Would you come out to your doctor?

Coming out is a major issue for almost all people who are lesbian, gay, bisexual or transgender. But have you come out to your doctor?

Every one has his or her own saga. Some are horrific, some warm, some supportive, some funny, some violent. Many people spend months, or even years, thinking about how to handle coming out to those close to them. They see how others they know have handled it, read about other people coming out, ask questions on the Internet and use other methods to get some ideas of what to do and what to expect. Often there is a lot of planning, fear and worry involved. Then the time comes, the news is broken, things in the relationships change – or not. Then the event is over. And the next time the person needs to come out, the past experiences may make it easier.

But in spite of all the planning, some people don’t come out to their doctors. This can be for any one of several reasons. And not coming out to the doctor can be a mistake, sometimes a very serious one.

national coming out day gay outing

Why don’t LGBTQ patients come out to their doctors?

There may be a number of reasons. I’ve heard several different ones from patients who finally did come out to me or to other doctors. Some reasons are:

1. I didn’t think a straight doctor would understand.

Not understand what? That you’re attracted to and having sex with people of the same sex?  I think what mean is that they feared their doctor wouldn’t approve.

2. It’s personal, and I didn’t want to tell you.

Hmmm, but you’re willing to discuss your bowel habits in great detail, your irregular menstrual cycles, and let me insert a finger into your intimate areas.  Trust me, telling me you’re gay is hardly the most intimate thing we’ve done in my office.

3. I didn’t think you’d like me if you knew that I was LGBTQ.

This takes us back to fear #1. I don’t have to like you to take good care of you as a patient. And, do you really think that I’m so shallow that I’d change my opinion of you just because of that?  Though granted, some people are shallow. But hopefully after you’ve established a good rapport with your doctor, you can trust that it should work out fine. Then again, there’s a good argument for coming out early to your doctor – if the doctor is going to have an issue with it, it’s better to know early on, and find another doctor.

There are other reasons given, but often it comes down to the fact that many LGBTQ people are used to being closeted, and keeping information about their sexuality private. They’re afraid of alienating the doctor and experiencing another rejection.

I wish I could say that that never happens. But that isn’t the case. I’ve seen it happen to patients and I’ve had it happen to me. When it did happen to me, I felt angry and hurt. But a few minutes later, I felt relieved. Relieved that I hadn’t continued to see that doctor, built a professional relationship with him and then found out a few years later that he was “uncomfortable” with gays. Then I’d have had to move on. Instead, I found out during the first exam and just left and got a new doctor.

Regardless, it is important to let your doctor know that you are LGBTQ. You should have told him about all of your other past medical history so that he has a baseline to work from. Don’t keep him in the dark about your sexuality. Not telling him can have repercussions.

Why does my doctor need to know?

Many reasons. First of all, LGBTQ patients may have some diseases that aren’t seen as commonly in the remaining 90-95% of the population. Not just HIV/AIDS, but other diseases as well.

LGBTQs often suffer from depression. Many have seriously considered or attempted suicide. They may have a higher instance of eating disorders, perhaps use or used street drugs or may drink more alcohol. They may have a higher rate of sexually transmitted diseases. Some may have suffered physical or psychological abuse, spent time homeless or in community shelters, may have become prostitutes just to survive. These are all issues that the doctor may need to consider when examining a patient.

Additionally, there are some things that need to be done as part of preventive medicine. It used to be thought that lesbians had a much lower incidence of forms of cancers of the genital tract because they didn’t have sex with men, and often had fewer STDs than their straight counterparts. On that basis, some lesbians weren’t offered Pap, smears or were only offered them sporadically.

Anal cancer is something that needs to be considered in gay male patients who are receptive to anal intercourse.

Then there was the recent outbreak of meningitis that was seen primarily in just some gay men in New York City.

Bisexuals and transgendered patients also have their own issues – some in common with gay males and lesbians, and some quite different.

And HPV, and the various cancers it’s associated with, are a concern for everyone.

Not letting your doctor know about your sexuality can cause him to not consider you as the whole patient, with your individual, specific and potential problems as an LGBTQ patient.

Should I talk about my sexual health with my doctor?

Yes.

Ideally, you and your doctor should form a partnership and cooperate so that you get the best health care available.

