Genetics: RNA Interference Cuts Hepatitis Down to Size Immunology: New Mouse Gives Glimpse into Complications of Diabetes Oncology: Zebrafish Lights Path of Leukemia   Researchers Report Quick, Inexpensive HIV Test Lawsuits for Medical Monitoring May Aid Public Health Pilot HIV Screening Finds Infection 43 Percent Higher than for Self-referrals   HSPH Names New Head of Population and International Health Spaulding Names New President New Appointments to Full and Named Professorships Farmer and Spengler Win Heinz Award MyCourses Training for Faculty Nominations Sought for Invitational Awards Nominations Sought for Dean's Award Recognizing Support of Women Staff Joslin Receives Funding to Train Pediatric Endocrinologists Honors and Advances News Brief In Memoriam: Donald O'Hara   Resident Mocks Gay Physician   How a Doctor Builds a Family   Front Page

INCIDENT REPORT Resident Mocks Gay Physician A new column, Incident Report, debuts below in this issue of Focus. Daniel Goodenough, the Takeda professor of cell biology, has written the general introduction to the column and the specific response to this issue's critical incident. In the future, the responses to selected incidents will be written by other volunteer faculty members. This issue of Focus heralds a new experimental column, Incident Report, that will provide a context for discussion about our differences. In each column, real incidents will be presented that have been submitted by members of our community, together with a response. The goal of providing a public forum for discussion and reflection is to develop among ourselves a shared vocabulary and a safe context to engage in learning about why we see each other the way we do. If we take time to understand the lenses through which we view each other, the more thoughtful we will become in caring for each other, our students, and our patients. It is too often the case that we project our frustrations and fears concerning an increasingly complex, sometimes alienating, work environment onto each other, particularly onto those around us about whom we have the least understanding and harbor stereotypes. We have all been carefully taught values in our families and communities, values of beautiful and ugly, special and shameful, desirable and mundane. These values may seem so "normal" that we are blind to the considerable power given to them by the privilege of our professional stature, power that can marginalize and sometimes vilify the values of others. We must seek to undo these inequities. The goal of these discussions is not to shame, blame, or promulgate a politically correct agenda. Rather, it is to normalize conversation about taboo subjects, always in the interest of learning about ourselves and how we can emerge as better professionals. Value is placed on being mindful so that we can professionally monitor our blind spots and projections. Incident: A senior resident makes fun of a staff physician who is gay and somewhat closeted. In front of approximately 15 people, the resident makes effeminate gestures and uses the term "faggot" after the physician leaves the room. No one in the group reprimands the resident and some actually join in. Response: Estimates suggest that up to 10 percent of us are gay, lesbian, bisexual, or transgendered (GLBT). This means that we all have GLBT individuals in our families and communities. No one "chooses" to be GLBT any more than one chooses to be heterosexual. There are deep cultural and religious feelings about GLBT individuals that color our lenses and populate our past and present experiences. Each of us has been taught to hold complex and deep convictions about GLBT individuals, and it is important for us professionally to understand why we have them. In the case presented, the senior resident is not showing appropriate professional manners. Moreover, the resident's position of power (once the attending has left the room) silences everyone else's values and beliefs, denying the opportunity to provide feedback. Being silenced generates a sense of shame in one's lack of strength and conviction to speak out in the face of unprofessional behavior. Since others joined in, the resident has also condoned this non-professionalism, ensuring that those for whom the resident is a role model will likely ape this hurtful conduct. Instead of generating a team of colleagues, joined in a common goal of providing the best medical care, this lapse of professional behavior has divided and silenced the team members, with a concomitant loss of trust and respect. Repair is not possible because the power inequity makes it unsafe to speak. This outcome most certainly was not the resident's intention. Nonetheless, it is important for the resident to understand where this non-professionalism comes from, so that he or she can avoid a repeat performance. Sadly, due to inequity in power, the resident did not receive any feedback and may yet be unaware of the incident's destructiveness. As a community, we must agree that open discussions about our professional behavior are permitted, even welcomed, if we are to provide the best teaching for our students and health care for our patients.