Coming Out to Your Doctor 

Approaching forty can be a pivotal moment in the life of gay men. It is a time when many men take a long hard look in the bathroom mirror. Their inspection may reveal that once soft, brown, wavy hair has become overpopulated by coarse, wiry, gray ones, and that dark circles of stress under the eyes, which normally vanish with some sleep, have now been tarnished with time. Further inspection -- a complete 360- degree view of oneself (which is recommended periodically so you are not suddenly taken aback one day when you catch sight of your backside in a department store dressing room as you try on a new bathing suit) -- may reveal that age is catching up to you. Gravity has convinced your waistline to soften, and the dreaded fear of back fat has begun to rear its ugly head. Is there anything you can do?

The two most useful promises you need to make to yourself at forty are these:

• Pay closer attention to your diet and exercise routine.
• Start a strict daily facial regimen.

Parenthetically, the changes going on with the outside of your body may ignite a fuse of fear that something even more insidious is going on inside, waiting to explode. The question becomes: "How healthy am I?" (The only way to know is to seek a doctor's opinion.) Then, as a gay man you should think, "What should I look for in a doctor?" or more important, "Should I find a gay doctor?" (The answer is yes!)

Historically, homosexuals have avoided health care or remained closeted to their health- care provider due to the threat of homophobia. Doctors are notorious for being judgmental toward their homosexual patients, simply because they are uncomfortable with the gay lifestyle themselves. Many straight doctors I've talked to make the same errors that I made initially as a young general practitioner -- they unknowingly label their patients and try to categorize them. We all do this in our everyday lives. It makes us feel comfortable.

Questions involving sexuality may be regarded as an invasion of one's privacy, especially when asked on the initial visit. Asking a patient, point blank, if they are gay or straight creates an immediate barrier between the patient and the doctor. Regardless of their sexual orientation, forcing someone to "label" themselves can be perceived by the patient as a form of judgment. To corner a patient in such a manner can make them feel vulnerable. Dr. Lawrence Higgins, one of the best medical mentors I had the privilege of training with, once warned me about labeling patients. He suggested that the more appropriate way to elicit a sexual history from a patient was to fi rst 6 ask them, "How frequently they have sex with women and men?" A November 2006 article published in the Journal of the American Medical Association suggested that doctors should ask their patients the question, "Do you have sex with men, women, or both?" Simple adjustments such as these are far less confrontational to patients and open the door to discussion. This approach also suggests that the doctor is nonbiased and understands that people are sexually active in different ways. Included are bisexuals as well as a subgroup of heterosexual men who sometimes engage in sexual activity with other men who do not consider themselves bisexual. Sexual desire is particularly important to discuss, especially for men who are not comfortable discussing sexual acts as they pertain to an identity. For example there is a subgroup of African- American men who consider themselves heterosexual yet they participate in sexual activity with other men. This concept was brilliantly realized in J. L. King's book, On the Down Low: A Journey into the Lives of "Straight" Black Men Who Sleep with Men. The importance of these issues is not to exclude men by categorizing them as homosexual, but rather to adopt the more appropriate term, MSM, or men who have sex with men.

Some men desperately want to come out to their doctors. It may be a good idea in such cases if the doctor asks if they have ever felt an attraction to another man in order to provoke a conversation. It is important to keep an open mind because men come out at all ages and some may even be married and have children. This can be an even more difficult process for men who are already a member of a minority group -- racial or religious. Imagine the impact of being both a sexual and a racial/religious minority in your country. Finding your identity as a gay man is complicated enough; having to integrate this with your existing persona involves quite a bit of ingenuity. It is difficult to quantify the number of gay men who live in the United States. Several studies have attempted to estimate the prevalence of homosexuals. In 1994, E. O. Laumann found that 2.8 percent of all men described themselves as gay, whereas in the same report revealed that 9.1 percent described themselves as having had a same- sex sexual encounter. This statistic reiterates the fact that there are men who do not identify themselves as gay for many reasons. While some men will eventually identify themselves as gay, more do not because of internalized homophobia, bisexuality, and racial prejudice.

This has forced clinicians into creating the aforementioned term, MSM.

In light of these issues, it may be best for doctors to stop asking all patients if they are "single, married, or divorced," as these categories are too narrow. Many gay patients, even those who are in a long- term relationship, do not consider themselves "married." Marriage is a legal entity that does not exist for homosexuals, many of whom say that they are single, despite the fact that they are in a long- term relationship. Partnered is a more suitable word because it is important for doctors to come across as gay friendly, even if you are a gay doctor. One of the most important aspects of a great doctor-patient relationship is trust. A physician should always encourage patients to tell the truth: "A doctor is not your mother and not the police. He or she is there to help you, and without the truth, a doctor cannot help you." Most patients would feel comfortable with this approach, and it makes a doctor- patient relationship a bit easier. Linked with the idea of trust is honesty, which is why you should come out to your doctor. All gay men are urged to do so. Some people argue that their sexuality is something that they feel they do not need to disclose to their doctor, but this is nonsense. Your sexuality and your lifestyle are important contributing factors to your health. It is vital that your doctor understands everything there is to know about you. Coming out to your doctor should not be burdened by shame, and if your doctor is not comfortable with treating homosexuals, then you should find yourself a new doctor.