You should feel free to ask questions, get advice and have open discussions. In fact, it may be important that you initiate these conversations yourself. There have been a number of studies and surveys that have shown that some doctors are uncomfortable discussing patients’ sexual issues, problems and diseases. These doctors might never ask about STDs, erectile dysfunction, female orgasm, menopause or other things of that nature. They operate on the assumption that, if there’s something wrong or if the patient has a question, the patient will bring it up. Of course, that’s not how it should be, but sometimes that’s the way it is.

So, make sure that if your doctor doesn’t mention things like Pap smears, STDs and other sexual health issues, that you do when necessary. If you do bring up questions on sexual health, and your doctor avoids them or gives incomplete information, you might want to consider seeing another doctor. In larger cities, there are LGBTQ practices, you might be more comfortable seeing a doctor in one of those practices, or finding a solo LGBTQ practitioner. There are online resources that you can use to locate practitioners who are either LGBTQ or LGBTQ-friendly. But note that these sites do not screen the doctors who are listed there or verify their credentials – you’ll need to do that. If you can’t find an LGBTQ doctor near you, ask your friends what doctors they go to and if they’d recommend them.

What do I do if my doctor doesn’t react well when I tell him I’m LGBTQ?

Ideally, this shouldn’t be an issue. Your doctor should be professional enough so that this shouldn’t make any difference to him. But, if he reacts negatively or you begin to feel uncomfortable with him, you might want to consider seeing someone else. But consider that his reaction may be to the fact that you haven’t given him all of the information that he asked for in your initial visit. He might be upset that you didn’t trust him enough to tell him the full story. In that case, his reaction may be temporary, and it may not be a reaction to you. Ultimately, though, you may need to make a decision about continuing or terminating the doctor-patient relationship.

Bottom line: You need to be open and honest with your doctor. It’s in your own best interests, and his.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • Nathanael

    Half of all straight women have engaged in anal sex, and pegging is increasingly popular among heterosexual couples. So, uh, yeah, if it matters in any way, he should be asking ALL of his patients what they do sexually. The gender of the people they do it with is really less of an issue. But the thing is, the vast majority of doctors don’t *do* that.

  • Nathanael

    Trouble is that, as far as I can tell, over half of doctors are authoritarian nitwits. It can be hard to find one who isn’t. Some are passive-aggressive authoritarian nitwits, too.

  • Nathanael

    Bogus stereotyping based on garbage (like giving lesbians fewer pap smears) is a good reason NOT to tell your doctor anything he or she doesn’t need to know. Of course, it would be lovely if we all had science-based doctors, but most doctors operate on a level similar to that of witch doctors.

    As an aside, I’d tell anything to a doctor with a “public health” background — they are consistently *competent*. Most ordinary private practice doctors *suck* in *so many ways* by comparison.

  • Butch1

    I would definitely speak with your physician about it. You shouldn’t be made to feel like there is something morally wrong with you for having to ask for one of these exams and you should definitely mention their names as well.

    They should not unload their own religious or moral baggage on any patient in a medical office or hospital. That isn’t their place or their job. They do not belong interacting with patients if they cannot separate the two.

  • Roger Jungemann

    When I turned 18, I signed a patient confidentiality form and shortly after came out to my doctor. He violated the agreement by telling my mom that I had a “gender identity disorder”. He told me that many people are gay because they were molested. He also asked me many borderline inappropriate questions like, “the back of your throat looks irritated. Have you been engaging in oral sex?” I hadn’t.

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  • Mike_in_the_Tundra

    Gay ghetto? Sorry sonny, but there’s no ghetto here. I live in a suburb of Minneapolis.

    As for the HMO, sorry about that.

  • vonlmo

    Not all of us have to luck of living in the local gay ghetto & having Dr Sparkle Pony as our G.P. Instead, we are given a HMO employee-MD who quite often was born in & raised in a foreign culture where gays are treated as non entities or murdered. When the third world starts to evolve in their social values & ships over similarly “educated” physicians, maybe then I’ll reconsider.

  • http://adgitadiaries.com/ karmanot

    Yep, it help pays for the wifey’s new Benz.

