Tag: Stigma

Why Psychiatrists do not Wear White Coats

I trained in a location where white coats were never worn by psychiatrists. I only wore mine during the professional photos on the first day of residency. From that point forward it remained in my closet. 

The choice to discard the white coat always made sense to me, because I believe one of the most healing aspects of psychiatry is the physician patient relationship. One way to enhance that relationship is to make my patients feel as comfortable as possible. There is a concept in primary care called “white coat hypertension” where some patients have increased blood pressure only when coming to see their doctor. In psychiatry you can imagine a similar scenario. Some patients experience severe anxiety prior to the initial encounter. Others have had previous bad experiences with psychiatrists making them more prone to this “white coat syndrome.”

My goal is to have a meaningful conversation with my patients, and some of the material we discuss is very sensitive. There is no reason to make that conversation any more intimidating than it already is. Everything from my style of interviewing, to dress is meant to be casual to help establish trust. Trust is an important foundation for any relationship and is critical for any physician patient relationship. 

I detached myself long ago from white coats as a symbol of knowledge or prestige. I trust in my skills as a physician and allow those skills to speak for themselves. 

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Shame and Stigma Caused by Male Infertility

Infertility is a Real Problem Many Couples Face

I had an interesting conversation the other day on the topic of male infertility. What’s most interesting, is we rarely discuss male causes of infertility in American Society. When infertility discussions occur, they are often focused on the female in the relationship. Recently there has been a focus on male causes of infertility. According to the centers for disease control (CDC) about 6 percent of married women age 15 to 44 are unable to get pregnant after 1 year of trying. About 12 percent of women aged 15 to 44 have difficulty getting pregnant or carrying to term. The CDC estimates that in a significant percent of infertile couples, male infertility is the cause. It’s clear from the CDC data, that not only is infertility common but there are both male and female factors at play. 

Stigma and Shame

As a psychiatrist, I’m no stranger to stigma and shame. It’s common and pervasive in the mental health community, although it’s improving slowly. It takes a lot for most men to make the decision to see a doctor and be tested in the first place. While gender roles are evolving in society many men balk at the idea that they may be the cause of the couple’s infertility. Most men will provide answers like “I’m doing great, I do not need to be tested” when the issue comes up. Now, imagine you are healthy young male in the prime of your life, and you are unable to conceive with your spouse after 1 year. You decide to get tested for male infertility and discover that you have a low sperm count. This can result in questions of masculinity, and profound shame for many men. This is especially relevant for males who see themselves as “alpha males” in other areas of life. The question becomes how can we have these conversations in a meaningful way while reducing stigma and shame in the process?

Understanding as a way Forward

Traditionally there has been more options for females seeking support while undergoing an infertility work up. Men simply did not talk about these issues in part because a structure and setting did not exist. This issue must be approached from an empathetic and nonjudgmental stance. A good place to begin any discussion on male infertility is with education about the topic. Once patients learn about how common these issues are, and the potential causes they can start seeing the problem like any other medical issue. Providing education during the evaluation as well as online resources that the patient can explore is a good start. I also like to explore how much the patient values having a biological child. We can explore the pros and cons of going through infertility treatments and decide how far the patient is wiling to go. It’s important to be clear about what the patient is willing or unwilling to do in this process. We want to emphasize throughout the discussion that receiving treatment does not make them any less of a man. Helping men to process their emotions and better understand their reaction to this information is essential.

Hopefully, more awareness about this issue will lead to increased access to therapists and other support networks for male patients dealing with infertility. 

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