Honesty Deprivation in Queer Medical Care

“I’ve never been 100% honest at the doctor’s office” I say to Lisa as we sit under a tree next to Dunkin Donuts. “I usually pretend I’m straight so they don’t ask about my sex life.” She laughs at me and tells me she did the same for a long time.

So, let’s talk about honesty. 

Brutal honesty, especially with our primary care physicians, is often difficult. The relationship between doctor and patient becomes a lot more complicated when the patient is queer. I am openly queer in my personal life and my medical experience is pretty run-of-the-mill. It is by no means the worst it could be but it has never been a truly positive experience. I have dealt with the ever present “it’s all in your head” response to my concerns as well as meeting midwives who held my hand during terrifying procedures. Without divulging my entire medical history I would like to look at how complete honesty has been robbed from the LGBTQ community when engaging with medical professionals. 

For the last hundred years, all aspects of queerness have been pathologized and medicalized. Homosexual attraction was classified as a mental disorder until very recently. This diagnosis was made official in the 1968 DSM-II which is the American Classification manual for Mental Disorders. This diagnosis was not removed from the DSM until 1987. It was not removed from the World Diagnostic Manual (ICD) until 1992. During the years when homosexuality (and for that matter bi and pansexuality) were classified as mental disorders all sorts of heinous “therapies” were carried out on the queer community. These ranged from tortureous conversion therapy all the way to talk therapy with psychiatrists who were taught in line with damaging Freudian theory. For those who don’t know, Freud believed homosexuality was a normal state of sexual development but if one stayed in that state they were developmentally retarded and in need of serious medical treatment. 

In overlapping decades  AIDs was labeled as a gay and queer disease. The 1980’s AIDs crisis has led to a heap of intergenerational trauma for the community. Even today most Trans people have to play the medicalization game of their experience to qualify for hormone treatment. This long history of medicalized shame and fear has created an internalized sense that our experience of gender and sexuality is inherently a cause for treatment and secrecy. This, in turn, creates a sense of alienation from the service a medical provider is supposed to give. 

I, like many others in the queer community, have thus never been completely honest with our primary care physicians. Usually this comes out when discussing my sexual history and drug intake. I completely gloss over who my past partners have been. Even when I was in relationships with women or non-binary people, I have always used male pronouns to describe them and our sexual activity. This is if I even admit to being sexually active at all. Before my current relationship, which happens to be with someone who was designated male at birth, it was a fifty-fifty chance that I might simply say I was not sexually active at that time. I knew if I admitted to romantic relationships with women I would be bombarded with questions that would not actually be in service of the medical treatment I was seeking. 

This has also come into play when asked about alcohol consumption. I have been drinking off and on since I was nineteen but when asked at the doctor’s office I have always said I never drank at all. Looking back at these kinds of interactions I usually said this for two reasons. One, I am a woman and I have had my own experience of medical problems being overlooked because of my gender and adding any kind of substance intake to my file might jeopardize my chances of being listened to. I have had medical professionals completely ignore what I have told them and say my symptoms have to be because I was drinking too much (I was not) or because of my diagnosed depression (it was not). On the other hand, when someone knows I am openly queer, which is rare with doctors, I am keenly aware that anything I say about my queerness and medicalization can contribute to harmful beliefs about queer identities. Sadly, addiction has always been high in the community but I have never wanted to promote that with my own interactions for fear of reinforcing stigmatization. 

Unfortunately this is all too common in the LGBTQ community. Over 50% of LGBTQ individuals have reported discrimination by health care professionals. This statistic jumps if the person is Trans or a Person of Color. One in five Trans people are flat out denied treatment because of their gender identity while most find that providers are simply unqualified to deal with their medical needs. If an LGBTQ identified person is a Person of Color they are twice as likely to avoid medical services because of discrimination and stigmatization and only 16% of the entire LGBTQ community report informing their doctors of their sexual orientation.  

So, the main question is; what can we do to promote honesty between doctors and their queer patients? I have two answers for that. First and foremost we need to end the stigmatization of queer identities. This has been in the works for many years and I do not believe this work can be done overnight. Political movements such as marriage equality and the inclusion of non-binary identities on legal ID’s are helping normalize queer identities in legal situations. The normalization of queer narratives, told by queer artists is also helping immensely. This has been most recently seen and praised in FX’s Pose. This destigmatization is a slow change that is well in the works and I want to push allies and younger generations to find new ways to promote this normalization and acceptance of queer stories. 

The second task is much harder because it demands the help of the medical community with whom we are not engaging. We need more comprehensive LGBTQ medical training. This training also has to be created with the help of queer patients and physicians. We need to find a way to have open conversations focused on listening to the LGBTQ community’s desires and needs. I would recommend the National LGBT Health Education Center which is a division of Fenway Health as a starting place. They offer lots of information for patients and providers as well as publications that I believe could help to begin creating a nationwide medical reform. Though, I also ask those in the community to not only speak your truth but to stand up for your dignity. We cannot be bullied into being denied a service which is also a human right. Our existence is natural and beautiful and needs to be affirmed in the most basic of ways. 

Sources

The Survey which provided the Statistics on Trans assistance denial

https://www.thetaskforce.org/static_html/downloads/resources_and_tools/ntds_report_on_health.pdf

Lopez, German. “Descrimination is Doing it’s Dirty Work.” Vox. May 2nd, 2017.

https://www.vox.com/identities/2017/5/2/15505132/lgbtq-discrimination-cap-survey

Sexual Orientation Information Survey

JAMA Intern Med. 2017 Jun 1;177(6):819-828. doi: 10.1001/jamainternmed.2017.0906.

https://www.ncbi.nlm.nih.gov/pubmed/28437523

Fenway Health https://www.lgbthealtheducation.org/

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