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A doctor's conundrum

Dr. Scott Hadland, chief of adolescent medicine at Mass. General, reports on a recent missive from a doctor in another state and asks for some advice:

Last week I got a rude letter by snail mail from another doc, telling me I should stick to patient care, stay out of LGBTQ advocacy & "leave politics at the clinic door".

What to do? Respond? Or does the adage "ignore the trolls" also apply to snail mail from a colleague?

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If the patients are at the clinic door, you should treat them, and ignore whatever the politicians say.

Alas, too many politicians in this country are trying to tell doctors they shouldn't treat certain types of patients.


If the patients are at the clinic door

They're not. This is a letter from a colleague.


"Leave politics out of this" is code. It means "I do not like what you are doing because it goes against the status quo, which I endorse implicitly if not explicitly".

I wouldn't like to say what the querent should do without knowing more about the power dynamic between them and the letter-writer, because I'm never comfortable insisting someone else should fall on their sword for a good cause when I am at no risk myself.

That said, the response I'd like to give if possible in their shoes would be something along the lines of this:

"Dear Dr. [name of asshat colleague], I have received your letter of [date] in which you suggest I 'leave politics at the clinic door'. I decline to do so. If you don't like that, take it up with [name of relevant authority figure]. Signed, Dr. [non-asshat]".


Mail back a one-word reply:


Send snail mail telling him you posted a response on social media. That will keep him busy.


I think that's the appropriate response. People do not live in a vacuum. Their environment matters and can cause good health or ill health.

People who can't mind their own fucking salvation are great causes of ill health, especially in anxious kids. Isolation kills. Creating a healthier society saves lives.


It seems to have nothing to do with either the Luddite labor movement nor the later meaning of "vague distrust of technology".


Dr. Backwards Ass Fucktard better?

And, since you missed the subtext, this has a fuckton to do with "distrust of technology".

You also seem to have missed the fact that words have vernacular meaning beyond their precise original meaning, too.

I would not consider it prudent to provide any response. Because if the doctor who wrote the original letter chooses to share the response online, an entire internet of hateful transphobic whackanoodles could be unleashed. There are already too many hospitals dealing with threats from them.


Prudence is one thing. But Elie Wiesel said, "Neutrality favors the oppressor", and he was right.


He is (presumably) providing appropriate care to LGBTQ adolescents, and ensuring that other physicians within the hospital are expected to do the same. They can do this far more effectively for their patients if they’re not dealing with bomb threats on a weekly basis.


...because there's no way they're treating LGBTQ patients appropriately


Snail mail? Must be from someone older than God. Ignore.

There's a famous reply to an obnoxious letter from 1974 (full story here) that seems apropos:

Attached is a letter that [I] received on [date]. I feel that you should be aware that some asshole is signing your name to stupid letters.


I'm not on Twitter so I can't respond to the doc's query directly, but I suppose I'd ask him what he would hope to accomplish in a response to the letter writer. That might help him decide whether and how to handle the situation.

Personally, I'd take the "judo" approach and use the troll's shit against him. Submit an article to JAMA or NEJM about the challenges of providing care to children and adolescents in this toxic environment, including the full text of the letter as context.

An AJPH editorial explaining how and why it matters - citing the letter - would also be a good use of ink and electrons.

If some governing authority banned penicillin and isopropyl alcohol, would Dr. Transphobe just keep their mouth shut, "stick to patient care," "leave politics at the clinic door," and not say anything about it? Doubtful. They would probably decide that it's not a political issue to advocate against laws that are massively harmful to their patients, and they'd be correct. Not everything that's politicized culturally is inherently political. LGBTQ rights are in that category. It is not political to advocate against laws that are massively harmful to that group of patients.