On one hand is does not have to a big deal to come out to your doctor, just wear a T-shirt that says, “Born Gay, Fabulous by Choice,” or “I am not a Lesbian but my Girlfriend is,” or “Better Gay than Grumpy.” But seriously folks…in this day and age when gay marriage is all over the news and well known LGBT personalities are on television daily, coming out to your doctor need not be the trauma it once was.

But having said that, it is important to come out to your medical team and you should not leave it to chance. Your medical team needs to have complete picture to provide you with the most appropriate treatment from both a medical and a culturally sensitive perspective. If you are, for instance, a sexual active gay male, they need to be aware of the need for testing for HIV/AIDS and sexually transmitted diseases without you having to ask. If you are lesbian you can avoid all the useless and embarrassing questions about birth control. If you are a transsexual, they need to know so they will not prescribe something that will interfere with your transition or maintenance. They need to know if you are in a relationship so your significant other can be included in the conversation and decisions from the beginning. It also needs to be clear that your significant other/spouse is the legal party responsible for your care should you be incapacitated.

Your advanced directive (a document that details how you want to be treated in an emergency or life threatening situation) needs to be up to date and included in your medical file. Whoever you have designated as the person to make decisions for you if you are incapacitated, should also have a copy. You might also consider drawing up powers of attorney for both medical and financial affairs. Hospitals now ask for an authorized visitor list, be sure to list your partner or a good friend so they will not be denied a visit because they are not part of a “traditional” family. But in an emergency situation you may be not be able to tell them so your significant other will need documentation they can wave around the emergency room.

LGBT history is rife with horror stories about significant others being shut out of hospital rooms where their partner lay dying. Stories too, of folks not seeking out medical care because they didn’t want to come out, or didn’t want anyone to know they were born some other sex than they appear to be. I recall an older closeted Lesbian friend checking her partner into the hospital and when asked what her relationship to the patient was, she stammered and stuttered. The clerk asked tenderly if she was her significant other. My friend agreed tearfully, first time in their 35 year history she acknowledged her partner publically for who she was. Hopefully the world has moved on and we get to be who we are and still entitled to the best care.

Mental health services

Seeking out mental health services for the LGBT community can be tricky. There is a long history of mental health professionals trying to “cure” us, some with absolutely horrifying techniques. In this modern age many straight therapists are convinced they can help us but be cautious about their good intentions. At some point they are clueless as to what is like to come out or to attempt a good life when the world thinks you are a pariah. You should not have explain your lifestyle to your therapist, issues with your mother, yes, but not about your attraction to same sex. A relationship with a good therapist may be one of the most intimate relationships of your life and it would be difficult to achieve that intimacy if you have to explain the most basic facts of your life. If you would like to know more, The America Psychological Association, Division 44, the Society for the Psychological Study of Lesbian, Gay, Bisexual and Transgender Issues has a wealth of resources on the subject http://www.apadivisions.org/division-44/index.aspx

Before you go to the doctor

Before you go to the doctor, think about what you want from them. If you want total acceptance, ask around for a LGBT doctor. Many local LGBT centers can provide lists of local practitioners. To locate a center near you go to http://www.lgbtcenters.org/Centers/find-a-center.aspx

But if you are part of a health plan where choosing your own doctor is limited, think about what role you want to play with your new medical advisor. Do you want to be the “demo dyke” where it is incumbent upon you to explain everything about gay life? Do you just want to be treated for whatever it is you are seeing the doctor for and nothing more? Do you want the medical team to just naturally include your spouse/partner/lover/significant other (we have got to come up with a word for this!) in the conversation?

The first step in being accepted by a new medical team is getting your own mind straight (!) around the issue. How you feel about yourself will affect how they treat you. You get to call the shots even if you are still coming out and not sure who you are. Your attitude will set the stage for this very important relationship. Walk in there like you are the fabulous human being you are.  If you are defensive and nervous they will pick up on that. But, not to worry too much even if you are, younger doctors will have had had some sort of diversity training in medical school, as will the younger nurses. The biggest challenge may well be the receptionist who is less likely to have had any training.

It is important to come out to your doctor for there are some sexual preference/gender/sexual identity related health issues that you may want to discuss with them. Here are just a few references, there are many more online for you to check out. The better informed you are about your potential health issues the better your doctor can assist you with them, maybe even prevent them.

Lesbian (http://womenshealth.gov/publications/our-publications/fact-sheet/lesbian-bisexual-health.html#c)

Gay male  (http://www.cdc.gov/msmhealth/for-your-health.htm).

