Dear (straight) doctors: advice from a gay patient

Last year my very good friend Dr. Monica Tschirhart was giving a lecture to some medical students in Oklahoma about LGBTQ+ health. She reached out and asked if I had anything to share. After giving it some thought, this was the feedback I gave her based on my own personal experience and stories from friends.

  • LGBTQ+ people, particularly those in conservative areas, can be afraid of coming out, even to their healthcare provider. The most important thing you can do for them is make them feel comfortable talking about all aspects of their health, including their sex life. This may mean putting aside your personal beliefs or judgments — doing so will make you a better physician.
  • Don’t assume the person you are interacting with is straight. Doing so by asking about their girlfriend/wife (if they present as male) or boyfriend/husband (if they present as female) already forces them to correct you, making the already stressful “coming out to the doctor” worse.
  • Don’t assume that just because they are married they are straight, regardless if it’s from the intake form or a wedding band.
  • If discussing their sexual practices, don’t use euphemisms – be direct. Like straight folks, “sex” means many things, oral sex, anal sex, etc. If they say they are having “safe sex” it could be they use condoms when having anal sex but are having unprotected oral sex. Also don’t cringe. If you can’t say “do you practice safe anal sex” without cringing, practice in the mirror until you do.
  • Never, ever ask “are you the girl” or “are you the boy” regarding sex. If you’re comfortable with the terms, ask “do you bottom” or “do you top”. If you aren’t comfortable with those terms ask “are you on the receiving end or giving end of anal sex”. Again, practice in the mirror until you can say it without cringing.
  • If asking about their sexual practices, don’t assume they are monogamous if they have a partner. LGBTQ+ folks are often non-monogamous and just because they have a partner/boyfriend/girlfriend/husband/wife doesn’t mean they’re only having sex with that person. And yes, most of the time their significant other is fully aware and OK with it.
  • Don’t inadvertently out your patient. Unless they tell you differently, you should treat how they identify as confidential. LGBTQ+ folks can be fired for being gay, ostracized from their communities of faith, and worse. It’s sad, but there are good reasons why some people are still in the closet — particularly in conservative areas of the country. The moment you out them you’ve violated their trust and potentially their safety.

Daniel added these two very important points to the conversation:

  • Treat your patients as individuals, not stereotypes. If you want to talk about sexual health, start by asking them about their sexual practices (or lack thereof) instead of assuming you know what “people like them” do based on their age, race, sexual orientation, gender identity, or whatever.
  • Give your patients an opportunity to tell you what name and pronoun they want to be addressed by — and always use it, both in conversation with them and in conversation or notes about them.

This doesn’t even touch on PrEP, knowing the risk factors of STI transmission of different types of sex, etc which are all important but I think is somewhat secondary if the LGBTQ+ person won’t open up to begin with.

Dr. Tschirhart said that the students appreciated some of my comments and that it made it more real to them than some general statistics. And that’s just it — we’re people, not statistics or stereotypes.

The above is decidedly cis-gay-male centric based on my own experience. LGBTQ+ folks, what other things would you like doctors to know to provide great care for our community?

PS: The American Medical Association’s LGBTQ physicians resources page is a great springboard for doctors too.

 

Find an LGBTQ+ primary care physician you can trust

Recently I was discussing with a friend how much better medical care I received as a gay man when I started going to a gay primary care physician. It occurred to me that it might not be obvious to other LGBTQ+ individuals how important it is to have a medical provider you can fully trust and open up to so I thought I’d share my experience.

When I first came out in 2000, I was suffering from depression attempting to reconcile my fundamentalist Southern Baptist faith with being gay. During a visit to my doctor I brought up my depression and ultimately came out to him in tears there in the exam room. I got the deer in the headlights look. Instead of compassion, reassurance, or suggestion to talk with a counselor I got a prescription for anti-depressants and told I should be tested for HIV immediately. I changed doctors after that.

I came out to my next doctor in the first meeting wanting to make sure I had found someone who wouldn’t flinch. This doctor was straight but treated me being gay as a total non-issue. As part of the physical he asked about my mental health, any depression, if I was seeing anyone, was I having sex, etc. We discussed safe sex practices and had a discussion about regular STI testing based on my sex practices and risk profile. After I started dating Benjamin, he asked about Benjamin at every visit. He treated me like a human being — that made all the difference.

