"Coming Out" to your Doctor Skip to the content

Do you need to "Come out" to your Doctor?

This question comes from a friend who is a Family Nurse Practitioner (FNP) and has encountered a similar situation a couple of times when treating her lesbian, gay, bisexual and transgender (LGBT) patients.

To best understand the situation she provided me with a document from the Rhode Island Department of Health. It is a simple document that outlines a few what you should do’s and a few what you shouldn’t do when taking a sexual health screening as it relates to LGBT patients.

The document indicates that it is important for the person asking the questions to be non-judgmental and non-moralistic. The document also uses the open ended suggestion of stating “Tell me about your sex life” to a patient.

Lambda Legal: When Healthcare Isn't CaringThe problem she faces is when she asks about a patients sexual history and they state a simple yes/no or are aloof altogether in answering the question. This is a very common occurrence. Lambda Legal did a study in 2010 titled “When Health Care Isn’t Caring” and found that 73% of transgender respondents and 29% of lesbian, gay or bisexual respondents believe they would be treated differently by medical personnel because they’re LGBT.

Often during this screening she will ask “So are you seeing anyone?” She feels it is gender neutral so it can illicit the right information from a patient, but if the patient answers with a simple yes with no other details she finds the conversation stuck. Her question to me is “What is a good follow up question to find out if the “someone” they are seeing is male or female?”

From what I’ve gathered she has tried a variety of approaches and is trying to find the path ofLesbian, Gay, Bisexual and Transgender Healthcare Needs least resistance. She wants her patients to know that she isn’t going to treat them any differently. This is a tough balance because as a medical practitioner she can’t really talk about how supportive of the LGBT community she is, without the patient ever even mentioning that they are LGBT in the first place. As a professional you can’t go on a hunch that a patient may be LGBT without them actually saying it. So it’s a very delicate balance in getting a patient to feel open and comfortable enough to reveal this personal piece of information about themselves without fearing that they will be judged by their medical provider for who they are.

I find this situation very similar to coming out to someone for the first time (or choosing not to.) This is a very daunting situation for many LGBT people and it happens on a regular basis. Much of our society makes assumptions based on someone’s physical appearance; the way they walk, the way they talk, etc. So on any given day as a LGBT person you may have someone cast a preconceived stereotype or assumption on you. Within a split second you need to decide whether or not you will come out by correcting the persons inaccurate assumption or if it something you’ll ignore because it’s not worth the effort.

Personal Story of Coming Out (or not)

Let me provide an example that happened to me earlier this year. I was at the hair salon with the woman who typically cuts my hair. This had been maybe the 3rd time she had cut my hair so she didn’t know a whole lot about me and I didn’t know a whole lot about her. (This is not a scenario where she had been cutting my hair for 10 years). This was probably in March (whenever opening day of fishing season is in Connecticut). Anyway – just as she was about done finishing my hair she said “Is your husband a fisherman?” I had to have had a look of shock and confusion on my face. I was so incredibly confused about why she was asking me about fishermen (I do not fish therefore have no idea when fishing season begins). So in my confused, trying to process rapidly state, I went right over the husband part and on to being a fisherman. It was not an intentional “I don’t want to out myself right now” but more of a general confused moment because of being asked something so random. So after my asking her about fishing season she was done with my hair and I had no clear easy way of going back to say, “oh by the way I have a wife.” As much as I would love to just throw it out there in a “oh by the way” fashion that’s just not my style. When people make the mistake of assuming something and they’re wrong they are often embarrassed and it creates a real awkward moment.

So basically I had my chance to correct her on the fact that I have a wife and not a husband and I blew it. Since I didn’t correct her at the moment (reComing out as lesbian, gay, bisexual or transgenderregardless of why I didn’t) she would now assume that I indeed have a husband. So it creates that level of awkwardness when you see the person next. It’s not comfortable to just bring it up randomly again and say “Oh remember when I was here last you asked me about my husband being a fisherman? Well I really have a wife.” It’s just weird to me. Please keep in mind that this is my personal experience and personal opinion. There are plenty of other people who would have handled the situation differently than I did.

At any rate – I haven’t been back to that salon since this happened. I didn’t care for her all that much anyway so it’s not a huge loss to me, but it is lost revenue to the business owner of the salon. So one simple misstep on behalf of a stylist cost that salon business. It’s situations like this that happen on a regular basis to LGBT people around the process of coming out. Something as simple as stopping into a bank and having the teller yell “I wish you and your husband a happy Thanksgiving” as you are walking out the door is another example. The person who is being yelled to isn’t going to do an about face, walk back up to the counter, correct the teller and say “Actually I am married to a woman.” It takes too much time out of the day to be doing this over and over again. You have to pick your battles.

