Coming Out of the Closet to My Patients

It was inevitable. Someone would find out and then the news would spread faster than you could say, ‘tweet’. It’s not like I was hiding anything, but, then, I was not actively denying either. When my patient, John, asked me point blank if it was it true, the gig was up and I had to come clean and admit it. I am straight.

I could tell by his crestfallen look that John was disappointed. It was the second time I had seen this expression – eyes a bit narrowed and the corners of his mouth pointing definitely down. About a year prior, he found out that, unlike him, I was not a Christian. Now, he knew, unlike him, I was not gay. Not a Christian, not gay. To John, this was not good.

Maybe John felt duped. My skinny jeans, passion for Kenneth Cole shoes, and knowledge of the lyrics to most every Lady Gaga song, may, in retrospect, have been misleading. I did indeed fly at a moment’s notice to NYC to stand in line at the Met for two hours to see the exhibit of the work of the late fashion designer Alexander McQueen, but I was sure I spotted some other MSW there too- and it was my daughter’s idea we go. I do wear a wedding band on my finger, but then so do half of the Gay Men’s Choir.

I suspect that what really led John and most of my other gay patients to think me also to be gay, was not what I wore or my interests, but that I am a man who decided to be an HIV care provider. They assumed my response to the AIDS crisis was motivated by my sexuality – a call to arms among the rainbow brotherhood - rather than by my medical curiosity or sense of social responsibility. Certainly, there is a historical precedent. In the early days of AIDS, many at the forefront of HIV medical care and research were gay men and women. Often these providers had practices that included gay men and many did answer their own calls to action from their communities. I came along just after that first wave of that clinician response, long after that first MMWR report of a mysterious illness felling young men in the Castro and the Village. As a medical trainee, for me, HIV was less a disease of the gay than an affliction of the young – people my age who were succumbing not to the built-in obsolescence that accompanies old age, but an infection that sucked the once over-flowing vitality out of them.

Of course, to my patient John and many other men, being treated by a gay doctor can be a comfort, just as some women prefer female clinicians. When you share experiences there is not as much to explain. I have been a health care provider to gay men for almost two decades and still I don’t always understand what my patients may be talking about when they describe their dating, social lives, and sex. I rely on gay providers and a few patients willing to share to help clue me in. So, I understand and acknowledge John’s disappointment.

Additionally, gay patients, previously stung by prejudice and discrimination within the health care system may not be willing to give a straight doctor the benefit of the doubt. Some have been scorned overtly by local medical providers and even by providers in our ivory tower academic centers. And, with a ballot scheduled this May to allow North Carolina voters to add an amendment to the state constitution to ban same-sex marriage, potentially threatening some domestic partnership benefits and domestic violence law protections, it is easy to see how many gay men and women may feel under siege.

Straight doctors may also be clueless in other ways. A study published last September in JAMA that examined medical school curricula for instruction in health topics related to lesbian, gay, bisexual and transgender (LGBT) health found that the median time dedicated to such issues was only 5 hours across the entire 4 years of medical education. The authors highlight in their article that LGBT individuals experience significant barriers to health care, despite a number of health disparities including higher rates of diabetes and hypertension. Another study conducted with over 700 physicians in California (of all places) found almost 1 in 5 was sometimes or often uncomfortable providing care to gay patients. As many health care providers are not well versed in how to best apply their skills to LGBT patients, such patients may then naturally gravitate toward those who are, including gay providers.

Soon after my appointment with John, a few other patients came in to clinic and after the pleasantries, told me they heard I was straight. Clearly, John knows more of my patients than I realized. “I always assumed you were gay, doc”, one long time patient told me. Trying to be careful not to offend any sense of my masculinity, he assured me he did not think me particularly effeminate. “Just thought you were because you’re an AIDS doctor”, he confirmed. I am an AIDS doctor and I am proud that my patients thought me a kindred spirit. I am even happier that none, including John, have dropped me for being straight.