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Doctor phobia: even though they're out to family and friends, many gays and lesbians still fear coming out in their doctors' offices. As a result, they're not getting the best care.

Andy Rohr thought his primary health care provider--a Harvard graduate and staff physician at renowned Massachusetts General Hospital--looked great on paper. But, after the 27-year-old Boston resident revealed that he is gay, the physician unnecessarily and callously pushed an HIV antibody test on him and was exceedingly cavalier about the results, telling Rohr that if the news was bad he would call the next week between Monday and Wednesday. "Every time the phone would ring, it was just traumatic," he recalls, "When I walked in [to that doctor's office] I wasn't worried at all, and I left really scared. Because he's a doctor I trusted what I thought would be his better Judgment."

Openly gay Chuck Millis, 43, of Wilmington, Del., was told by a specialist that he needed to take an HW test--and be proven uninfected--before the physician would consider performing surgery to ease painful bowel problems. "Not only was I mortified, I was practically hysterical and informed him that by no means would I even consider letting him perform anything on me," he recalls. "And I left."

Rohr and Millis are not alone in being treated poorly by seemingly homophobic health care professionals. That could explain why many gays and lesbians are choosing to remain in the closet with their doctors, experts say, and are falling to get adequate care as a result. "If we lived in a world where homophobia didn't exist, every gay man and lesbian would disclose their sexual orientation to their health care provider," says Mhel Kavanaugh-Lynch, a physician and president of the Lesbian Health Fund, a program of the Gay and Lesbian Medical Association, "Unfortunately, homophobin remains a stark reality, both in and out of health care settings."

Despite working in the medical profession, Kavanaugh-Lynch also is reluctant to come out to some of her own doctors. The 44-year--old from El Ceritto, Calif., says she takes several factors into consideration when deciding whether to reveal her sexual orientation, including if it's a one-time visit to a specialist or if her condition requires her to talk about her sexual practices. "I'm not sure it's always wise to come out to every provider you see," she laments, and that's a sad thing to have to say.

A December 2002 study by Witick-Combs Communications-Harris Interactive showed that more than half of all gay, lesbian, bisexual, and transgendered Americans don't reveal their sexual orientation to their doctors. And while the masons for remaining in the health care closet aren't fully understood, many gay health experts believe a unique "don't ask, don't tell" situation is created between physicians and their patients through three key problem areas'. Doctors are typically poorly educated about gay health issues, gay patients are typically unaware that they have unique health risks, and real or perceived homophobia among physicians.

"I've heard gay and lesbian people ask, 'What difference does it make if he knows what I do in bed? I'm Just here for a sore throat,'" says David Haltiwanger, the openly gay director of clinical programs and public policy at Chase Brexton Health Services, a gay-oriented Baltimore clinic, "Well, that sore throat could be gonorrhea, and the physician is going to be much less likely to diagnose that than if you were candid and said you've bad oral sex with several men."

But a fear of talking openly about sex is precisely what keeps so many gay men and lesbians from disclosing their orientation--or even visiting the doctor in the first place, suggests Patricia Robertson, codirector of the Lesbian Health Research Center at the University of California, San Francisco. In fact, it's one of the key reasons--in addition to being less likely to have health insurance and having lower incomes--why lesbians in particular are believed by some clinicians and researchers to be far less likely than straight women to seek regular health care, particularly preventative medicine. "If this is indeed happening, it can have serious health implications," says Susan Ball, a physician and associate professor of medicine at Cornell University's Weill Medical College. "For women, that means not getting your regular Pap test; for women over age 40, that means not getting your annual mammogram. As you get older you also need to check your cholesterol, you need to get colonoscopies. All this stuff is important."

Most practicing physicians have had only a few hours training in talking sexual histories for both say and straight patients, says Robert Winn, a physician at Philadelphia's gay-focused Mazzoni Center. And the health care profession overall is failing to provide an inclusive environment to gay patients, adds Les Gallo-Silver, director of clinical programs at New York City's Cancer Care. When filling out an information and medical history form, patients are typically asked to check a box to indicate their marital status. The options almost always consist of "single," "married," "divorced," or "widowed," leaving no option for partnered gays. For female patients, the paperwork also commonly asks what form of birth control is being used, which is a nonissue for many lesbian patients. "I get really pissed off at the forms," says Lisa Zimmerman, 33, of Selden, N.Y. "I'll cross out 'married' and write in 'partnered.' Next to birth control I'll write 'not necessary.'"

Intake forms with a built-in heterosexual bias also can unwittingly mislead doctors, notes Winn, who is bisexual and currently married to a woman. He says his doctors automatically assume he's heterosexual when they learn he's married. "And based on that, they assume they know everything about my sexual practices, now or in the past, and no one ever delves into my past," he says. "I have to tell them if I want them to know."

Despite all the trepidation surrounding disclosure, most doctors are unfazed when learning of their patients' sexual orientation, argues Cheryl Pearson-Fields, deputy director of the Mautner Project, an organization devoted to preventing cancer in lesbians. "Front my experience," she says, "the vast majority of providers aren't homophobic; they just don't know they have gay and lesbian patients, that their gay and lesbian patients have unique needs, and that they're not meeting them."

The medical profession is gradually improving, says Winn, who teaches at Philadelphia's Thomas Jefferson University. His school now offers a half-day segment to first-year medical students on gay health disparities. And groups such as the Gay and Lesbian Medical Association, the Mautner Project, and the Lesbian Health Fund are reaching out to medical professionals. Health care provider Kaiser Permanente has even crafted "A Provider's Handbook on Culturally Competent Care: Lesbian, Gay, Bisexual, and Transgendered Population," a 72-page booklet to formally educate its medical staff on gay health issues, Allerton says.

But there's still a long way to go, says Barbara Lewis, a lesbian physician's assistant at Washington, D.C.'s renowned Whitman-Walker Clinic. Even at Whitman-Walker, which has a 30-year history of working with gay men, lesbians, and AIDS patients, there's room for improvement in combating homophobia. "It's kind of outrageous that people working in an HIV clinic would have trouble talking about sex and sexual orientation. But we do," she says. "We need more training around this."

Haltiwanger agrees. He says one of his clinic's lesbian clients came to him after a former health care provider "talked about her lesbianism using terms like 'your dirty little habit' and compared it to heroin addiction. And that wasn't in the dark ages," he says. "It was within the last five years."
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Title Annotation:++Health
Author:Adams, Bob
Publication:The Advocate (The national gay & lesbian newsmagazine)
Geographic Code:1USA
Date:Aug 31, 2004
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