First, Do No Harm

by | Oct 18, 2017 | 0 comments

I feel so fortunate to be a physician. Individuals trust me to share their stories, their struggles, and joys. That trust remains in my heart and inevitably changes me for the better. I am awed by human resiliency.

Some in medicine would say that holding people’s stories “in my heart” is unprofessional—that physicians need to maintain distance and objectivity. Twice in my career others have questioned my professionalism. These are the two instances I am most proud of.

In February of 2011, I was at a leadership retreat, surrounded by the cherry woodwork of UW’s Fluno Center. One of my medical partners and I walked to the capitol square over lunch and stood in awe as thousands marched to support public unions. My fellow family physician and I were distracted the rest of the afternoon: history seemed to be in the making mere blocks away.

As physicians on the north side of Madison, we knew well how unions protected injured workers. We wanted to do something, so we hatched a half-baked plan overnight via Facebook. Our loosely formed “Badger Doctors” group held a protest clinic the next day, seeing hundreds of patients and writing work excuses for some. We fashioned ourselves as just a few family docs making a personal and political statement, but our poorly coordinated message was lost in the chaos that followed. National media showed the same horrid clip of me on Fox and CNN. Physicians who were identified suffered substantial wage loss and temporary removal from leadership positions.

Had I known that frigid February morning was to be my 15 minutes of fame, I certainly would have chosen my hat and sunglasses more carefully. Despite the significant consequences, I still am glad we stood up for those more vulnerable.

Targeted for fighting stigma

More recently, a healthcare administrator led an investigation focusing on me because of my teaching regarding the care of transgender patients. The controversy arose regarding the diagnoses physicians use to describe the medical issues addressed at each visit. In the area of gender medicine, many of the descriptive codes are medically inaccurate or unnecessarily pejorative. This bias is further complicated by active legal battles regarding whether health insurance covers medically necessary treatment for gender dysphoria.

The administrator uniformly disagreed with physicians who have expertise in transgender medicine when we described the complexities involved in this practice. Her letter admonished: “We believe [Dr. Oriel’s] intent was to ensure [her] services would be covered by insurance so patients would not have to pay out-of-pocket for those services.”

There are strict regulations requiring accuracy in this process or physicians can be accused of fraud. Over the years I’ve developed a spiel for any patient who asks me to alter diagnoses that are in their records. I so regularly explain this that many of my patients will find it familiar: “I worked hard for this license, and I cannot do anything that might place it at risk.”

In retrospect, it’s hard to know how much of my decision to resign after 22 years was personal burnout or a need for a new adventure. Still, as I recall these events, I retain significant righteous indignation about the way an administrator was allowed to accelerate an adversarial process regarding a group of people who are tremendously medically underserved rather than engage physician experts in a collaborative process. My trans patients were held to different standards as compared to my cisgender patients. I had to resign: First, do no harm.

Back to the mission

Because of this career shift, I’ve been rummaging through old files as I update credentials. I ran across my application to medical school that began, “I want to do something important, something that matters, something that makes a difference.” I’ve read over a thousand medical student applications as a teacher of family medicine. Suffice it to say my clichéd but authentic essay ranks substantially below mean.

Though the language is uninspiring, I remain connected to the intent and the emotion of the statement I wrote as a 23-year-old. I also ran across a crumpled article clipped from the traditionally conservative American Medical Association’s newspaper from the late 1990s. When I was president of the Gay and Lesbian Medical Association, I was quoted alongside an equally earnest photo: “People clearly feel more safe than they did a generation ago to be identified as a gay or lesbian physician…Without a doubt, I owe a debt to the people who paved the way for me to be able to say, ‘Hi, I’m a lesbian and I’m your doctor.’” I cringe a little and wonder if I really said that. I’d like to think not. It’s not like I walk into an exam room and announce, “Hi, I’m doctor Kathy Oriel and I’m a lesbian.” Then again, I don’t really need to.

Of course, as a family physician, I love caring for people of any age, race, background, gender, or orientation. As a physician, when I enter that exam room, it’s about what the individual in front of me needs—not about my identity or viewpoints. I remember fondly so many moments of being with people, and a few stand out because I was able to contribute, in whatever small way, to the lives of those within my community.

Who I serve

Joan (not her real name) established care in her late 60s. After decades of knowing she was transgender, she was finally ready to start hormones and transition. Until then, she lived in fear of her adult children disowning her or that she might lose her job. Not even six months after starting estrogen, she was diagnosed with a devastating stomach cancer. Her partner patiently educated every individual who walked into the room regarding her correct name and gender. I worked with the hospital to properly denote her name, and encouraged providers to write notes that didn’t start with, “this 67-year-old biologic male” or “this 67-year-old transsexual female.”

She enrolled in hospice, and was soon homebound. During a visit Joan told me, “I’ve accepted myself and this cancer. I was born the wrong sex and the only thing I want is to die the right one.” Trans people who had no cash to spare donated funds for a legal name change. Hospice arranged for a judge to legally change her name and gender marker without her needing to appear in court. Joan’s partner called on a Friday afternoon to let me know all was well and Joan’s name was now legal and her gender was legally female. Two days later, Joan died peacefully at home, her last wish fulfilled.

Progress and the work ahead

I’ve been fortunate enough to see love literally make a family many a time. A few years ago I sat in the hospital room of a woman as she labored to give birth, her supportive partner at her side. It was one of the most beautiful births I’ve attended. The resident doctor accompanying me came to Madison because he wanted to be an advocate for LGBTQ patients. After the birth, I asked the gynecologist on call to assist. As I looked around the room, I noticed that everyone in the room was gay: all three physicians, the nurse, and the parents. It didn’t seem that long ago that I learned how to perform inseminations because the infertility specialist in town refused to inseminate lesbians. Luckily, he has long since retired. That moment with the new parents and child was a moment that for me marked progress. I noticed how routine a two-mom birth had become and that healthcare professionals are able to care openly.

I believe that often things align exactly how they are meant to. Earlier this year, I was burned out and cynical about most of what the medical industrial complex aimed to do. I needed time to recharge and contemplate next steps. I’ve decided to work for myself, starting a small solo practice called—for lack of a more creative name—Oriel Medicine. Nurse Melisa and I will be working out of a small office. We’ll use an electronic health record, but patients will actively decide what information will be available to whom.

Though I’m sure specifics of my new practice will morph over time, I still plan on being a family doctor. I will provide primary care for newborns through centurions. I will continue to provide services people in our community value: insemination, confidential STI testing, PreP, and of course, transgender care. I’ll continue to provide support for those wanting to stay clean and sober, including Suboxone®. I hope I never let a day go by without remembering what an honor it is to carry the title of “my doctor.” I know—pretty clichéd and sappy, but that’s how I roll.

Depending on insurance coverage, all are welcome at Oriel Medicine, whether or not they identify with any of our LGBTQ+ letters.

To obtain specifics about Oriel Medicine’s hours, enroll as a patient, and get more information regarding insurance coverage, consult the website: or follow Oriel Medicine on Facebook.

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