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A few days ago I wrote about a patient who wished to transfer from Urs Truly to the nurse, who is female, on the reported grounds she prefers a female. [1] This is a regular request in Medicine and in Psychology: a preference to someone more like yourself. I wish I had a shilling for every time a gay male patients has asked me for a ‘gay therapist’ who is male too. I often tell them there isn’t one like there here but Dr. So-and-so is excellent, so how about he try her/him but this is often declined. In a similar vein, female patients often ask for seeing a female provider.

In my field if a patient requests a certain type of someone folks try to oblige them.** However the opposite is considered not good viz. a patient requesting they see a white doctor or ‘someone not gay’. [2]

There is good data that shows children in grade school who are put in a class where the teacher is ‘like them’ do much better for it. However, no one flips it around to say to little Dicky Purdy (who is black in this example) “because you are black we are putting you in Mr. Penno’s class, because Mr. Penno is black.”

I have a very WASP-sounding name. I know I’ve received patients (new and transfer types) of white folks hearing/seeing my name and thinking ‘he’s white and not a foreigner”. I always ask a new or transfer patient ‘what were the matters with the previous psychiatrist that you are looking to find a new one?” What’s often said is “He/she was OK but I couldn’t understand his accent’. I smell a rat on this. This is more likely the previous was doctor was Indian and they want a white dude. Imagine their dismay/dissonance when they get one – but not of their political views or (worse) sexual orientation! I sometimes see the dismay in their faces in the evaluation as they connect the dots. I see them wondering whether to return to their previous shrink or stay with me, or figure out where on earth can they find a straight white conservative psychiatrist. [3]

Urs Truly is no exception. The Good Doctor was specifically picked as he is ‘like me”, done on the superficial joke he would understand my Better Midler references, but really because I feel more at ease to talk about some matters without having to stop and explain things. In my defense, this is a preference not a necessary. When he retires I hope I am OK with anyone so long as he or she is good and not judgmental. [4]

There is something in the field of psychology/therapy called ‘goodness of click’: yo have an at-ease emotion with your provider/physician. Unfortunately you don’t know until you meet up; all the rave reviews and credentials are no use if you don’t feel a rapport with your counselor. The bottom line is if you don’t feel comfortable enough with the person before you, better to go elsewhere – at least in Medicine or Psychology.

A counselor or a physician wanting to be rid of a patient they don’t especially like or isn’t like them – that’s a different topic.

Do you have a preference to the type of physician or counselor you see, based on who you are?

“I don’t like him” they are both thinking perhaps.

[1] This is how it was explained to me anyway. It may be a euphemism she thought me an old goat or she couldn’t manipulate me into giving her what she wanted.

[2] It’s true seeing a counselor like themselves makes the patient initially at ease, but this sometimes delays the actual therapy. The connection gets them ‘in the door’, but then the work isn’t so obvious. A female patient with PTSD/issues with men may feel not at ease for seeing a male therapist, but the transference issues are obvious and in the long run more likely to work.

[3] Fat chance of that. As the old while male analytically-trained psychiatrists retire they are being replaced with a diversity of types, predominately female.

[4] My pediatrician Dr. Helen Nutting was the one who inspired me to go into medicine. Later on I learned Lorraine her office manager was actually her long time companion. Well !

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August 2022

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