The Ins and Outs of Gay Sex (43 page)

I
had been struggling with my own sexuality for quite some time, and I had not yet come out on a professional level.
In the midst of my emotional turmoil I developed a Bell’s palsy, or paralysis of one side of my face.
Being a physician, I immediately thought the worst and assumed I was in the midst of a lethal stroke.
I sought emergency medical attention from a well-respected colleague of mine.
The doctor, although not gay, had a reputation of being gay-friendly.
Like many gay men who hide their sexuality, I struggled with whether I should admit my homosexuality to the doctor.
I knew that in rare instances Bell’s palsy could result from AIDS and my sexuality might be important.
In the end I vowed to finally tell the truth.

“
Come on in, Steve,” he called out across a room crowded with patients.
His warmth was genuine.
He tapped my cheek and pronounced “Bell’s palsy” even before we reached the examining room.

“Are you sure that’s all it is?”
I asked as I edged up onto the table.

“Pretty sure, but let’s do this right.
First a medical history, then a complete exam.
We’re going to pretend you’re a patient and not a doctor.”

This was fine with me.
When doctors get sick, all of their medical
training goes right out the window.
I wanted him to pretend I knew nothing—which at the moment was absolutely true.

He asked straightforward questions regarding my drooping cheek and unblinking eye before moving on to an inventory of illnesses I’d had in the past.
So far my sexuality remained hidden, and I kept looking for an opening to bring it up in case he never asked.
When he closed my chart and tucked his pen into his breast pocket, I thought he’d finished asking questions.
I cleared my throat and took a deep breath of courage.
I was going to admit something for the first time.

The tone in his voice as he said “And of course you’re not gay” stopped me cold.

I laughed with him while once again listening to the latest “fag” joke—for the last time.
He took care of me that day and then I found a new doctor, someone who was gay-friendly not only in practice but in heart.

Medical care is changing, and so are doctors’ perceptions of homosexuality.
Although the AIDS epidemic has done great harm to the gay community, it has also accomplished some good.
In addition to mobilizing us into a cohesive political force that can no longer be ignored, it ushered in an era of gay medicine.
For the first time physicians were paying attention to gays as a unique group with our own unique problems and needs, in ways previously reserved for the elderly (geriatric medicine), women (women’s health), and adolescents as a subset of pediatrics.
True, gay healthcare initially focused on AIDS, but out of that grew AIDS prevention and healthcare directed at wellness instead of illness.

AIDS forced gay men out of the closet and forced doctors to realize that many of the “normal” men they had treated for years were, in fact, gay—and it made no difference at all.
We learned that if it was okay to walk into a doctor’s office as an openly gay man to be treated for AIDS,
it was also okay to walk into that same office to be treated for the flu or high blood pressure or any other problem.
The difference was that now we could be treated under an umbrella of honesty—both with ourselves and our physicians.

Not only has the AIDS epidemic liberated gay patients from this medical closet, it has also liberated healthcare workers.
Suddenly AIDS allowed physicians to admit their own homosexuality, with many finding their vocation treating gay men and women—and not just for AIDS.
We see openly gay plastic surgeons (who needs more work than a queen?
), dermatologists, surgeons, psychiatrists—specialists in every field of medicine now cater to gay patient populations.

AIDS has also forced insurance companies, health maintenance organizations (HMOs), and numerous other ancillary services to take note of gays.
Now domestic partners can obtain health coverage under some plans, and insurance companies in urban centers market to gay communities.

Gay healthcare has made great strides during the AIDS epidemic, and there is no longer any reason to go to a physician with whom you can’t be honest about your sexuality.

Today many gay men can choose whether to see a male or female doctor and even one who is gay or straight.
I am not saying that every gay man should be cared for by a like-minded physician.
A straight doctor is certainly capable of treating gay patients in a nonhomophobic environment—just as women have received excellent care from male physicians.
The key to any successful doctor-patient relationship is mutual respect and trust.
If you have this with your doctor, then it does not matter if it’s a he or she, gay or straight.

While your sexuality does not define every medical condition you might someday face, there are certain gay-specific issues that you may need to discuss with your doctor.
For instance, your high blood pressure can be treated by any internist, but rectal bleeding after anal sex may be difficult to discuss with a straight doctor—just as it may be difficult for some straight doctors to hear.
As we all know, not everyone who seems open and free from homophobia really is.
One way to determine if a potential doctor is right for you is to ask friends who have seen him (or her).
If they tell you that they never discussed sexual issues, or that when they did, the physician seemed uptight, it is probably best to look elsewhere for care.

By the same token, not every gay physician will be right for you.
Gay doctors can be just as homophobic as straight doctors, and the mere fact that they’re gay does not mean they dispense quality care.
Your doctor’s clinical judgment, intelligence, and ability to relate to you are far more important than his or her sex and sexuality.

