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HomeInvestingDo I Need to Come Out of the Closet to My Patients?

Do I Need to Come Out of the Closet to My Patients?


By Adam Safdi, WCI Columnist

Many 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.

med school scholarship sponsor

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.

doctor coming out to patients

  • 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? Comment below!



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