  • http://adgitadiaries.com/ karmanot

    In our area there is a problem of patient profiling, particularly the HIV/AIDS folks who use proscribed pain killers and stimulants . Apparently proscriptions are a major source for third market traffic. We had to advocate for sensitivity seminars to instruct professionals not to profile. We also managed to get fired a Christian nurse who gave major ‘attitude’ to her gay charges and promised to pray for them. Lesson: Advocate, be polite, be informed and be insistent.

  • http://www.americablog.com/ Naja pallida

    That might be because there have been a few highly publicized cases in the last five or six years, and the board has had a lot of turn over to ostensibly fix problems within its ranks, but when it comes to any governor-appointed public-advocacy boards in Texas “all-around failure” is a pretty apt description. They are pretty much universally influenced by corporate money, and the state legislature has its claws everywhere.

  • docsterx

    Interesting. I have a few colleagues in Texas who say that the board there is always ready to follow up on patient complaints and that it loves to make practicing physicians’ lives miserable. Most state medical boards are really proactive on the side of patients. Texas’ board may just be an all-around failure.

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  • http://www.americablog.com/ Naja pallida

    Do a few searches on the Texas Medical Board. I wouldn’t trust them to scratch their own scrota. It took years of public shaming in the media for them to finally take assault by physicians seriously. Members have repeatedly been accused of corruption, conflicts of interest, and their peer review process for complaints is a complete farce. But this is pretty much par for the course for Texas state boards, when they’re appointed by a corrupt governor.

  • docsterx

    They are. But it starts with the people who are in medical school now and the ones that have recently graduated. Takes a while to get out to all doctors and all doctors might not be receptive to learning about it or incorporating it in their practices.

  • Indigo

    Do you suppose their doctors know?

  • Whitewitch

    Will do – in a plan though and have to “change” ….

  • http://adgitadiaries.com/ karmanot

    Closeted Republicans are known for scheduling their weekly/monthly rectal exams.

  • http://adgitadiaries.com/ karmanot

    I know what you mean Larry. I was an advocate for many years. I would have helped you in a nano-second. I wish a better and more positive medical future for you.

  • http://adgitadiaries.com/ karmanot

    The minute a doctor sees and speaks to you condescendingly as less than an adult, dump her/him. Health is too important to put into the hands of an authoritarian nitwit.

  • http://adgitadiaries.com/ karmanot

    If the voices in your head are telling you that crazy evil is all about us then I’m right there with you; if not I’m right there with you anyway. { } { } :-)

  • Larry Pepper

    When you have lived a lifetime of rejection, the last thing you need when you are in pain, or deathly ill, is to have more rejection, and having to fight when you are deathly ill for your rights is more detrimental than helpful. If I told my physician about my sexual orientation, the only thing I can see he would do different, is test for STD’s common with homosexuals, in which case I get those for free at the local clinic, so I don’t see the need, other than if I were HIV positive, then tell him and any medical staff.

  • Whitewitch

    Do you think they will soon get “behind” pushing for medication education about/for women as well?

  • Whitewitch

    Actually, at this time there are no mental health issues – other than her overwhelming focus on them. Not sure why she keeps going on and on about it. As a person who has suffered from mental illness for well over 40 years, I can promise you that most doctors that know you are mentally ill will not address any real health issues – because to them you are just crazy. I am used to it..but I will giggle loudly when she finally notices my leg is missing.

  • docsterx

    Maybe I should have used a different phrase other than ” . . . getting behind pushing . . . ” for LGBTQ issues.

  • docsterx

    Sorry to hear about some of the really negative experiences that some of you have had. Some of the problems may be from prejudice or bigotry, some may be from a lack of being taught about LGBTQ patients and their issues. The only information we got on gay patients when I went through medical school was incidentally mentioned when we had a few lectures on HIV and AIDS. Similar things happened with women, blacks and other minority groups. They got short shrift in medical education in the past, too. That is changing now to a degree. John has another post that I did that has a few paragraphs on how medicine and medical societies are getting behind pushing for medical education for LGBTQ issues. Keep an eye out for that post.

  • http://adgitadiaries.com/ karmanot

    These days it is absolutely essential to be one’s own advocate. If having troubles in a clinic ask if they have a medical navigator and make an appointment.

  • http://adgitadiaries.com/ karmanot

    I’ll help ya. When my first love in the earliest days of the plague was diagnosed with HIV he fainted from shock in the doctor’s office at the University Hospital. The doctor just turned his back and walked out.

