Medical Miscommunication

The quality of verbal communication with all levels of medical personnel was also an important component of the overall healthcare experience, influencing not only choice of clinic but also honest communication, adherence, and satisfaction with care:

“I called the office and his receptionist—actually she’s half the reason I chose him—because she has this wonderful voice. And she started talking on the phone, and I wanted to go just so I could listen to her talk. She was so warm and reassuring…” (Atlanta, 35) “And then, I had a few of them [doctors] actual ly tell me, ‘Well, if you stop the homosexual sex, you could live longer.’” (Brooklyn, 35)

“My doctor—now, I wouldn’t say she’s uncaring, but she’s not that caring either. She’s like, ‘I wanna put you on medication.’ And I’m like ‘Why? My viral load is undetectable, and my T-cell count is in the 700s.’ And I’m like, ‘No!’ She says, ‘Well, that’s the way you wanna go, fine. But it’s your life, and if you die quicker because of it then don’t come crying to me.’ And she filled out a medical form for me and said, ‘Refuses to take medications’ in big letters!” (Brooklyn, 30) canadian pharmacy viagra

“She [the nurse] wouldn’t tell me what she was doing. She starts thumping here and there, and I have a history of a vein problems. I know where the veins are that I have that work. So she’s just poking and poking everything. And I’m—do you want me—are you taking out blood?’ Just didn’t say— well, it turns out she wasn’t taking out blood, she was finding a place to insert to give me an IV.” (Albany, 60)

“I have a good rapport with my doctor. We talk, and I tell him everything.” (Brooklyn, 30)

“I was talking to her [the doctor] about the symptoms I was having. And she asked me when the last time I had anal sex? And I told her, like, whenever it was. And she’s like, ‘Well, you know, the anus really isn’t made for that.’” (Manhattan, 33)

“And when you see her [the medical provider], it’s damn near like seein’ your mama, you know what I mean? She goes through all the motions, she chats with you, she laughs with you. She tells you everything. She’s just a lovely, bright person.” (Brooklyn, 25)

“With the heterosexual male patients that my doctors have, I hear them talking about girlfriends and what not. We don’t have that relationship. He don’t talk about what I do, or what my dates are. Its always come in, breathe in, breathe out, and out the door.” (Atlanta, 30)
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According to one participant, communication with medical personnel was like interacting with another culture altogether:

“I think a lot of times it’s just a culture. And a lot of these people [doctors] might be knowledgeable, but they’re not knowledgeable of the people they’re dealing with. So they’re generally mechanical. They know how to do this, they know how to do that, but they don’t know how to deal with you. They don’t know.” (Buffalo, 33)

Whether perceived as bad or good, it was obvious that the quality and level of interpersonal communication in the doctor-patient relationship was an important aspect of their overall medical experience.

Provider Preferences and Cultural Competence

The importance of a personal connection with medical providers was also seen as an important component of the doctor-patient relationship, specifically with regards to race, gender, and sexual orientation:

“Black male doctors, because I am a black male, have always been easier for me to relate to. My doctor now says, ‘What have you been eatin’?’ And I say ‘McDonalds.’ He says, ‘Brother, you need to cut that out.’ You know, they get real with you.” (Atlanta, 33)

“I think part of that is where I come from. I’m from Detroit—it’s a very black city. I’ve always had black doctors. I’ve never in my life gone to a white doctor, or one that was not black.” (Atlanta, 35)
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“If you’re not gay, or you’re not black, then you don’t need to be my doctor. I have to be able to relate somehow because a doctor is somebody that’s important in your life.” (Brooklyn, 27)

“I just feel more comfortable talking to a man. I’m a man. I feel more comfortable talking to a man about my parts and all that, because he has the same parts.” (Buffalo, 40)

“We don’t have enough people of color in the medical field. We need more of us out there. And so they have to sympathize, because if I wanna talk about collard greens, and somebody stayed in the suburbs, they don’t know anything about collard greens. They have no understanding so I can’t communicate—because you have to have that communication to deal with the doctor so he can know where you’re coming from, you know? (Buffalo, 32)

Black culture was something that several participants desired their medical providers to understand, and black medical providers were requested because of the perception that they could relate on a more personal level than providers of other ethnicities. Additionally, the issue of cultural competence emerged with regards to perceived negative experiences with foreign-born medical doctors, which had an impact on the medical experience:

“You know, racially, I’ve seen some [foreign doctors] interact with white patients in a more per sonable, more sociable…but when it comes to black patients, some of them are like, ‘whatever,’ and they’ll just do this and do that.’” (Atlanta, 33) buy kamagra uk

“With Asian doctors, there’s a language barrier there. They don’t understand what you’re saying, you might not understand what they’re saying. But for black doctors, they’ve had to bust their butt harder to get where they’re at.” (Manhattan, 28)

“There are times—rather than have a foreign doctor or healthcare provider—I will walk out and do without.” (Manhattan, 60)

“Just everyone who’s not black, to me, really— they just don’t understand too much about my culture.” (Harlem, 35)

Regardless of specific gender, race, and sexual orientation preferences for their doctors, feeling an individual connection with a medical provider was a central theme for the BMSM in this study, underscoring that doctors be trained to communicate effectively with all patients culturally “foreign” to them, not just the patients born outside the United States.

Investing in One’s Health

Investment in one’s health is a dynamic choice influenced by all the personal, social, and institutional variables that make up the medical “experience.” As one participant stated:

“Make me feel that it’s a positive enough process that I will work towards doing my part in it. Because if I’ve been turned off, then I don’t wanna hear anything, and I will probably act in a manner that’s not in my own self-interest, because I’ve just been turned off by the whole experience. Whereas if I feel that someone else cares, that’s the kind of like encouragement for me to really invest in myself better.” (Manhattan, 60)
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The amount of investment one makes in his health may, in part, be a reflection of how much he perceives his provider accepts and invests in him as he is. This notion is magnified for BMSM, where the unique experiences with racial and sexual prejudice that lead to displacement and social isolation may make the medical encounter a more crucial place for effective social and medical interventions than for other populations.