If you’re an LGBT patient and your doctor doesn’t know it, it’s time for a conversation. Otherwise, you could be missing out on preventive care, treatments or counseling you need. But it shouldn’t take an agonizing effort to reveal your sexual orientation or gender identity — because inclusive providers would know from day one. Below, two physicians, both LGBT health advocates, explain why sharing this information is vital to your health, and how up-to-date health care practices make openness routine.
Matter of Fact
“Patients should be looking for providers that reach out to them,” says Dr. Jesse Joad, president of GLMA: Health Professionals Advancing LGBT Equality. “That make it clear that LGBT people are welcome in their practice and will be treated respectfully.”
Inclusive brochures in the waiting room and welcoming websites and advertising help set a practice’s tone. “There’s the way they have intake when their patients arrive — the kind of questions that are asked, and the kindness and thoughtfulness with which they’re asked,” Joad says. “That’s how it should go, so that it’s just natural for the patient to come out to their doctor, their health care provider.”
Even so, you’re likely to run into others in the health care system along the way who make assumptions. Joad describes a recent encounter with a provider who asked if she was married. “I said, ‘Yes,’ and they said, ‘What does your husband do?'” she relates. “And I said, ‘Well, it’s my wife, and this is what she does.’ I just said it in a very matter-of-fact way. And she didn’t miss a beat. I think she might have gone to some training not to do a triple-take. But she didn’t even say, ‘Oh.’ She just took down the information.”
If the subject of sexuality doesn’t come up naturally in the course of care, Joad says, simply saying, “You know, I need to have this conversation with you,” is a good start.
“Do Ask, Do Tell”
“It’s important for clinicians to create an environment and ask appropriate questions that allow people to feel comfortable discussing these issues, which they may not have discussed with anyone ever before,” says Dr. Harvey Makadon, director of education and training programs at The Fenway Institute.
Ideally, questions about sexual orientation and gender identity are “normalized” — they’re another part of your intake form and medical records, just like your age and ethnicity, says Makadon, who is also a professor of medicine at Harvard Medical School.
In his work with The Fenway Institute, which focuses on health issues particularly related to LGBT communities, Makadon travels to hospitals and other health facilities across the country to help them create a better environment and improve education for clinicians and communications with patients.
“Do Ask, Do Tell,” created by the National LGBT Health Education Center, part of the Institute, is a resource for health facilities seeking to encourage LGBT patients to come out to health providers. Posters and downloadable brochures explain how being open improves your health care and also address concerns about coming out, such as confidentiality; how to inform providers of preferred terms when referring to you, your spouse or partner; and resources for finding providers with whom you’re more comfortable.
“Meet My Partner”
Partner inclusion — having someone by your side as you learn about a life-changing health condition or face major surgery — is something most people want. That desire sparked Joad’s own medical coming-out moment years ago.
With the possibility of surgery under discussion, Joad decided she didn’t want to take the information back to her then-partner (now spouse) and try to explain all the issues. Instead, she wanted her partner there so she could ask questions directly of the doctors.
“And it worked out just fine,” Joad says. “We didn’t walk in and say, ‘We’re lesbians.'” Joad simply introduced her partner and said she wanted her to be in on the discussion. “And that was it. That was the first time,” she says.
“I Have Questions”
Depending on whether you’re gay, lesbian, bisexual or transgender, the GLMA website offers top-10 lists of issues to discuss with your health provider. Besides helping you prepare for health care visits, your list may better inform your doctor or nurse.
“Sometimes their health provider may not know all the risks,” Joad says. “For gay men, of course, HIV is very well known, but there are others,” she adds, such as hepatitis. “[Health providers] may not know that a gay man needs a hepatitis vaccine,” Joad says. “But they’d be more than happy to give it to them if they knew it.”
Providers might not be aware of the mental health fallout from continually living with stigma, Joad says, such as higher incidences of depression, suicidal thoughts and actual suicide, particularly among adolescents. Substance and tobacco use are more common in LGBT people, she adds.
Breast cancer risk is higher for lesbians, Joad says. “Lesbians who don’t have a very good relationship with their provider just don’t get the kind of screenings, like Pap smears and mammograms, that others do, because they just don’t go.”
With transgender people, Joad says, “Just take the stigma for LGB people and multiply it by many,” including more risk of physical violence on the street. Transgender patients have specialized medical needs: They may be on hormone treatment and have had various surgeries.
“All those things the provider needs to know about in order to take care of them,” Joad says. “What has already happened to them, what they’d like to have happened, as well as all the mental health services and supports that they need.”
Conversation Starters
If your health care provider isn’t aware of your sexual orientation or gender identity, these are potential ways to open a discussion:
— “There’s a conversation I need to have with you.”
— “This is my partner.”
— “I have a list of questions.”
— “I’m interested in HIV testing.”
— “How do you approach patient confidentiality?”
— “I’ve taking these hormones as part of my transgender treatment.”
— “Please refer to me as ‘he’ (or ‘she’).”
Expect More
Makadon empathizes with those who are reluctant to come out. His personal experience was frustrating and underwhelming. “I made a decision that I was going to come out to my provider because I wanted my new primary care doctor to talk to me about being gay and having an HIV test,” he says. “And for the first time, I talked with a clinician about being gay — and he never brought up the issue again. I think for far too many people, that’s too common an experience.”
Today, much work remains to be done, Makadon says, although he sees some enlightenment and efforts to improve in areas throughout the country, with health systems in major cities not necessarily the most progressive.
Joad says older LGBT people who’ve experienced insensitive or inadequate health care in the past should see a difference with changing times. “The fears that were really the case as recently as 10 years ago are probably not as big a barrier as they were then,” she says.
Her advice to those patients who are ready to come out: It’s the provider’s job to understand and help you. Be proud of who you are, and be matter-of-fact. And have that sort of confident demeanor you should have, knowing and expecting you will be treated well and your concerns will be addressed.
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How to Come Out to Your Doctor as an LGBT Patient originally appeared on usnews.com