  • http://adgitadiaries.com/ karmanot

    So true!

  • docsterx

    Having an open gay or lesbian patient can be a real learning experience for some straight doctors. So you can be helping him while he’s helping you.

  • docsterx

    Just a suggestion. If your current primary care doc is so focused on your mental health issues, perhaps she should refer you to a psychiatrist or psychologist to treat them. Then, knowing that they were being dealt with adequately, she could focus on your physical problems.

  • docsterx

    I’ve got friends in Dallas and Houston. They have gay primary care doctors taking care of them. But if you came out and the doctor decided he couldn’t take care of you because of your sexuality, the state board of medicine in that individual state might be interested in hearing about that. But, honestly, if my doctor acted like that, I’d get another one. I realize that in small towns there might not be a lot of doctors to choose from. But, by not being open, you can seriously set yourself up to have some major medical consequences, as I mentioned in the post.

  • Whitewitch

    This is exactly why I am not forth coming with the Medical Profession. It is strictly a “need to know” thing in my world. I am in the process of trying to change doctors, because the current MD is so focused on my “mental illness” that I could come in without a leg and she would not notice.

  • Whitewitch

    You are kidding right? I don’t even tell my doctor that I smoke or that I suffer from mental illness…there is no way I would ever tell them I am bi…no way. Judgement is something one does not need to experience with a doctor. Christ it is bad enough being a woman and listening to the Bias one suffers due to that – believe me if I could lie about being a woman I would

  • Monoceros Forth

    Brother. It’s just sickening. “Eeyup, I just lied to a patient and broke my oath to do no harm, but at least I’m not gay!” [expletive deleted]

  • Mike_in_the_Tundra

    On further thought, he should be asking those questions of all his patients.

  • http://www.rebeccamorn.com/mind BeccaM

    This idea of being able to be honest with one’s doctor is vital, and it applies to almost any aspect. I remember once seeing a doctor who was rude, brusque, and rather patronizing, and whose attitude was that I was wasting his time.

    When I asked a friend about it, she said, “Oh yeah, he’s like that towards all his female patients. Thinks we’re all hysterical hypochondriacs. Ask to be reassigned to Dr. So-and-so instead, she’s way nicer.”

    I never regretted the change… and knew immediately I’d made the right decision when my new doctor actually heated her instruments before commencing the nether parts exam.

    That first doctor? He left that office less than a year later, prompted mainly by the number of patient complaints, which the practice partners did not like one bit.

  • Mike_in_the_Tundra

    I think that the doctor in question started brushing up on gay sex after I first saw him. Sometimes, I’m surprised by what he asks, although he should be asking those things.

  • http://www.rebeccamorn.com/mind BeccaM

    What a horrible monster… I seriously hope this doctor isn’t in practice anymore, because that’s just effin’ sick to do that to a patient.

  • http://www.rebeccamorn.com/mind BeccaM

    Those ‘dirty looks’ are something you might want to mention to your doctor(s) the next time you’re there. That’s rather unprofessional.

  • Mike_in_the_Tundra

    Here in Minneapolis, one can go to the Red Door for HIV testing, but I’m more comfortable going to my own doctor. We really should feel comfortable discussing sexual matters in any medical facility that does testing.

  • http://www.americablog.com/ Naja pallida

    It’s tough, especially in those places (Hi, I’m from Texas) where you never know if your doctor is suddenly going to decide that they cannot treat you because of their ‘moral objections’… but all I can say is that everyone should make every effort to find a physician you are comfortable being able to discuss anything with. Finding a physician who has some understanding of your life, and actually seeks to treat you as a whole person instead of just the random symptoms you sometimes come in with, could be the most important medical decision you ever make.

  • http://www.americablog.com/ Naja pallida

    Seriously, if you’re not comfortable at any time during a doctor’s visit, speak up. If necessary, make a stink about it. There’s absolutely no reason you should be putting up with those kind of things. I don’t trust doctors at all myself; maybe I’ve just had far too many who have thought they were a lot smarter than they could ever have hoped to be. So I’m not adverse to giving them a piece of my mind if they’re not acting in a professional manner.

  • PeteWa

    yep.

  • PeteWa

    yep.

