National Coming Out Day
It’s National Coming Out Day today. My previous post about how to be a caring, non-judgmental physician and seeing LGBT patients.
or
It’s National Coming Out Day today. My previous post about how to be a caring, non-judgmental physician and seeing LGBT patients.
This is a medical weblog--a collection of thoughts about medicine, medical training, and health policy--written by a fifth-year medical student.
I recently stopped blogging, as I graduated from medical school and I'm now a physician in my residency training in New York City. But feel free to read and enjoy!
(To get rid of this thing, just wave your mouse over it. Ta da!
Hey Graham,
Would it be okay if I share your GLBTQ post with my language and communication in health care class? You have a bunch of good tips that I think the other students could benefit from as well.
Best,
Xavier
Hey Graham:
Happy NCOD.
Also, on suggestions from your earlier NCOD post,
instead of “sex”, use the term “gender” on forms.
Randy
Graham – HAPPY NATIONAL COMING OUT DAY!
Here’s a great contribution from two lesbian women to commemorate the National Coming Out Day:
The Ultimate Coming Out – Wow!
You can also go directly to FaithoftheAbomination.com. Their story will be told in a documentary film. I feel this will be groundbreaking for the GLBT community.
I just wanted to say thank you for your understanding and compassion on the LGBT subject. Being a gay man, I ended up leaving my Dr. and don’t have a PCP at the moment because my old one just seemed too uncomfortable talking to me. He was a bit older, so I understood, but I’m still without a doctor right now.
Thanks again
Ribeye
I’m concerned about this one: “Ask about sexual history honestly and openly. If you’re unsure on what or how to ask, try to let the patient explain–and let them know about your ignorance.”
Um, a doctor should *never* ask a patient, “So what do two girls do in bed anyway?” If someone is asking about whether she can transmit an STI to her partner, *do not* ask her to list all her sexual practices so that you can tell her which ones are risky.
If you read the guidelines and realise you feel too ignorant to take a sexual history, educate yourself. Realise that there are very few sexual practices that are exclusive to a particular gender pairing. Everything two women can do is done within straight couples. With the exception of ‘docking,’ anything two men can do is also done within straight couples. Lesbians, gay men, bisexuals and straight people can all be extremely promiscuous, sexually inactive, or monogamous. They can all experience problems within their sexual relationships. If you feel too ignorant to take a sexual history of a lesbian, gay or bisexual person then you are too ignorant to take a sexual history of a straight person. So it’s time to break out the books or to ask some questions of a colleague.
Trans is a little more challenging if you don’t know the difference between pre- and post-op. You need to know how to ask what the patient needs from you.
RE the recommendation to refer when you are uncomfortable. Someone who cares enough about their patients to fake it is probably ok. Someone who hates fags and thinks it would be a good idea to castrate them all and let them bleed to death so they can burn in hell for all eternity is probably not ok. They should be encouraged to stay away from LGBT patients (probably all women and children too) until they are better educated.
Ribeye:
Nashville is supposed to be a great place to be gay, so I’ve heard. I have a nurse friend in the area. If you want, I can try to get some referrals of gay or gay friendly docs for you.
I would think that there’s got to be some good docs asscociated with Vandy. YOu need to have a doc you can feel comfortable with talking about gay health issues.
Or, you can go down the path I did.
I wanted a young, male board cert. internist for my PCP. I hear the primary care at my friendly local university medical center is world-class. So, I call ‘em up, they suggest I see this particular Dr. His CV is impressive, he’s convenient to my office, I make an appointment.
He seems a little…reserved…upon meeting him. Not uncomfortable, but just..maybe a little uptight. Not a problem, but I’m thinking “Ok, he’s good for the asthma and the other stuff, but what if I have a…butt thing or something…”. I decide I’ll look for someone new before I need to see him again.
Two weeks later, I’m reading a nationally-syndicated sex advice column…and I just about shat myself. Turns out, Dr. Scaredy-pants is their medical advisor, is *TOTALLY* kink-aware, totally *NOT* a homophobe and *UTTERLY* unshockable. Still waters and all that.
That was eight years ago – I really, *REALLY* like him now. Haven’t had anything come up that really tests his limits of compassion or ability to maintain a straight face, but he’s great.
I think the point about not assuming your patients are straight is the crucial one; I’m not exactly your stereotypical homo, so people don’t necessarily make the connection. Also, just because I identify as gay, doesn’t mean I don’t sleep with women (or vice-versa). I recognize that’s a touchy subject, but the issue is, in part, if I’m a man who sleeps with men, which is not the same as being gay, per se.
E
I would also add (as a queer female bodied person who goes to doctors frequently because of medical conditions) that doctors need to be more clear about what “sexual activity” actually is. I finally asked a high school nurse when she asked me, “Are you sexually active?” if she was interested in whether or not was engaging in oral sex with women, oral sex with a man (giving or receiving), vaginal penetration with a penis, vaginal penetration with a dildo, performing vaginal penetration with fingers (again, giving or receiving), anal sex (with penis/dildo/fingers, giving/receiving) and the list kept going on. She blushed very red and said she was asking about anything involving mucus membranes touching. By that definition she was also interested in kissing, which would have been totally left out if I said I wasn’t sexually active. This is a problem I’ve had again and again with doctors, even those who say that they are LGBT friendly- sex is much harder to define than the language “sexually active” would suggest. I think it’s just something that heterosexuals don’t think of very frequently.
Also, I’m constantly asked if I use birth control. There is a big difference between birth control and protection against STDs. Wearing gloves while fisting doesn’t stop me or my partner from getting pregnant, but it does make it much less likely that whatever bacteria are swarming around on my hands will get into her body. I never know how to answer that question, because I feel like every answer is wrong (I usually just write “lesbian” in the blank if it’s on an intake form). If I say that I’m sexually active but I don’t use birth control, and I’m also female at the peak of her fertility, I generally get the “use birth control” lecture before I can get in there that I haven’t slept with a biological man in six years.
I’m really glad that you posted this, actually, because I’ve been trying to communicate these problems for a while and haven’t known who to go to. It’s awesome that there’s at least one person in medicine who’s interested.