Nearly 5 percent of the U.S. population identify as LGBTQ, according to the latest poll by Gallup. But if you aren’t talking to your doctor about your sexual orientation, you could be missing out on the best health advice. For example, someone who is transgender should be aware of how heart attack symptoms are different depending on your birth sex, and your sexual orientation could be a risk factor for certain diseases, from cancer to HIV.
“On a fundamental level, it’s important for our doctors to know who we are,” said Dr. Lara Stepleman, a psychologist and patient- and family-centered care LGBTQ information officer at Augusta University Health. “We develop a closer relationship with our providers when they know things like we have a partner or children or what we do for work. Another issue is that your doctor could miss critical health information or certain risk assessments if he or she doesn’t know that background.”
Open for conversation
Still, the burden shouldn’t be on you. Part of Stepleman’s role as AU Health’s LGBTQ information officer is to educate and remind physicians and staff that patients have all types of backgrounds and it’s important to be respectful no matter what that background is.
While patients often may not want to say anything because of an earlier bad experience or because they’re afraid of how a doctor might respond, doctors may not ask because they don’t think it’s something patients want to talk about.
For example, one Johns Hopkins study found that nearly 80 percent of doctors said they didn’t think patients wanted to disclose sexual orientation. But the same study found that 90 percent of patients were fine about it. Another study in Boston found that 63 percent of patients have told their doctors about their sexual orientation, but that only 14 percent of doctors asked.
All that may change soon since the Centers for Medicare and Medicaid Services now says all electronic health records must have the capacity to record sexual orientation and gender identity patient information, although hospitals may vary in the extent to which they require doctors and other providers to record this information.
So how can patients help make these kinds of open conversations more natural? Here are a few tips:
1. Look for an opening and be willing to speak up.
Your doctor may inadvertently use the wrong pronoun or may ask about your wife when you have a husband. That’s your chance to gently correct your doctor—then let the conversation go from there.
2. Choose your doctor carefully.
In a perfect world, we’d all be kind, considerate and respectful of one another. Unfortunately, that doesn’t always happen. So as you choose who you go to for your health care, make sure it’s someone you feel comfortable with. When evaluating a potential primary care provider ask yourself, does this doctor ask you questions and involve you and your identified family members in your care? If a physician’s body language, tone or demeanor make you feel uncomfortable, ask to be referred to a different doctor.
3. Use a conversation starter.
It could be hard to plainly say, “I’m a lesbian,” or “I’m transgender.” So start easy. When your doctor asks if you have questions or concerns, it’s your chance to say:
- “I need to ask you something in confidence.”
- “I need to talk to you about something.”
- “I want to tell you about my partner.”
- “I’m interested in HIV testing.”
- “I’m taking these hormones as part of my transgender treatment.”
- “Can you please refer to me as ‘he’ (or ‘she’)?”
- “I have a list of questions.”
- “I want to share about my sexual orientation.”
4. Don’t feel like it’s your job to educate your doctor.
“While it’s OK for you to provide some education, you should not be in the role of having to teach your doctor about your sexual orientation,” said Stepleman. It’s a fine balance, but you definitely want someone who’s willing to put in some care to ensure your health needs are getting cared for—just as you would expect if you identified as a diabetic, a cancer patient or a heart patient. If you feel like that’s not the case, you may want to find another doctor.
5. Be empowered.
No patient should ever be treated disrespectfully, rudely or callously. According to a recent local poll, 18 percent of patients said their doctor blamed them for their health status, 13 percent said doctors used harsh or abusive language toward them, 12 percent refused treatment, and 11 percent said they were treated poorly because of sexual orientation. “These are real things people are experiencing in our community,” said Stepleman. “So if you feel you are experiencing sexual orientation or gender-related discrimination, don’t be afraid to contact an office manager, patient representative or use other avenues to make sure that hospitals and doctors’ offices are following federal, state or their own nondiscrimination policies.”
Let’s get better
It’s a universal fact that the more we tell our doctors about who we are as a whole person and our symptoms, the better our care is.
Being willing to speak up while remaining respectful and courteous is our job. The rest is our doctors’.
