Many people avoid going to the doctor. In today’s world, it is easy to not find the time, money, or energy to put yourself and your healthcare at the top of the list. In fact, even those of us who are doctors put it off from time to time, as it is quite natural to have hesitancy and anxiety around your health. Being seen, analyzed, touched, or tested (even in a clinical way) can be stress-inducing. While it may be a relief to ignore your health in the short-term, we all know that putting off healthcare can have serious consequences. Many issues that can be easily treated if caught early can turn into much bigger and more dangerous ailments if left undetected.
A further complication, that is often not understood, is that identifying as an LGBTQ+ person can cause even more stress and anxiety when seeking medical care. Our community tends to delay and avoid care more often – because of previously experienced discrimination, abuse, trauma, ill-informed practitioners, and even refusal of treatment – based on our sexual orientation or gender expression. Even if you have not experienced discrimination or abuse firsthand, the perceived possibility of being treated unfairly or unkindly can cause many LGBTQ+ patients to delay routine care, avoid changing doctors or seeking second opinions, and/or avoid specialists or integrative care, as to not bring more unknown variables into their medical experience.
Our community has every reason to be wary. Many people report incidences of ill-informed doctors and staff who have asked inappropriate questions, have shamed them, or refused to treat. It happens everywhere – not just in small towns or rural communities. Many of us are old enough to remember the collective response at the start of the AIDS crisis, and how many of our brothers and sisters were abused, neglected, and died due to prejudice and a lack of action. Now, we see a repeat of many of the same behaviors and discriminations being hurled upon the Trans community, as it is challenging to find practitioners who are informed about gender identity, expression, and Trans Medicine. Many patients report inappropriate questions, unneeded physical exams, and refusal to treat, still today.
Trans patients are not the only group still experiencing discrimination. Gay, lesbian, bisexual, and other sexual minorities also deal with a number of awkward and anxiety producing scenarios, even when providers are not ill-intentioned. A friend of mine who identifies as a lesbian and who is in a long-term, monogamous relationship with another woman, had a recent experience with a doctor’s staff where the intake form did not specify a “domestic partner” or other non-heterosexual language. Much to her surprise, the Nurse insisted on doing her intake in the hallway, which was crowded and not private. Deciding there was no reason to out herself until meeting with the doctor, she answered the nurse’s questions as simply and directly as possible, but the nurse could not understand how she could possibly be “sexually active”, “not menopausal”, “not seeking to conceive”, and “not on birth control” all simultaneously. Even trying to politely explain “she did not need it” and was “not interested in birth control”, did not prevent the nurse from beginning a passionate and public argument that she needed birth control, to the point that my friend had to blurt out “I’m a lesbian!” to get the barrage of persuasion to cease. She got a few awkward looks and the nurse was obviously uncomfortable, but she said that the experience really made her aware of how traumatizing seeing an ill-informed or prejudiced practitioner could be. Her story also reminded me, as a physician, how important it is that EVERYONE on my staff be educated and trained in cultural competency on LGBTQ+ issues, not just the doctors.
Hearing these types of stories and reports of anxiety in our community led me to think about how I might help you become more empowered and take control of your experience as an LGBTQ+ patient, so that you can limit your negative experiences and be more confident and in control, should discrimination occur. Here are some tips that I have formulated over the years to help you be a better patient advocate for yourself:
Do your research: Read the practice or doctor’s website, look at online reviews, ask your friends and colleagues. Look for any “open” or “affirming” language that might signal to you that the practice is informed and welcoming. Also, look for any bad reviews from someone who feels there was discriminatory behavior.
Ask for an intake form in advance: Intake forms tell you a lot about the understanding level of a doctor and their staff. Does the intake form ask for your preferred pronouns? Does it use any gender-neutral language? Does it have “Domestic Partner” or other non-traditional labels? This is the quickest way to ascertain if there is a general awareness of our community’s needs.
Remember your rights: You have the right to change doctors. If someone isn’t resonating with you for ANY reason, you have the right to keep looking for the doctor that fits you and your needs. You have the right to refuse any procedure. You have the right to ask for someone else to be in the room. You have the right to leave at any time – even in the middle of an exam.
Pay attention to the staff: A doctor’s front desk, receptionists, and other staff are often a reflection of the practice’s core values. If something unkind or uncomfortable happens over the phone or in the waiting room, then it is more likely to happen again throughout your experience.
Try alternative, holistic care: Shameless self-promotion here, but integrative physicians are often on the forefront of understanding the mind-body-spirit connection, and therefore are often more aware of the sensitivities that different groups face. That can be true for different sexuality and gender expressions, but it is also true for racial and cultural minorities, trauma and assault survivors, and people with disabilities. Naturopathic Doctors, like me, often make a strong effort to study the needs and sensitives of these groups, but so do other integrative physicians and practitioners: such as Osteopaths, Chiropractors, and Acupuncturists. Learning about alternative medicine can provide a new type of experience, and you may find it warmer and more personalized.
If you feel confident, teach the teachable: Even doctors and staff with the best of intentions mess up occasionally. It’s okay to ask someone to say something or do something differently. It’s okay to correct your pronouns. If the person is teachable, they will be grateful for the correction and eager to better serve you. We are all human and always learning – and we all make mistakes. It is what happens after the mistake is made that often turns something innocent or ill-informed into insult or injury. Trust your discernment to know the difference. If someone is unwilling to respect your boundaries or they repeatedly use the wrong terms or pronouns after being corrected, then they are probably not teachable and it’s best to move on.
It is my wish this Pride season that everyone in our community feels empowered to take control of their health and to be their own best advocate. Together, we can create a safer and healthier world for ourselves and each other. For more questions around concerns and best practices in LGBTQ+ Medicine, email me at: firstname.lastname@example.org