I went to the doctor today for a regular checkup. Since my last "home" doctor was in Washington, I go to school in Massachusetts, and I'm living in New Jersey this summer, I had to go to a new doctor. I haven't been to any doctor in a while, so I was nervous about going. I was also nervous about giving my medical history, especially the part about sexual activity. I'm a sexually active woman. But I'm also sexually active with a woman, and it is daunting to have to disclose my sexual orientation to a stranger whom I have to trust with my body and health. (The first time after I became sexually active that a doctor asked me about it, I said I wasn't sexually active just so I wouldn't have to go through that ordeal. Not my finest moment, I admit.)
So the doctor I saw gets:
+30 points for asking me whether I'm sexually active with men or women
+20 points for reacting neutrally to my answer
-20 points for not asking me if I use protection
-20 points for thinking pap smears are irrelevant for young gold-star lesbians
+20 points for suggesting I get the HPV vaccine
...For a total of +30 sexual orientation competence points.
Her office had me fill out a lengthy, annoying questionnaire about my medical history. The office gets:
+10 points for using the word "sex" to ask about physical sex
+20 points for formatting it so the patient can write in "F," "M," or "I"
-30 points for not including a separate question about gender
...For a total of 0 gender competence points.
Which cursory, informal assessment leaves this particular clinic with a total of +30 lgbtq competence points, on an arbitrary scale yet to be determined. I'm sure I would have more to talk about if I were trans; since I'm cis, my actual medical care does not involve trans-specific issues, so I can't comment on how well the doctor I saw would handle them.
All this is simply to highlight the fact that it makes a difference when doctors and other health care providers are competent in talking about and dealing with lgbtq issues, even when those issues aren't directly related to health. In my case, I was relieved when my doctor asked about my sexual orientation, and her good response allowed me to be more open about my health. This in turn allowed her to do her job better, and means that I am more likely to receive adequate medical care. On the other hand, her failure to ask about protection and insist on regular pap smears leads me to think that her medical knowledge about lesbian sexual health is limited to common knowledge that assumes pap smears and protection are unnecessary for women like me.
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The problem I always have with doctor visits are that in some ways my body resembles that of a woman (making stuff like pelvic exams/pap smears relevant), but my hormones are in a normal male range. So what am I supposed to tell them? It's never been made entirely clear to me what information is medically relevant and when.
ReplyDeleteI guess what I'm trying to say is that the question of disclosing/not disclosing to a doctor is a little more complicated than sex/gender boxes, because physical sex is a little more complicated than just a person's plumbing, and it makes me very sad that there's such a knowledge vacuum with this stuff.
It's also been fun for me to explain (at various stages of my transition) to doctors that the fact that I said I was having sex with a man did not necessarily mean having sex with a cis man. Which is a whole other can of cissexist worms. Sigh.
Oh believe me, I am not at all trying to say that my assessment of gender stuff at the doctor's office is complete. Like I said in the post, I'm not really in a position to evaluate how this particular office/doctor treats trans and other complicated gender issues beyond what shows up on the preliminary forms, which to be completely honest are not very nice to anyone. (Lots of unclear questions, demands for information no sane person has memorized, vague questions that make it impossible to give accurate answers, etc.)
ReplyDeletePart of what I'm trying to get at in this post is that it is nice when doctors show inklings of competence in dealing with people who are not hetero- and/or cis- sexual, and there are lots of ways in which they really need to be much, much better educated and prepared to do so.
Amen.
ReplyDeleteI really like that you tallied and considered how LGBT friendly they are, I should totally analyze and consider that next time I go.
ReplyDeleteThanks, Q.U.! It's all very informal, of course, but I realized I was thinking about it, and then I realized it was important that I was thinking about it... It sounds weird to say that sexual orientation is an important factor in a routine medical check-up, but it is! And gender identity even more so.
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