[I’ll preface this post by saying that I am in excellent health and expect to be rambling on this blog for many more years.]
During the drive back from British Columbia on our vacation this past weekend I got a bit introspective about death. You see, both my grandfather and uncle died from pancreatic cancer (and reportedly my great-grandfather did too) — it’s hereditary. There is no early detection and when you’re diagnosed in the later stages you have, on average, about 3.5 months to live. Treatment options are limited and can extend your life by a few months to a few years (see the 5-year survival rate). Oh, and did I mention it’s extremely painful?
On the plus side, there’s this gem from the American Cancer Society:
Almost all patients [who are diagnosed with pancreatic cancer] are older than 45. About two-thirds are at least 65 years old. The average age at the time of diagnosis is 71.
So as an almost-40-year-old I have a statistically safe 5 years before I need to be at all worried and a couple more decades before the odds start working against me. And it’s perfectly possible that I will never get cancer and live to a ripe old age.
But, what if tomorrow I was told I had 3 months to live… what would I do?
I’m making that list now and seeing which of those things I should start doing sooner rather than later.
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.
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.
I just got back from a much-needed vacation to Buenos Aires. Time with Jonobie (my wonderful friend and travel companion), sunshine, and new adventures were all in order. Also in order was becoming almost completely disconnected from my day-to-day life.
I removed Slack and my personal email account from my phone (work email is never accessed from my phone), the two most prevalent distractions from living in the now. I removed easy access to NPR and the New York Times from my phone’s home screen and succeeded in not looking at them once. I tried to limit my time on Facebook (already accessed only from the mobile web interface) to posting photos into our shared Argentina! album. Ditto Instagram. That was mostly, but not entirely, successful.
And you know, it was excellent.
I received a small handful of texts from people that I love and a few emails to my travel-only email account from the very few people that have the address. Through those and friends commenting on the Facebook and Instagram photos I felt somewhat connected with my tribe.
I didn’t feel overwhelmed by all the things piling up while I was away – things that likely don’t warrant worrying about anyway and none of which needed an immediate response from me (and they certainly didn’t get one!). I wasn’t tied to checking my personal email and Slack messages. I was free to live in the now, mostly guilt-free.
The challenge is to pull this level of disconnectedness into my daily life while still being connected to people. I’ve decided to stop having my personal email open at work. I’m going to squash all kinds of Slack notifications, perhaps not even reinstalling it on my phone. I’m going to continue ramping down reading the news to mitigate the stress that results from reading about the shit-show that is our new president.
That said, how can I retain connectivity with my tribe? More game nights? More lunches with friends? More texts? More old-school long-form emails? Therein lies the real challenge: how to stay connected to people and yet disconnected from the electronic distractions.
Last week I had yet more blood drawn to check my cholesterol levels. My doctor and I have been working on getting my LDLs down and my HDLs up since late last year. In December I started taking fish oil pills to decrease my LDL levels which seem to have worked: 150 -> 142 -> 118. Two months ago he put me on niacin to raise my HDL levels which also seems to be working, albeit not as much as we were hoping: 33 -> 38 at 2 grams/day. Regardless my cholesterol levels are changing for the better. Currently at: 118 LDL, 38 HDL.
Which is good – glad to know the hot flashes twice a day and the fish burps at bedtime aren’t for nothing.