22 —- OUT IN THE MOUNTAINS — MARCH 1998 _he Associates in Recovery Janet K. Brown, M.A.,.C.A.D.C. LICENSED PSYCHOLOGIST — MASTER \ CERTIFIED ALCOHOL AND DRUG COUNSELOR Jean Townsend, M.A., L.C.M.H.C. LCENSED CLINICAL MENTAL HEALTH COUNSELOR Burlington, Vermont (802) 863-8162 Milton, Vermont (802) 803--4816 I Heal I ng Bodywork Swedish - Reflexology - Polarity - Reiki Master Flevel with abandonment to a truly great massage rarely found anywhere. And be your best again. Prince Jhorev (802) 785-2244 V James R. Nelson MACP Psychotherapist (802) 651-7764 Burlington, VT 05401 Professional Confidential Iren Smolarski 658-8401 MA Psych.; Ph.D. Lit. Toward Intimacy Group for LGBT now forming Fee based on Individual Means Individual & Couples Psychotherapy I"""--‘H-_-""""""""""l Out in the Mountains I VERIVEONTS FORUM FOR LESBIAN. GAY. BISEXUAL D.ND TRANSGEWDER ISSUES I By subscribing now to On: in the Mountains, not only will you get delivery. to your I I mailbox (in a discreet envelope). but you also help underwrite the rising costs of publishing and Ilisuibuting the newspaper. We welcome any additional contributions you can make to I support this and other important publishing projects. Chocks should be made payable to I I Mountain Pride Media. and sent, along with this card, to: ‘K OITM V PO. Box I77 V Burlington, Vermont V 05402-0177 Name Address Town/City ____~_______________ State Zip I Ll One Year (520) 0 Two Years (535) 0 Low Income (SIO) 0 Contribution: S______ 2-" \ min- I Show your support — Subscribe today! www.vtpride.oI-g ‘ ‘.3 1‘ C JW. .‘ rt.‘/..'vC»'.i'=? ‘«'.'7/at ellbeing Lesbians Challenging Barriers - The Search for Adequate Health Care for Older Women - Part II BY CHRISTINE DEROSIERS AND JOY D. GRIFFITH A useful model for the in- teractions between doctors and older patients is the encounter ‘which is composed by two el- ements, the transaction and the reaction. The transaction (per- formance) is the part of an en- counter most often experi- enced when a patient is sitting in her doctor's office. The doc- tor performs her skill on the patient’s physical illness, but besides the trust the two may share, each remains firmly within her own skin often to the satisfaction of both. The reaction encounter is a bond of mutual recognition occurring between the two parties, so that for an instant each know what it is like to be in the position of the other. These occurrences are rare in Western medicine, but do oc- cur nonetheless, enhancing the experience of both physician and patient. These reactions are found most often in the contexts of pediatrics, obstet- rics, substance abuse treat- ment, and psychiatry, but why not every encounter, we ask? While some doctors search out the reaction encoun- ter, finding it quite satisfying, most doctors base their profes- sional satisfaction on a series of successful transactions: Residents in internal medicine tend to believe that their role is to care for medical not psychosocial problems; that they have insufficient time to discuss social and psychologi- cal problems; that such discus- sion is toostressful for patients; and that such talk is beyond the internist’s capacity to solve and thus a waste of time! In- ternists are disturbed and anx- ious when they encounter these issues of their patients and most often wish to post- pone exploration of the patient’s psychosocial problems...they do not wish to get involved in that at all. This can obviously lead to conflicts with some patients (more than likely lesbians who have spent a lifetime independently car- ~ ing for themselves), especially when the doctor is operating on a false set of assumptions about the patient. Doctors who seek transactions may assume an older patient will have poorly Verbalized complaints and a complicated history of past illness, thereby offering ’ ”little scope for therapeutic in- tervention. However, even doctors who seek reaction encounters also assume that an older pa- tient is unable to provide her satisfaction as well. This is of- ten due to the problem of poor understanding of the needs and abilities of most older people. Neither, a general practitioner unused to work- ing with older patients or a gerontologist whose vision is colored by cohort centrism, can provide the kind of respectful and informative health care many older patients seek. Limited knowledge and understanding of older lesbi- ans occurs when: 1. a doctor forms a better rela- tionship with a part of the pa- tient, the kidney or heart, for example, than the whole per- son. This is a satisfying trans- action, because the part is suc- cessfully treated_without really dealing with the rest of the pa- tient! 2. when the doctor blames the patient for the impotence the doctor feels in working with the patient, thereby shirking medical responsiblity. The doc- tor will tell a patient that she should simply live with her ill- ness or disability (avoidance). 3. when the doctor's frustra- tion is taken out on the patient through language by describ- ,ing patients as ”blocking beds”, and actions, where sym- bols of medical exasperation such as catheter bags and heavy use of sedatives become common...these doctors_ have resorted to defaming their pa- tient. Interviewee S. T., echoed a dissatisfaction with main- stream medical care many times throughout the discus- sion, for reasons such as those above. S. T. talked extensively about the ”insincerity of the medical profession.” Recently, she found herself losing pe- ripheral vision, so she went to an ophthalmologist. Five oph- thalmologists later, including one that called her neurotic, she finally found someone who would listen to her con- cerns and actually be able to help her. 5. T. also noted that while female doctors tend to listen better, she found one who was as equally dismissive as any male doctor she has ever consulted. P. O., is presently on dis- ability and used medicaid to get her eyeglasses corrected. The ophthalmologist was amazed to notice what quality glass frames she had and quizzed her about the name and where purchased. P. O. was merely puzzled at first, until she went from the oph- thalmologist to the glass frame shop. The shop owner becom- ing aware of P. O. being on medicaid began to quiz her about her expensive glass frames and finally out of frus- tration, P. O. exclaimed that she bought them at the University when she was working on her Ph.D. and a student with health insurance a few years ago. P. O. was angry that med- icaid patients must undergo this type of prejudice. A. P. dislikes doctors call- ing her by her first name, yet she is expected to call them ”doctor”. She feels that be- cause of her age, she deserves a little more. respect than what _ they give her. A. P.’s solution? » She calls them by their first names right back! I. G. did not go to a doc- tor for thirty years after two miserable, one nearly fatal, ex- periences in her twenties. She was experiencing gall bladder attacks, which are rare for someone in their twenties, and was repeatedly misdiagnosed , by her doctor, who only wanted to do vaginal exams (J. G. said that, inexplicably, they did vaginal exams for every- thing in the ’50’s). Finally, dur- ing one daytime attack after ‘nearly a year of pain, the doc- tor looked at her and realized her body had gone into shock. Only after she was rushed to the hospital near death, did he realize his mistake and actually apologized, explaining to her that he thought she had sim- ply been just another hysteri- cal female! ]. G.’s other nega- tive experience occurred just a few years after this episode. Suffering from an extremely high fever, J. G. was taken by ambulance to the hospital. Upon arrival at the hospital, ' her leg became inflamed ‘and she was unable to use the leg for any kind of movement. Her throat was also inflamed with I pain. The first thing that went wrong was the orderly taking her to the gym ward rather than emergency. When]. G. was fi- . nally placed with an emer- gency doctor, he performed a vaginal against her will. She was unable to physically move in any kind of protest against his judgment. Later, they dis- , covered she was suffering from Strep Throat and as an adult the strep had traveled into her appendage (leg) rather than any of her internal organs. She was treated around the clock with penicillin I.V. and re- leased a week later on crutches! We need to find a health- care practitioner who treats the patient the way she wants to be treated. Fortunately for the ADEQUATE, p24