Transsexual/transgender (MTF) (http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Health-Care-for-Transgender-Individuals)

Transsexual/transgender (FTM) http://www.ftmguide.org/tandhealth.html

 

At the office

The first thing most doctor’s offices ask you to do is to fill out a form. Try to have a little fun with the form. Where it asks marital status, write in single Lesbian, or married gay male. Actually, it would prevent many awkward moments if they asked your sexual/gender preferences in advance. They could ask Male or Female or Other with a write in box. Or they could have a list: Check all that apply of these 15 different definitions of your sexual/gender identity!  It seems the list grows daily as everyone has found a definition that suits them, but it makes it hard for some of us to keep up!

Many medical facilities now use the term “significant other” rather than spouse on their intake forms. If you are married in a state that allows same sex marriages, you, of course, get to legally fill in the spouse box with your husband/wife’s name. But if the form includes language you don’t like, cross out the offensive bits and write in what you want. It is a passive (passive aggressive?) way to let them know who you are. They can read it out of sight from you and choose their response without having to confront you.

Meeting your doctor

If you are new at this try not to blurt out that you are LGBT in the first three seconds! Quite likely the doctor will not care whether you are or not. The topic will be far more important to you than your doctor.

Try to just let your sexual preference come up in the course of the conversation. For instance, when they ask what sort of birth control you use and if you are exclusively lesbian tell them you use the only one that is 100% effective and has no medical side effects! Use the appropriate pronouns when talking about your sex partner and let the doctor figure it out for themselves. If you are cool about it, they most likely will be too.

You might want (as suggested by the Human Rights Campaign) to ask to meet with the doctor in their office or at least before you take your clothes off and talk about your concerns. And you don’t have to go to the appointment alone, take a friend for moral support. Human Rights Campaign has a little checklist http://www.hrc.org/resources/entry/coming-out-to-your-doctor

It a perfect world your health care provider will ask you gender neutral questions and do their best make you comfortable. But, they are just human beings like us and may stumble. Don’t assume right off that it is because they don’t like you and are anti-gay. The medical relationship in an intimate one and a lot of doctors and nurses, are not comfortable with that intimacy. Imagine how difficult it would be if you had to ask a complete stranger about their sex life while they are lying there in a paper gown.

I knew a gay surgeon who got very uncomfortable once when he had to tell me I had breast cancer. He offered to leave the room and let me deal with the news privately. I told him to sit by me and hold my hand while I cried. He was very uncomfortable as surgeons are not usually known for their bedside manners but he did it and we became good friends. And I trusted him more after that.  If you are medical professional reading this, take note!

Be sure to have reviewed the list of health risks for your proclivities. Ask medical questions, but do not expect the average medical doctor to know specifically about LGBT health.  A legitimate question is to ask if they have many gay patients. In fact this might be a question to ask before choosing them as your primary care physician if you get the chance.

But, let’s suppose for a moment that your doctor is from another country and English is not his/her primary language and they start to lecture you on the benefits of being married as happened to me once with a doctor from India. Or, you get a puzzled look when you say you have no need for birth control or you say you are concerned about the health risks of having sex with men and you get a puzzled look from the doctor. You may have to explain that you are gay and very content with your “alternative” lifestyle and ask them to please just answer your questions about whatever medical condition you are concerned about. If they are part of an organization and they make you uncomfortable or make inappropriate remarks, report them to the administration. If they are in private practice, report them to the local American Medical Association. If you want to keep them as your doctor, you could stop by later and drop off some reading material to educate them. Here are some resources of where to find those books and if you are still in the coming out stage you might them helpful as well. http://www.pflagnyc.org/support/suggestedreading,

http://www.ncbi.nlm.nih.gov/books/NBK64806/

http://www.huffingtonpost.com/2014/12/21/books-lgbt-authors-_n_6357548.html

 

And, of course, if there are neo-Nazi magazines or a fundamentalist evangelist on the TV in the waiting room, get the “bleep” out of there and go find another doctor!

Good luck with your quest to come out to your doctor. They do need to know all about you to give you the best of care.

Outside the doctor’s office

There are many public policy issues surrounding LGBT health care. If you would like to know more the Human Rights Campaign Foundation puts out a downloadable Healthcare Equality Index. It reports on hospitals’ self-assessment about complying with non-discrimination requirements, etc.

Lambda Legal has published a book When Health Care isn’t Caring about the problems facing the LGBT community in obtaining adequate health care.  http://www.lambdalegal.org/publications/when-health-care-isnt-caring