You also can find a gay or gay-friendly physician through a gay and lesbian switchboard.
Many doctors actively court the gay community by listing themselves with these services.
Gay-friendly doctors also advertise in local gay-specific magazines or yellow pages.
Other than word of mouth (which is probably the best recommendation) these are the most common ways for doctors to reach out to the gay community.

Calling your local hospital to ask for a recommendation is also a good way to find a gay doctor.
While the hospital may not specifically maintain a listing of homosexual physicians (although it may), chances are it can tell you who specializes in HIV treatment.
The doctor recommended may not be gay, but there is a high probability that whoever it is won’t be homophobic.
Even if you don’t have HIV you probably will be welcomed as a patient.

National hot lines, the Internet, and the Gay and Lesbian Medical Association are other good sources for finding gay or gay-friendly physicians.

If your community has no gay or gay-friendly physicians, find the closest one to consult with on gay-related health issues.
It might be worth your while to travel manageable distances on those occasions when you want to discuss a problem you can’t tell your local doctor.
Even most rural areas have been affected by the HIV epidemic, and you should be able to find someone close by who is at least gay-friendly.
I have received phone calls from men around the country with questions they can’t ask their community physician.
This is one of the few situations when I am not opposed to telephone medicine.
Most doctors will answer your questions, tell you if your problem could be related to your sexuality, and try to refer you to someone who can help.
So if you can’t travel to a doctor you’d feel comfortable with, try picking up the phone and calling.
Just don’t abandon your community physician, whom you’ll want to see for routine medical problems.

There are certain qualities to look for in any physician you choose.
And remember that the important phrase is “you choose,” because healthcare today is like any other service-oriented industry—it is competitive, and you, the consumer, have the right to make a choice.
Even HMOs with strict provider lists usually afford some choice by offering more than one physician in each specialty.

Do not go to a doctor you don’t like or can’t be honest with.
He or she may have the reputation as being the best and the brightest, but it’s better to find someone you can relate to on a personal level.
Most ordinary medical problems require the services of a
good
doctor, not some world
expert who can’t look you in the eye.
Any good doctor knows when your problem is beyond his or her abilities and will be honest about it.
Chances are that situation will never arise.

A big question facing many patients is whether to seek a doctor through a clinic or a private office.
Private offices generally offer more personal care and allow for a close relationship with your doctor—but not always.
Some practices have become so large that they are nothing more than healthcare factories.
For some of us the word “clinic” conjures up images of dirty booths, with desperately ill, indigent patients who wait hours for treatment.
While this is the case in many facilities, more and more clinics resemble posh doctor’s offices dispensing quality care, and you should not count them out.
Stay away from any clinic or doctor’s office where you cannot see
one
primary physician at least most of the time.
There will be occasions when your doctor is away and you are treated by a covering staff member, but this occurs even in single physician offices.
If you see a different doctor at each treatment, you forfeit a chance to forge a strong doctor-patient relationship.
This is important, especially when you are being treated for a chronic illness.
Not only will your relationships with your many physicians suffer, but so too might your medical care.
Each visit with a different doctor necessitates spending time reviewing your chart.
If the doctor is rushed, important points might be missed.
Any lingering questions may still not be answered, or you’ll have to spend valuable time reviewing all that has come before.

Although clinics may lack the personal touch of a private office, many are multispecialty sites where you can see doctors specializing in almost all areas of medicine.
This may be a plus if you see a range of different specialists (an internist for high blood pressure, a gastroenterologist for an ulcer, and a plastic surgeon for everything else!
).

Some clinics are staffed by residents in training from local hospitals, and this may not be what you want.
While residents are always supervised by an attending (certified) physician, your primary care is dispensed by a doctor in training.
Most residents are excellent physicians and may be more versed in newer methods than more established doctors.
Residents, however, train on average for three years and leave, so you’ll be reassigned and have to start building a relationship from scratch.

In addition to offering more personal doctor-patient care, a single-physician office or small group practice may foster a closer relationship with other healthcare workers.
This may sound like a trivial matter, but many patients rely on smart nurses and secretaries to answer simple questions over the telephone.
If office personnel know you, they can expedite paperwork and simple matters like prescription renewals without demanding that you first speak to the doctor.
Staff members often can get to the doctor more quickly than you can, and you’ll waste less time waiting for medication or that disability check.

Patients on disability (with Medicare insurance) tend to think that a clinic is their only healthcare option.
While this may have been true in the past, today most private physicians accept Medicare.
If you have Medicare, call the physician you’d like to see and ask if he or she will take your insurance.
Don’t assume you’re relegated to clinics.

Unfortunately, the same is not true for many men on public assistance or welfare.
Most private physicians will not accept this type of health coverage because of low reimbursement rates.
Still, it’s certainly worth a phone call to inquire.