handsome doctor P1020971As an openly-gay mental health professional, I have long assumed that most LGBT folks are out to their health providers.


Recently, I was asked to present a talk to an LGBT group on the pros and cons of coming out to your doctor. I was a little perplexed: “What would be the cons?” I thought. So I went on-line and read about the topic. I also read about all these new books out about “Don’t Trust Your Doctor” and similar blah-blah-blah.

In this column, I would like to address the relationship that we – as LGBTers – have with our our health care professionals, how to be “out” with them and how to get them to give us what we really want (and need).

Here are some questions that I asked the group:

What is your relationship with your doctor/dentist/acupuncturist/psychotherapist?  Are you on the same team?  Or are you at odds?

Do you trust him or her?

How open can you be – or SHOULD you be – with your health care team?  Are you out to them?

Are they LGBT-friendly?  If not, what can you do about it?

Let’s be clear here:  your relationships with your health care providers (“HCPs”) are crucial to your health – you’re likely to get crappy healthcare if you can’t trust and be out to your HCPs.  But don’t get paranoid; get graciously assertive!  There are a lot of “don’t trust your doctor” books out right now, but don’t get sucked into that vortex of fear. Instead, take the advice of Dr. Robert Lamberts, a Georgian physician whose blog, Musings of a Distractible Mind, says that since patients are half of the doctor-patient relationship, they need a few rules of their own. Inspired by Dr. Lamberts, here are my own 7 rules for patients.

Rule 1:  Being out is part of who you are.
Do you want an HCP who is homophobic?  If you think it doesn’t matter, ask yourself:  would I put up with a racist HCP?  A misogynist HCP?  I doubt it.  Yet somehow we allow our own homophobia to keep us silent when we’re talking to our doctor, dentist, acupuncturist, psychotherapist, psychiatrist, etc.  What’s up with that?  If you feel tempted to stay silent about your LGBT status, ask yourself:  “What am I afraid of?” and answer the question.  Confront your own homophobia head-on.  Part of working with a good HCP is that you can both be honest with each other and comfortably ask questions back and forth.  If you hesitate to tell your doctor about PreP or STDs or your psychiatrist about breaking up with your same-sex lover, you’re likely to get poor, incomplete treatment.

Rule 2: You have the right – and obligation – to ask questions.
When you consider giving your hard-earned cash to an HCP, why not ask them questions like: “Do you have any other LGBT clients?” “Are you comfortable working with LGBT clients?” “If not, who would you recommend who is?” You have the right to ask these questions…calmly, rationally and respectfully.  If you get an answer you don’t like, don’t go off on the person.  Instead, gracefully and firmly, move on.  You don’t want to waste your time on someone who’s not comfortable with you JUST AS YOU ARE RIGHT NOW. An HCP who does not want to be questioned does not deserve your trust. I recommend that you go to your next HCP visit with written questions so you remember to ask what’s important.  If your HCP starts to rush out of the room, stop him or her by saying, “Excuse me, but I still have some questions.”  It’s your time, money and health:  be assertive.

Rule 3: Your HCP can’t do it alone.
The best HCP can do very little with patients who ignore instructions. If your HCP doesn’t explain things well, be persistant and ask more questions.  Don’t pretend you understand what he/she is saying.  Following your HCP’s instructions is your responsibility.

Rule 4: Be honest about what’s bugging you.
Many of us are embarrassed to tell our HCP the truth. However, if we want to get “better”, we need to tell them what’s wrong.  Your symptoms might sound strange or you may be afraid of what some of your symptoms mean, but the goal is to fix (or prevent) problems, and trying to do that with bad or incomplete information is an exercise in futility.

Rule 5: HCPs don’t play favorites.
Good HCPs try to do right by their patients and build relationships over years with them.  But they are professionally obligated to keep emotional distance. Overtly liking or disliking a patient will cloud their judgment.  So don’t drives them crazy by demanding  “special treatment” because “Dr. Sarah knows who I am.”

Rule 6: Don’t mess with the staff.
HCP staff take an incredible amount of abuse at the hands of some patients. When I worked as a psychotherapist at Kaiser Permanente – Point Loma, It surprised me what rude things patients were willing to say to the support staff but not to me.  If they don’t meet your expectations, yelling at them won’t fix the problem.  You’ll get better results if you put your complain in writing so your HCP will have ammunition to change things when they speak (privately) with the offending staff person.

Rule 7: If you don’t trust, leave.
As HCPs. people come to us because we – hopefully – have knowledge and experience that may be helpful.  Your mental and physical health are precious: so why would you go to someone you don’t trust? I have seen many patients stick with HCPs they don’t like, respect or trust “because I don’t want to hurt his feelings.”  Come on folks, when this happens to you, it’s time to be assertive: it doesn’t matter if everyone else loves your HCP; if you don’t trust him or her, find someone else.

Patients who are open with their HCPs about their feelings and fears will often get the same level of openness in return. Patients and HCPs ultimately want the same thing, but we sometimes see ourselves on opposite sides of a divide. There is this sense that we’re facing off with each other and we’re not working together. It’s a tragedy that can be avoided.