By Adam Safdi, WCI ColumnistMany people might assume that LGBT folks come out of the closet only once in their life. (Doesn’t the whole world just know after the big reveal when we were 16? 18? 31? 61?) Nothing could be further from the truth. LGBT folks in medicine (and in general) are forced to come out over and over again. And as a doctor, the decision of whether to do so while doing our jobs could certainly affect our paychecks and our eventual wealth.
I can assure you, at least from my experience, that coming out does get easier with time, even if there is always some anxiety with the reveal. With each successful coming out, the LGBT person builds up their true family and support system. Sometimes, we are lucky enough that the new family is the same as our old “blood” family. Sometimes, we grow a chosen family—a group of friends who become our family who are unrelated to us by blood but who support us through thick and thin. With the growing family, we know that there is a pillar to lean on, so even if a new coming-out experience goes bad, we can move on knowing there is still love and acceptance in our lives elsewhere.
But what about in our lives as medical professionals? What are the situations where we might need to come out? And should we?
Do I Need to Come Out as a Doctor?
Here are some examples of when we might be forced to make a decision.
- Interviewing for residency or a new job? Family is not supposed to be asked about, but it often slips into the conversation.
- Working the day after Valentine’s Day (or substitute any other random holiday)? A patient might ask, “Did you and your wife do anything special?”
- Socializing with new neighbors, they might ask, “Do you know of any good churches in town?” There might be some LGBT-friendly churches out there, but the perception from some LGBT folks might be a feeling of unwelcomeness due to bad experiences with religion in the past.
Personally, I’m not shy about my gayness. I wear a rainbow caduceus lapel pin, I have a slightly more effeminate voice, and I flip my wrists and roll my eyes maybe a little too much. I wear a bow tie. I think most of my patients have figured out that I’m gay, and they either don’t care or they like me more for it. So, it surprises me still that some patients assume I’m straight and married to a woman.
How am I supposed to react when a patient assumes I’m straight? What do I say to the question, “Did you and your wife have a nice Valentine’s Day?”
For those readers not familiar with the medical profession, some doctors have short interactions with patients (such as emergency medicine physicians or some anesthesiologists), while other doctors might not have any face-to-face interactions with patients (such as some radiologists or pathologists). These providers likely don’t have to worry about coming out to patients because their meetings are so brief.
I am a nephrologist. My job involves continuing care of patients with kidney disease or kidney failure on dialysis. I know that part of a nephrologist's income is generated by seeing the same dialysis patients week after week, month after month, year after year. Seeing one hemodialysis patient for four visits in one month is 6.77 RVUs, which generates $338.50 per month (assuming a conversion factor of approximately $50 per RVU) or $4,062 per year.
If a patient finds out that I’m gay and doesn’t want me as their doctor anymore, that translates to less income for me. If a patient asks me a question about my personal life, should I stay quiet or pretend to be straight? How much is it worth to me to silence my truth?
Do I have an obligation to educate the patient on my sexuality? Am I supposed to say things like:
- “Well ma’am/sir, it’s more politically correct if you ask, ‘Did you and your spouse have a nice Valentine’s Day?’”
- “I try to use non-assuming language with you and my other patients. I would appreciate it if you did the same for me.”
Or am I supposed to be a radical justice warrior every time a patient assumes I’m straight?
- “What wife? I don’t have a wife.”
- “Oh, you mean my husband?”
How many of my patients would “fire me” for revealing my true self? How much money would I lose? LGBT folks in medicine are faced with this very fuzzy dilemma.
More information here:
A Q&A with QueerDoc’s Crystal Beal: How They’re Vital to the LGTBQ Patients Who Need Help
Being Gay as a Doctor
I wonder how many doctors stay in the closet because of this double bind. Or perhaps LGBT doctors choose to stay in the closet because medicine is a serious profession and being openly gay is treating it too frivolously?
Now, throw in the wrench if your family helps to pay for medical school. What if young student Dr. G knows he’s gay but doesn’t want to come out of the closet for fear that it will upset his mother? (My mother, may her soul rest in peace, thankfully loved my true self since she outed me when I turned 18. But that’s a story for another day.) How much pressure does student Dr. G feel to stay in the closet when he is in medical school? In residency? While still paying off loans? Even after the student loans are paid, because there might be residual guilt that mom helped pay for medical school? When Dr. G retires? Before mom dies?
As care providers, we ask patients about their sexual and gender identities as part of the necessary medical history, because it has health implications.
- Men who have sex with men and transgender women who have sex with men should receive the HPV vaccination and should be offered PrEP, DoxyPEP, and an HIV/STD screening.
- Men who have sex with men can be offered screening for anal high grade squamous intraepithelial lesions.
- Women who have sex with women should be informed they still need screening for gynecologic cancers.
- Transgender patients might need management of cross-gender hormone therapy, or their hormone therapy needs to be considered when other medications are being prescribed.
Yet despite our knowledge, many LGBT patients feel ashamed or scared to come out to their doctor for fear of being discriminated against, judged, or turned away. In the case of these patients, it might be especially helpful if their providers come out to them, because it allows an understanding that might evade other providers.