Our society automatically places this coming out process burden on LGBT people whether you are going to the salon, starting a new job or making a deposit at the bank. It happens each and every day and business people can take a step in the right direction by not making immediate assumptions about their clients.

This is a similar scenario to my friend who is inquiring about the patients sexual history for the purpose of answering medical questions. With the knowledge that your patient comes out on a routine basis to people may help guide you on how you could better address the situation.

Recommendations

My first recommendation would be to stop asking “So are you seeing anyone?” It’s a little bit too vague and a one word response isn’t going to help you get to the answers you need. The document provides a list of tips for asking about partners. I would say something like this “I talk with all of my patients about their sexual health, would you tell me a bit about yours? Such as are you in a relationship with a woman or man or none at all?” I believe the patient will pick up on the sincerity in your voice and the lack of judgement in your tone. By stating that finding our their sexual history is part of your routine job and merely acknowledging that they could be in a relationship with either sex gives them the option to talk about it and tell you. If you just said “are you in a relationship?” that’s not going to give you enough information. By being more specific by saying “in a relationship with a man or woman” you are giving them the ability to make it easy to speak up.

My second recommendation is to put yourself in your patients shoes. Look at it from their perspective. Your doctor says to you “Are you in a sexual relationship with a man?” It has now been inferred that you are heterosexual. It makes it that much harder for the patient to say “No I’m a lesbian.” It takes courage for your patient to speak up. Especially if we go back to those statistics from above. 73% of trans patients and 29% of LGB fear they will be treated differently. At least if the doctor is asking in a non-judgmental way the patient may feel that they will not be discriminated against.

My third and final recommendation would be to get your hands on some LGBT specific medical information. There are organizations out there that provide LGBT medical pamphlets that you could utilize in your office. It’s a subtle way of telling your patients that they are in a safe place. The patients who need to see it will notice it.

I hope this helps you and your patients. If you have other questions e-mail me at blog@jenntgrace.com or comment on this post below.

Human Rights Campaign Foundation - Healthcare Equality Index 2012If you are interested in more resources on this topic, the Human Rights Campaign Foundation puts out the Healthcare Equality Index which helps hospitals assess themselves to ensure best practices and that they are complying with non-discrimination requirements, etc. They are rated and the results are published in their report you can download. If you are looking to improve the quality of care for your LGBT patients I would look to this guide as a good starting point.

About Jenn T. Grace

Jenn T. Grace (she/her/hers) is an award-winning author and founder and CEO of Publish Your Purpose (PYP), the acclaimed hybrid publisher of non-fiction books. Jenn has published 100+ books written by thought leaders, visionaries, and entrepreneurs who are striving to make a difference. Jenn T. Grace’s work elevates and amplifies the voices of others—especially marginalized groups who are regularly excluded from traditional publishing.

9 comments to " Do you need to "Come out" to your Doctor? "

  • Diane

    While the suggestion of asking if a person is with a woman, man, or no one is an improvement over the more vague “are you seeing anyone,” I feel like it is still a bit limiting. The patient could be seeing someone who is genderqueer or agender, and if they are bisexual or pansexual, the gender of their current partner can lead to assumptions about their overall identity and sexual history. The fact that I’m married to a man, for example, generally leads people to assume that I’m heterosexual, and there are even fewer opportunities to correct that misconception without making it a “big announcement” than if I were married or involved with someone of another gender.

    That said, I know I’d feel more comfortable having a frank discussion with a provider who opened the conversation by acknowledging that I could be with either a man or a woman. I’m not sure whether someone on the transgender spectrum would feel the same way seeing the gender binary reinforced like that though.

    • Hi Diane,

      I think you bring up some great points on this particular issue. Your perspective is also unique to this situation because as you said since you are married to a man an assumption is cast upon you that you are heterosexual and I’m sure you’ve found yourself in that same position of deciding whether or not to come out, weighing the pros and cons of whether or not it is worth it.

