I am a doctor in a small town near Atlanta. I recently had a young woman come in for her annual physical and Pap smear. As usual, I went through a complete history, including a sexual history. When I asked if she was sexually active with "men, women, or both," she looked surprised, then hesitantly said "women". She seemed a bit nervous. To reassure her, I said "Thats fine. Im gay." Relief washed over her face. She excitedly explained to me that she was there with her girlfriend who was my next patient. Her girlfriend had never had a Pap smear. She had set up appointments for both of them, to offer moral support for her girlfriend. I talked to them both individually, then brought them into the same room and we discussed relationship issues together. They each stayed in the room for the others exam, which made them both more relaxed. They left having had a more comfortable visit with their doctor and having had a discussion about their health that was relevant to their individual lives and risk factors. For them, being out to their doctor lead to a very positive healthcare experience.
Should everyone be out to their doctor? Ideally, yes. However, that isnt always practical. These young women were very lucky to have randomly chosen a doctor who was gay and was sensitive about taking a sexual history. As you can imagine this scenario could have turned out very differently. Sadly, many doctors are still homophobic. Being out to such a doctor may only lead to an uncomfortable visit, but it may also lead to inferior medical care, attempts to "cure" the patient, or even hostility. Some caution is important.
Why is it important to be out to your physician? The reasons are numerous. Of course, there are issues about risks of sexually transmitted diseases in certain groups or with certain sexual practices. There are certain vaccines recommended for gay and bisexual men, which your doctor may not offer if he doesnt know your orientation. Lesbians have particular needs in their gynecologic care. Depression and substance abuse are more frequent in homosexuals and bisexuals, and an understanding of a persons home life and sources of stress are necessary to properly treat these diseases. Also, for your primary care doctor to provide optimal care to you, it is important that he or she know about the people and issues in your life.
How do you decide if you should to come out to your doctor? This may be easy if you already know your doctor is gay- or lesbian-friendly. You may find a gay-friendly physician through friends, advertisers in community publications, or through guides such as the "Lesbian, Gay, Bisexual-Friendly Physician List" published by the Atlanta Lesbian Cancer Initiative. Our organization (GAPHR) plans to start a referral network through our web site in the upcoming year. If you have trouble finding a physician whom you know is gay-friendly, you may have to rely on cues from your physician to decide if you can feel comfortable coming out to her or him. Obviously if she practices in an area with a large gay and lesbian population, she is more likely to be sensitive to sexual orientation issues. If he asks you questions about your sexual orientation, he should be comfortable with your answers. If the new-patient forms have questions about sexual orientation or sexuality, them it is probably safe to be out to the doctor, but these forms are sometimes copied from others and may not reflect your doctors comfort level with the issue. You may not want to write about your sexual orientation on the form, but may want to bring it up in the interview. Certainly, if your sexual orientation is important to a particular medical problem, then you should tell your doctor. If she is too uncomfortable with it, you can change doctors.
Your sexual orientation is frequently important to your healthcare. Sometimes it is difficult coming out to your doctor, and it may not always be a good experience. However, you have a right to receive high quality healthcare that it sensitive to your needs, whatever they may be. If you are not receiving that, then you should find a new doctor.