Fast forward to when I moved to Seattle in 2010. I intentionally sought out not just a gay-friendly doctor but a doctor who was himself gay. Asking around I discovered Dr. Chu and the good folks at Capitol Hill Medical. Hands down this is the best medical care I’ve ever received. I feel totally comfortable chatting about all aspects of my health and sex life with a fellow gay man who understands the LGTBQ+ community. The front desk doesn’t bat an eye when I call in and schedule a regular STI screening and I’ve experienced zero judgement.

Just because you’re gay doesn’t mean you have to have a gay doctor, but I believe it is vitally important that you have a primary care physician that you feel comfortable having open and frank conversations with. If you can’t talk to your doctor about any and all aspects of your health you aren’t getting the best medical care possible. If you’re looking for an LGBT+ health provider, check out the Gay and Lesbian Medical Association’s provider finder.

Regardless of your sexual orientation, race, or gender I strongly encourage you to find a primary care physician you trust. We all deserve the best medical care possible.

Happy Pride

Pride is Gay Christmas. You greet one another with “Happy Pride”, there’s a festive joyous spirit in the air, and it’s a chance to celebrate life among strangers and friends. Rainbows are everywhere. For one glorious weekend of the year you are immersed in your community. You can hold hands and steal a kiss from your boyfriend as you walk down the street and get smiled at by strangers rather than jeered.

There are street fairs, block parties, and concerts in the parks. Numerous organizations are staffing booths at all of them, including the Seattle Public Library, National Parks Service, the ACLU, and more local nonprofits than you can shake a stick at.

Today Seattle’s Pride Parade will include the City of Seattle, King County, churches, schools, and local service organizations both large and small. In addition, some of the largest and most well-known corporations like Alaska Airlines, Amazon, Delta, Google, IKEA, Microsoft, Starbucks, T-Mobile, Whole Foods and more will be represented by their LGBTQ employees. We are far past the days where only the alcohol companies wanted to be associated with us. The parade will last for hours because it’s that big. The support for our community is that big.

Fly a rainbow flag, kiss the one you love, and celebrate life.

Happy Pride!

Feeling Unsafe in Trump’s Rural America

This weekend Daniel and I got out of town and stayed at a lovely AirBnB out in Deming, WA — about 2 hours north of Seattle. Our AirBnB hosts were delightful people and our stay was great. Along the way I figured out that I now feel unsafe in rural America.

You don’t have to get far outside of Seattle to see pro-Trump signs. They’re on the side of I-5 as well as alongside small backroads but all primarily in rural areas. This isn’t surprising, urban centers are typically lean liberal (read: Democrat) and rural areas typically lean conservative (read: Republican). As someone who grew up in a rural, very conservative, area of the country I have first-hand experience with the racism and homophobia that go with such insular, isolated, usually-religious communities. Rural areas didn’t suddenly get more racist or homophobic the day Trump was elected, but they did get implicit affirmation that it’s OK to vent those opinions vocally, just like their new President did on the campaign trail.

As we left I-5 in left-leaning Whatcom county I started to feel more uncomfortable, wondering if it really was safe for two gay guys to stay at an AirBnB in a very rural area. After we checked in and walked along the road to the Nooksack river, I wondered if it was safe for us to be seen together as trucks with gun racks drove past. When the owner of the general store looked us over as we walked in together I wondered if we were in a safe place. I don’t know if we were or not but I felt unsafe all the same.

We got back to Seattle without incident this afternoon and I read about how Trump praised leaders of homophobic groups, as sharp contrast to former-President Obama’s proclamation of support. It’s no wonder I don’t feel safe in Trump-land.

I’m realize I’m being irrational, but I told Daniel that for our vacation this fall I didn’t want to visit any US county that went to Trump. That effectively nixed our plans to visit Alaska. I’m not all sad about this though, there are tons of wonderful blue cities in the US and literally hundreds of countries to visit where I feel safe. I’m sure they won’t mind taking my liberal US dollar either.

