Bitter Pill to Swallow: Coming Out to Your Doctor

Dr. Rhonda Johnson wants the LGBT community to be honest with their doctors about their sexuality.

Survey after survey shows the hesitation, awkward discussion and unaddressed issues that result from not having that conversation. Quite frankly, many consider it none of the doctor’s business.

But even in the 21st century, the LGBT community still suffers from a variety of unique ailments – all of them eased with openness. “I say coming out in general is a decision people in the LGBT make with great concern and consideration,” says Johnson, who serves as Medical director or health equity and quality services at Highmark Inc. “I think it’s important to come out to your doctor, and it’s important to come out to the right doctor.

Social pressures faced by the community often result in substance abuse, with increases in obesity, heart disease, diabetes and serious body image problems. A report from the Gay and Lesbian Medical Association cited studies that show gay men are 50 percent more likely to smoke, while gay women – the only demographic whose smoking rates increase with age – are 200 percent more likely.

Gay women, who are statistically less likely to bear children, are more likely to develop breast cancer as a result. And since marriage is often the means for many to gain health insurance, a lack of legal recognition for same-sex marriage means less coverage.

Gay men are also less likely to receive screenings for cancer and STDs, despite increased risks. Worst of all, AIDS still affects the community disproportionately. Studies show many gay men resent a discussion of AIDS after years of the media calling it a “gay disease.” But gay men account for 42 percent of HIV infections each year.

The situation may get even worse with many transgendered people, who might assume rejection and not even bother seeking health insurance in the first place.

“They have to feel their doctor would want to welcome them,” Johnson said. “Sometimes even the conversation with their own family is difficult. It should not be newsworthy in 2014 about someone’s sexual orientation. But it’s still is a news item. LGBT people are just beginning to have some of the same civil rights other people have.”

Fears of coming out to the medical professional might have been than justified in the past.

A study 1998 by the Gay and Lesbian Medical Association shows that 40-43 percent of medical students had thought the gay community should keep their sexuality private. A further 5-12 percent had found them “disgusting.” But the medical community has been moving forward from a sometimes-bumpy past.

“As a physician, we want us to move past,” Johnson said. “One time people with tuberculosis were isolated and put in sanitariums, that’s no longer the case. One time, mental health and Down Syndrome patients were isolated from society. But we moved beyond and made progress.

Things have changed. Hospitals often use everything from conventional to social media to reach the close-knit LGBT population. Highmark explicitly endorsed Pride Day and the Persad Center 5K to benefit LGBT youth.

The outreach can be subtle as well. Questionnaires that once asked for marital status now ask for relationship status, an acknowledgement of the often murky legal territory applied to LGBT couples. Physicians avoid applying labels, and certifications now require ongoing sensitivity training unheard of years ago. Furthermore, dialogue between doctor and patient focuses far more on issues of confidentiality.

At the same time, Dr. Johnson understands the hesitation. In her job, she sees the horrible power of stigmas.

For example, adolescents are increasingly unlikely to get the HPV vaccine, out of concern that doing so would condone premarital sex. Infection rates have skyrocketed as a result. “We still have ways to go,” Johnson says.

On the Web: Need help finding a doctor? Go online for the Gay and Lesbian Medical Association: www.glma.org or www.gayhealth.com.