chose not to. Was it for expedience (not enough time to get into a conversation about my spouse's sex)? Was it a symptom of the phenomenon of minority stress (hiding and concealing, sometimes also referred to as internalized homophobia)? Was it both?

NPs strive to create the perception that our time with our patients is unhurried. But the urgency to conclude a visit and proceed to the next one is omnipresent. Adding 60 seconds to a packed clinic schedule to disclose my sexual orientation to a patient seems superfluous. But is a preoccupation with maintaining a schedule sometimes just an excuse to stay hidden? Gay people and the scholars that study our lives understand that many of us internalize societal intolerance and carry an unconscious shame about our sexual identities. Despite working to overcome this, there remains a part of many of us that is fearful of what will happen when people “find out.”

Yet the caring theorists tell us that the essence of nursing care comes from bringing our authentic selves to the nurse–patient relationship. I have seen the power of these human connections in my practice. Patients respond to the authenticity and lack of pretense that characterize nurse–patient relationships. Have my decisions to not correct patient assumptions about my sexual orientation undermined our relationships?

I have considered corollaries to my unwillingness to correct my patients’ assumptions. Would a single mother hesitate to share her story of adopting a child without a male partner? Would a widower refrain from correcting the assumption that his spouse is still alive? I suspect that this would largely depend on the individual and in some cases on the perceived beliefs of the patient. But I am compelled by the belief that sharing truth in either scenario would enhance the authenticity of the relationship. Nevertheless, I remain reluctant to correct my patients’ misperceptions of my family life.

As a young man, my first primary care provider was a physician who, in my first visit with him, made an incidental disclosure that he was gay; a passing remark, with no attempt to encode the message. I remember the sense of relief that I felt knowing that I could be my authentic self with this doctor. I can't help but wonder if being as casual as my former provider would provide the same sense of safety for my own patients. Perhaps a teen who is resolving his sexual identity would have more hope that it does, in fact, “get better.” Perhaps a mother who worries her lesbian daughter won't have a family would find reassurance that gay people can find love and create beautiful families.

Perhaps the part of me that remembers when people like myself were characterized as deviants and perverts, unfit to teach or care for children, and couldn't marry the people they loved, is fearful of what will happen when my patients “find out.”

Many of us are members of hidden minority groups. For me, it is being a gay man. For others, it may be a gender identity that doesn't match the sex on their birth certificate, membership in an ethnic group, or a disability that is not evident. Is there a part of your identity that you do not disclose to your patients? Does your nondisclosure have an emotional cost or degrade your nurse–patient relationship? Or does it really not matter because we're just too busy and there are patients waiting?

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