Going to a doctor’s office or hospital can be a scary experience for anyone. But when you’re a member of the LGBTQ community, even the most routine questions can seem daunting. It gets even more complicated if you’re an LGBTQ minor.
How much of what you share is confidential? If you come out to your doctor, can he or she tell your parents? Do the ground rules change if you’re seeing a pediatrician or a therapist? How do you know you can trust your doctor to take care of you without judgment?
There’s no one-size-fits-all answer to these questions, according to experts. State law variance, compounded with health privacy regulations, present a cascade of complications in what could already be a stressful situation. What’s clear is that good communication between parents or guardians, health care providers and LGBTQ children themselves is critical to maintaining healthy provider-patient relationships.
[See: 8 Things You Didn’t Know About Counseling.]
Can My Doctor Out Me to My Parents? It’s Complicated.
Generally if a child is still a child, parents own the medical record, Vanessa K. Jensen, a pediatric psychologist at Cleveland Clinic Children’s, tells U.S. News. That’s reinforced in the HIPAA law itself. But the line can be challenging for health professionals when it comes to what’s legal, ethical and considered appropriate.
“In practice, what most of us do is make it clear with the parent and the child in the beginning of a relationship … we lay out the parameters of what we put in the chart and what we are comfortable keeping confidential if the parents are willing to agree to that,” Jensen says.
The American Academy of Pediatrics published a statement back in 2013 regarding adolescent sexual health and the role of the doctor in the situation. “Care should be confidential, and it is not the role of the pediatrician to inform parents/guardians about the teenager’s sexual identity or behavior; doing so could expose the youth to harm,” according to the statement. It further notes that sexual-minority youth deal with mental health issues around depression, substance abuse and suicidality, but also “face alarmingly high rates of verbal harassment and physical violence, including at home and at school.”
What complicates matters is that legal parameters vary by state. Teenagers can seek out mental health care without parental consent in Ohio, for instance, under very confined circumstances — i.e. for a limited number of appointments or by going to a free clinic, Jensen says.
In Washington, for example, the mental health age of consent for a minor to admit himself or herself for inpatient or outpatient mental treatment is 13 years old. In Massachusetts, gender-affirming hormone therapy for transgender minors requires legal guardian consent. There’s currently legislation in the House Committee on Health Care in Vermont that proposes “[allowing] minors to consent to mental health treatment for any condition related to the minor’s sexual orientation or gender identity.”
A doctor is obligated under HIPAA rules to break confidentiality and tell a child’s parents if minors have a plan to hurt themselves or if someone is hurting them. Dr. Cora Breuner, a professor in the department of pediatrics, adolescent medicine division at Seattle Children’s Hospital, points out that this doesn’t mean a provider has to inform parents of everything you’ve disclosed, a common misconception — only details relating to you hurting yourself or if someone is hurting you.
Dr. Alex Keuroghlian, a Boston-based psychiatrist and head of the National LGBT Health Education Center at the Fenway Institute, emphasizes that identifying as LGBTQ is not in and of itself a safety concern.
[See: The 10 Worst Countries for Gender Equality.]
A Tale of Two Health Care Experiences
U.S. News spoke with two 18-year-old transgender men about their experiences with health care professionals — and they couldn’t be more different. Though neither involved concerns about being outed to their parents, they illuminate obstacles LGBTQ children face.
Vincent Alexander Worden, a high school senior living in Plainfield, Illinois, is both transgender and queer (here meaning interested in both men and women). His primary care physician didn’t flinch when he came out to him first as queer and later as transgender, both when he was a minor. This experience seemingly informs his advice to LGBTQ youth.
“They just wish to help you and giving maybe [information about your sexual orientation or gender identity] can help them understand you better and then in return, help you more,” he says.
But Jaden Prendeau‘s visit to a psychiatric facility in Los Angeles was anything but helpful. Seventeen years old at the time, he recounted the traumatizing ordeal in a post on the self-publishing platform Medium. The most horrifying part of his experience was when employees made him strip upon intake at the hospital to confirm his gender identity, writing an incorrect big “F” on his chart. Now he’s even scared about visiting doctors who have been helpful to him in the past.
It’s evident that having a healthy, open relationship with your doctor, or any health care provider, could spell the difference between seeking treatment or forgoing it altogether.
How to Come Out to Your Doctor
If you’re ready to talk to your doctor, here’s what to keep in mind.
Find a professional you’re comfortable with. Patients can look for care on PsychologyToday.com for LGBT-affirming therapist designations, as well as on RAD Remedy, a website that connects trans, gender non-conforming, intersex, and queer people to proper health care. Prendeau, who works part-time at Trans Lifeline and attends Los Angeles City College, adds that if you’re not comfortable with your doctor, you should find another one. He acknowledges this can be difficult for people in more rural areas, an ongoing problem.
Talk. It might be scary at first, and you may not know the right words to use, but better out than in if you feel you’re speaking to a safe confidant, according to Keuroghlian, who also teaches at Harvard Medical School and trains psychiatry residents at Massachusetts General Hospital. He says you can’t put too much pressure on yourself as a patient to express it perfectly or in a certain way.
Remember it’s not a race. Patience is key to working through these issues, especially when your parents may not be as accepting of your sexuality or gender identity. Keuroghlian recommends building an affirming LGBTQ community around you and finding role models to support and mentor you. It’s important to not isolate socially.
[See: 10 Lessons from Empowered Patients.]
How Doctors Can Help Patients Feel Comfortable
Get educated. Just as the U.S. public has become more comfortable with homosexuality, so too have pediatricians in terms of caring for the LGBTQ population. For example, rather than asking a 17-year-old girl if she has a boyfriend, pediatricians now ask if she’s dating someone or which gender she’s attracted to, Jensen says. She notes that children are coming out to their pediatricians more and more because they ask questions other adults won’t.
Say you are LGBT-friendly online. Aside from websites like PsychologyToday.com, the Cleveland Clinic recently started a program where all medical staff were encouraged to add “LGBT-affirming” to their biographies online if so inclined. This simple message could yield lasting and impactful results. Case in point: One of the hospital’s pediatricians recently told Jensen that one of her patients came out to her because of this designation.
Bridge the gap between children and parents. Like Jensen explained, set up a written agreement with parents — particularly parents of older children — about what will stay confidential during therapy sessions. For example, parents may agree to receive only general progress reports and notification of dangerous or emergency situations. Alan Nessman, senior special counsel for the American Psychological Association’s Practice Organization, says the group recommends including this in the informed consent document to clarify privacy parameters upfront, and to help a child speak more freely, making therapy potentially more effective. This is a common way to help keep conversations about sex and sexual orientation private.
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Can My Doctor Out Me As Gay to My Parents? originally appeared on usnews.com
