Physicians have the opportunity – and the responsibility – to provide LGBTQ+ patients a safe space to disclose and discuss their sexuality. As physicians, we can and should be thoughtful about the meaning of a patient disclosing that information. The “coming out” may take the form of a check box on a questionnaire, with that information having little to no relevance to the patient’s reason for being in the office or the hospital. Conversely, a physician may find themselves in the important position of being the first trusted person with whom the patient shares this information. Patients may have been out for years in many settings, or may be very secretive about their LGBTQ+ identity.
What is important for physicians to remember is that this disclosure is made by people who at some level are prepared for rejection, avoidance, devaluation, neutrality, acceptance, or in the best case the hoped for response of celebration. Whenever someone shares their LGBTQ+ identity with a new physician, they are taking a risk. They risk that the information will not be understood, validated, and appreciated for what it is, despite the patient’s wish to be known and understood by their doctor. Being present with the patient – truly listening to what they have to say – goes a long way towards making the experience a positive one. Our University of Vermont College of Medicine students begin the process of learning these important skills from their first day as medical students. I have seen how the College’s emphasis on these important humanistic aspects of the work of caring for others helps them become excellent physicians, making a difference in patient care everyday.
The following are some additional points to consider for a physician to whom a patient comes out:
- Acknowledge and express appreciation for the information being shared.
- Ask how it was for the patient to share that information at that time.
- Maintain eye contact.
- Thank the patient for trusting the relationship enough to share the information.
- Ask about family and refer to family members and dating partners using the patient’s language (don’t refer to boyfriends or girlfriends as friends. EX: “How is your friend?”)
- Offer to always be available to be a resource or to find the right resources if the patient has questions or concerns about their health and wellbeing and how their sexual/gender identity may interact with those issues.
And here are some additional tips for healthcare providers from the Human Rights Campaign (http://www.hrc.org/resources/entry/coming-out-to-your-doctor):
- Educate yourself. Learn about the specific health issues facing LGBT people.
- Be sensitive. Make sure you and your staff know which pronouns are appropriate to use when referring to a transgender patient or same-sex couple. Present visual cues. Displaying an HRC equal sign or other LGBT-friendly emblem will demonstrate that your office is a safe space for all.
- Revise client forms. Allow options for male/female/transgender and use neutral terms like “partner” or “spouse” rather than “single,” “married” or “divorced.” Use “parent 1” and “parent 2” to include same-sex couples raising children.
- Don’t assume. Avoid making assumptions about a patient based on their appearance. When taking a sexual history, ask, “Are your current or past sexual partners men, women or both?”
- Listen attentively. Be sensitive to the fact that this disclosure may be difficult for your patients.