Betty went to her primary care doctor for depression. She is a 75-year-old retired secretary, and for months she had been unable to eat, sleep or take pleasure in anything. Her doctor took note of these symptoms and gave Betty some Prozac.
Problem is, the doctor didn't get the whole story. He didn't ask specifically, and Betty never volunteered, that her depression began when her partner Judith died. Betty and Judith had shared a life and home for nearly 40 years. They were never open as a couple, had no connections to the LGBT community and were known in their neighborhood as "those two ladies who live in the yellow house." Judith's death meant the end of Betty's entire support system. Prozac just wasn't going to be enough.
Betty's doctor was not able to help her because he hadn't gotten all the information. Not knowing about her sexual orientation and significant life relationship meant missing the whole diagnosis and giving her inadequate treatment.
Medical problems of any sort don't happen in a vacuum. Patients are not just collections of symptoms. Having a doctor who doesn't know you as a person is not only an uncomfortable or awkward experience; it can actually lead to the wrong diagnosis and the wrong treatment. As LGBT people, it is not just a nice thing to find health care providers who are comfortable knowing us and treating us -- it is essential.
BJ is a 22-year-old transgender man who came to the emergency room of a Manhattan hospital after getting beaten up. As a teenager BJ was kicked out of his parents' upstate NY home because of his gender identity, and he has been homeless on and off since that time. The ER doctor treated the cuts on BJ's face, but seeing that he was quite upset and agitated, asked the psychiatrist to see him.
BJ was unhappy to see the psychiatrist, saying he just wanted his face fixed and he was not "crazy." The psychiatrist admitted BJ to the psychiatric ward for his "agitation." During BJ's hospital stay, the staff called him by his birth name of Barbara because they felt obligated to use his "legal" name, they stopped the testosterone he had been on for years because they thought it was causing his "agitation," and they went to court to force him to take haldol. None of the medical staff ever asked BJ what happened or who attacked him. After he was discharged, BJ immediately stopped the haldol and vowed to never see doctors again.
Because of the doctors' ignorance and anxiety about BJ's gender identity, they didn't get basic information about the reason he presented to the ER. They subjected him to a nightmare hospitalization in which his needs were not taken into account, and he was not even called by his chosen name. They fought with him rather than treating him, depriving him of his hormone treatment and forcing unneeded medication on him. Worst of all, they discharged him to an unknown and possibly risky situation. Was BJ's attacker still out there, and was BJ in danger when he left the hospital?
Certainly our LGBT brothers and sisters who are closeted, homeless or otherwise less-privileged and comfortable are more at-risk for such medical mistreatment. But all of us should be aware of these stories. Those of us in the health professions owe it to our LGBT patients to educate our fellow practitioners so that they can give culturally competent and better care. As patients, all of us owe it to ourselves to find LGBT competent providers.
The Joint Commission has issued a guidance document to hospitals for giving competent, sensitive treatment to LGBT people. The Institute of Medicine came out with a report calling for better data on health inequities and healthcare needs of LGBT people. These are not just good policy suggestions. For LGBT people in need of health care (all of us, in other words) they could be lifesaving.