Let’s get back to the original question, though: do patients need to know when their physician is LGBT? I don’t have the answer. I think every LGBT provider out there needs to figure it out for themselves.
But what did I do last year when my patient asked, “Did you and your wife have a nice Valentine’s Day?” I stuttered for a moment and simply said, “Yes, we did, thank you.” Some days, I feel brave. Some days, I don’t feel particularly brave, or I simply want to avoid conflict. Am I proud of my response? No. But I just didn’t feel like making a big deal of it at the time.
What I love about the pursuit of financial independence is that I am taking the steps to not be bound by golden handcuffs or the dilemma of whether to come out to a patient. We are not financially independent, but we are more secure this year than last year. Going forward, if my patient asks if I took my wife out for Valentine’s Day, I’m going to come out and say:
“My husband and I had a lovely dinner at the fancy Italian place in town; it was so romantic. Thanks for asking. I hope you had a nice day as well.
“Now, how is your dialysis treatment going today?”
If you're part of the LGBTQ community, how does it affect you as a doctor? In what ways has being out of the closet affected your finances?
I have discussed this with 15 local seniors, all of us are frequent consumers of health care services. All of us pretty much agree on one point. Of what relevance is the information to us patients? I do not need to know my doctor’s sexual orientation, religious beliefs, politics, or the like. Honestly, I am NOT looking to be friends with my physicians. They are people who I consult with to help me manage my health, nothing more.
If you “come out” to me, I am going to question what your motivations for telling me are and more likely find another doctor.
Then we can safely assume that you and your friends will not be the patient asking their doc personal questions about their Valentine’s Day plans…
First, I find the supposition that if a doctor were to “come out” to you that you would request a change in providers. Let’s play that out in real life. You are about to have a biopsy of your small intestine. The male gastroenterologist comes in just prior to the procedure to discuss your case. You, justifiably, ask him what the recovery looks like and if you should expect any pain in the coming days. He replies, “Typically the recovery is very mild with minimal discomfort but occasionally there can be some abdominal pain over the next 24 hours. In fact, my wife just had this procedure done last week and she was pretty uncomfortable for a day or two afterwards.”
This doctor just “came out” to you about his sexual orientation. You now know something about how he is choosing to deploy his sexuality in a clear and undeniable way. It strikes me as very unlikely that any patient would stand up in that moment and demand to be seen by a doctor that wasn’t forcing his identity politics down everyone’s throat and could just “stick to medicine without all of this political junk.”
More broadly, I agree with you that the vast majority of doctor-patient interactions need no infusion of religious, political, or otherwise “loaded” topics that plague our societal discourse with judgements and discontent. If I am having a colonoscopy, it extremely unlikely the anesthesiologist’s views on the Israel/Gaza conflict are relevant to our one hour together, 55 minutes of which I will be enjoying a propofol induced nap.
However, Adam is describing a distinctly different doctor-patient relationship, one that as a dentist I deeply related to. Some of these medical relationships are frequent and ongoing. Sometimes loaded topics are infused into the conversation and sometimes they are relevant. Sometimes the way I respond to these questions can have a direct impact on whether or not the patient will come back to see me again and thus could impact my personal financial outcomes.
I have been in these situations in the dental office many times. Examples include being asked to pray with or for someone in the operatory before or during a procedure, and being asked who I intend to vote for to ensure their “Obamacare” continues or to ensure “Obamacare” goes away.
Managing those moments with social grace and internal integrity can be challenging. That’s all we are talking about here. It can be hard and pretending like it’s not serves no one. Rather, having a forum to talk safely amongst our peers about these challenges can be tremendously beneficial for providers and patients alike.
This is a community. One of the roles of community is to support each other when we find ourselves stuck, hurt, and uncertain. The better we are at building, broadening, and sustaining that community, the better we will all be for it.
Something I’ve noticed with social media is some doctors air thoughts that make me wonder if it suggests lessened aptitude as a physician.
I’m talking just general things, not necessarily of any political persuasion, that strike me as overconfident / smug. I’m not sure if someone being overconfident in views on social media matters for doctor care as it could be domain specific. It could also be that these people harbor views like this privately and social media is now just making transparent. I’m not talking about stuff that is overtly offensive but more what, if anything, should be inferred from the doctor displaying biases by overconfidently pontificating on non medical stuff on social media and/or conversationally. Emphasis is on biases, not that I particularly care what views otherwise my doctors or colleagues have.
This is straying from the topic of this essay where I think it inappropriate for a patient to be inferring anything from a doctor based on gender / race / sexual orientation etc. I thought this essay was good and thought provoking.
I think it is a tad bit bizarre for one to think they need or want to tell their patients anything about their personal life. You’re human. The patients are human. That’s all we need to know. We should all treat one another with dignity, regardless of which societal constructs we associate with (Yankee fans excluded, of course). You be you and be happy. They be they and be happy. The sooner society stops caring about identity politics the better.