  • http://AMERICAblog.com/ John Aravosis

    I think the hardest thing is coming out as fabulous. But perhaps that’s just me ;)

  • http://AMERICAblog.com/ John Aravosis

    I think the hardest thing is coming out as fabulous. But perhaps that’s just me ;)

  • Monoceros Forth

    I’m somewhat lucky I guess in having available in Seattle “Gay City”, a very GLBT-friend organization, for getting HIV testing. I’ve never felt too uncomfortable there in being honest about sexual matters. (And to think I want to get out of this city!)

  • arren

    My Doctor was the same way about asking me my preference. When I asked if he meant top or bottom we ended up in a discussion. This Doctor didn’t know what or how to ask his patients. Now he feels better asking because he understands the lingo. Then again I have another Doctor who knew me just come out and ask “Top, Bottom or Versatile?” haha

  • Mike_in_the_Tundra

    I’m also from a liberal city. My primary doctor is just great, and I’ve never had a problem getting a HIV test. Early on in our relationship, he was a bit funny. He was trying to ask in a diplomatic manner if I was the receptive partner. When I figured out what he was trying to ask, I told him just to ask if I was a top or a bottom. He’s been very relaxed about asking intimate questions ever since.

  • Monoceros Forth

    Holy hell. A doctor lied to you about having a deadly disease?

  • http://liberawheeler.blogspot.com/ Elijah Jacob Shalis

    My doctors have no problem with me being gay at all but I live in a Liberal city. However whenever I ask for an HIV test the nurses and assistants give me dirty looks.

  • PeteWa

    I can remember one time in particular that I wish I hadn’t been so open about being gay to my doctor, about 17 years ago.
    I had been having serious issues (which years later I found out were due to an allergy to milk) and went in for a check up.
    Long story short, the doc told me that I had AIDS, full blown. Because, you know, I was gay. The “exam” that he gave me was rather physically rough. Gave me an HIV test which he then “lost”. To this day, if I saw him in an alley alone I would beat the shit out of him.

  • Larry Pepper

    This is a touchy issue with me. I have tried, but each time I get disrespect, disgusting looks, poor care. I even went to an openly gay physician, who was so rude, no bedside manner. He did a prostate exam with the office door open, and everyone walking by could see, he did not believe in privacy, I had surgery and the male nurse refused to do the prep cleaning and I suspect he gave me pain medication on an empty stomach, on purpose, and I became very ill before surgery. So I don’t say anything to the medical profession, because I have found them to be homophobic, I just don’t seem to be good at finding the right one, the doctor I have now takes good care of me, but I would not mention my sexual orientation, I have been burned too many times.

  • S1AMER

    Not only should you come out to your doctor but, if you’re married (or seriously partnered), you should make sure your doctor knows that. My wife and I have both given our doctors copies of our advance directives and medical powers of attorney, so the doctors know who to call in case of an emergency and with whom to consult on medical decisionmaking.

    In conversations over the years, I’ve told my doctor about cases where spouses and partners were denied access to their loved ones and cut out of decision-making in ERs and ICUs. In part this is to educate her about the world in which I live, but it’s also to get her to commit to stepping in with ER doctors or others if we need her help in cases where she’s not involved (homophobia or not, medical personnel everywhere are likely to listen to a doctor).

  • S1AMER

    Yep. Doing so could be one of the most important medical decisions you’ll ever make.

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  • BusyTimmy

    If you can’t come out to your doctor, find a new doctor.

  • Indigo

    Oh, my. It’s been 30 years or so since I “came out” to my primary physician. How could anyone have it otherwise? Except for closeted Republicans, of course.

  • AngelaChanning

    I am very fortunate that my doctor is gay so coming out was a no brainer. There is no hesitation to talk about “boy parts” and any issues. Now on a lighter note, one of the best things about him is his bedside manner. I recently went in to have a lump on my neck checked out…(referred to a specialist, should be fine) and I joked that if I needed to have it removed, I could always add ascots to my wardrobe to cover the scar. This lead to a Vanessa Prentiss reference from Young and the Restless. (The character wore a veil to cover a scar.) The exercise of using references from the past ended with my doctor recounting the freak accident story of Isadora Duncan’s (dancer from 1920s) death, after her scarf was caught in the wheel of an automobile. Only two middle age gay men could have such a conversation. LOLs.

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