      I think the number one takeaway you touched on is being able to have the frank discussion with your healthcare provider. If you aren’t comfortable with your current healthcare provider perhaps it is a good time to look for another one. Referrals are key in these instances so I would recommend talking to other LGBT people in the area and find out who they go to and if they are comfortable with the level of care and their level of being out to their doctor. It is important that we feel safe and comfortable when at the doctor so if you aren’t in your current situation try to change things up and seek a provider who is known for their openness and acceptance. But at the same time, remember that we cannot cast assumptions on the healthcare providers as well. Just because we think they may not be LGBT friendly is no measure of whether or not they are. I am all for giving people the benefit of the doubt and our healthcare providers certainly deserve that same courtesy.

      If you aren’t sure where to start with finding a good provider in your area, I would recommend turning to your local LGBT chamber of commerce. Many states have LGBT chambers and they are the business hub to your local community. Check their member directory and see if there are any healthcare providers in it. If not, give the chamber office a call and ask if they know of anyone. Odds are that you’ll find a great connection through that channel. To see if an LGBT chamber is in your area look here; http://www.nglcc.org/community/ccbo/lgbtorganizations

  • George

    I have read so many articles advising that it is imperative to come out to your physician, and I remain silent. I don’t know if it is fear on my part, or simply a reluctance to tell my doctor that, “yes, I’m a married man but I’m gay.” Given that, I surmise I’d probably swallow several times before I could gain the courage to tell her that I’m active sexually with a wonderful man.

    We have never had any discussion regarding sexual tendencies or how I perform sexually, etc. I’m in good health, good shape, and though we have conversations that cover a myriad of topics, sexuality simply hasn’t come up.

    I’ve toyed with the idea of affirming my gay status to her, and wonder when I’ll get around to it – maybe our next appointment.

    • Hi George,

      That’s a really interesting take on things. It’s interesting how it can be so difficult to tell a medical professional of our LGBT status when they of all people know so much about us. Is it fear that things will change once you tell them, fear of disappointment or disapproval? Or even fear of judgement. I imagine it can be any number of things and it’s quite interesting the amount of people I’ve heard from in the same boat as you are. Thanks for commenting! 🙂

  • George

    Thank you Jenn, for your kind remarks. I don’t know if it’s fear, per se; but perhaps there’s an inner fear that I can’t even recognize or identify. I’ve had it on my mind on the last couple of occasions that I was in the office, but couldn’t spit it out. (Don’t read into that last few words!)

    I would have been reticent to say anything to her predecessor, as he’d known me for so many years. I innately have fewer issues with coming out to a woman as opposed to a man, so it ought not be such a hardship for me, dontcha think?

    I don’t recall when my next appointment is, but let’s see how it goes. My innermost desire is to announce it…can I actually accomplish that is the key question.

    I appreciate your commentary.

  • Jan

    Thank you for the great blog. The literature is a good idea for a start. The office can put out LGBT literature and I still may not mention my gender transition though. If I’m in a doctor’s office, I critically need medical help for something. I’ve had doctors examine me for a common sinus infection from across the room after they learned of my gender history. Other doctors don’t have a clue about medical care for T or LGB people. General literature on display helps but not a lot. If a specific LGBT welcoming flyer offering non-STD health advice, I would likely be open. I think directed marketing outside the office and building relationships within the LGBT communities would also help.

  • Kaye

    It’s vital to feel entirely at ease in a patient doctor relationship. Remember whatever it is you tell your doctor, there’s nothing new under the sun and your doctor has seen it all before.

    My doctor has been looking after me pretty well since she became a doctor, a little over thirty years ago. She’s also my wife’s doctor and our son’s doctor. I’ve always felt comfortable with her, she was super when I came out to her as trans and guided me throughout my transition. During my annual physical, she simply asks if I’m sexually active, I’ve always been comfortable answering her question. It’s a yes plus, or no response.

    Kaye

  • George

    On May 29th of this year, I had a doctor’s appointment, and I had clarified with myself precisely what I needed to do. I needed to let her know that I’m gay. I finally decided I had the appropriate amount of confidence and comfort to make the announcement, though some nerve endings were a bit tentative.
    As we finished up our discussion of my very good health, as well as the normal every-day patter, I said, “Oh one more thing…I’m gay.” Her response, as she gathered her paperwork and began to leave, was “Okay.”
    When I returned home, I sent an email to Jenn, who champions the cause so gracefully, and told her what had transpired. In the email, I told her “what in the hell made me so nervous for so long?”
    Coming out to my doctor took me an awful long time, but the reality was “so what.” What I thought would be difficult was a snap, and I’m hopeful someone else will give it a shot after reading this.

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