Allergic to religion

I grew up in a small Texas town where there were more churches – 23 to be exact – than banks and restaurants combined. We attended church as a family every Sunday morning for Sunday school and service, not to mention youth choir, youth group, Wednesday night service and more. There I learned sex before marriage was wrong, good girls dressed demurely, wives were subservient to their husbands, hate the sin & love the sinner, and that all gays were going to hell.

The last bit was more than a little inconvenient when I figured out that I was gay around the age of 12. I then spent the next 9 years praying to god to take away my feelings and make me straight. Eternal damnation can be a pretty strong motivator. I had almost a decade of self-loathing, self-hating, and depression before deciding that literally the only way I was going to survive was believing that god made me gay. I was fortunate that I was able to turn that corner. Many LGBT youth do not.

When I was 22 during my first job after college I struggled to reconcile being gay and Christian. I approached the youth minister at the Baptist church I was attending for help. He counseled me that being celibate in both mind and body was the only way to be gay and also live in god’s grace. We formed a friendship and played racquetball at the local Y after work. At least until this Baptist youth minister with a wife and kids hit on me in the locker room after a match. I guess celibacy only applies to non-closeted homos.

I found another church in Austin that appeared to accept me. “Come as you are” was their slogan. Early on I met with the teaching pastor at a coffee shop and we discussed my apprehension about attending the church given my prior experiences. He assured me that I was welcome – and I was for a while. I was an ASL interpreter almost every Sunday for 4 years until they decided that no one who was gay could be a “spiritual leader” in the church. They then proceeded to debate if interpreting the sermon counted as being a spiritual leader. If so, I would be asked to step down. I was just a few months away from moving to Denver so I bypassed the charades altogether and stopped attending the church.

Despite that betrayal I sought out and attended a church regularly after moving to Denver. Like a domestic violence survivor, I kept going back.

Then came California’s Prop-8. Nothing brings good Christians together like hate.

Catholics, Mormons, Evangelicals, and other religious groups all banded together to force their belief of “traditional marriage” on others using lies and deception. All to revoke the rights of loving couples to obtain a civil marriage — a purely civil and non-religious contract that provides many important legal rights that cannot be obtained by other means. The final day of the Prop-8 trial was the day I decided that I wanted nothing to do with religion of any kind. God and his followers could go screw themselves. I’m not throwing the baby out with the bathwater. To quote my blog entry at the time: forget the bathwater, the baby’s dead.

Since that day I have a very strong allergic reaction to religion of any kind. I get defensive. I get sad. I get angry. I lash out. I do whatever is necessary to protect myself from the feeling of deep betrayal and memories of self-loathing and self-hatred. Religious-themed Christmas music triggers it. Attending a function in a religious building triggers it. Knowing how many pious Evangelicals voted for Trump despite his bigotry, misogyny, and racism continues to set me off daily.

The damage to me is done and I want no part of it. I have been abused by religion enough and I am fortunate to have escaped with my life. The day I turned my back on religion was a turning point in my life. Since then I have become a healthier, happier, more caring, more compassionate, more empathetic, and more loving person.

 

#WhyIMarch: For visibility

Saturday, the day after Trump’s inauguration, I am joining the Women’s March in Seattle, a sister march to the one happening in Washington, DC. I am marching for visibility. Visibility for myself, my partner, my female friends, my friends of color, my LGBT friends, my Muslim friends, and others.

I have zero confidence that the incoming administration seeks to represent or benefit anyone who isn’t an affluent old white straight cis male. Look at how Trump’s top 4 cabinet positions are all white males, the first time in 28 years. Or how all of his cabinet is anti-LGBT. Or his intent to deport illegal immigrants and build a wall between the US and Mexico. Or create a Muslim registry here in the US. Or how he personally treats women, as exhibited by his treatment of Fox news anchor Megyn Kelly and his comment to “grab them by the pussy”.

I hate to break it to Trump, but straight cis white males are in the minority in this country. Hell, males alone are in the minority in this country.1

So I’m marching to make sure Trump and the rest of his administration know that we are here and we are not going away. We will stand up for each other and actively resist any efforts to erode our civil liberties. We are angry and we are motivated.

March with me.

Not in Seattle or Washington DC: find a march near you.


1 In 2010, 50.8% of the people in the US were women according to the census.