Should you come out to your doctor? Maybe.

As a patient, should you come out to your doctor? Maybe. That was my initial thought when writing this piece. Depending on your doctor, coming out may improve your relationship, or make it more uncomfortable.

Recently, I stumbled across an article suggesting that coming out to your doctor leads to improved quality of care. I took a step back and decided to address this topic from the perspective of a 19 year old patient, just coming to terms with their sexuality; then, from the perspective of a 28 year old primary care physician.

At 19 I didn’t know what a top or bottom was. I didn’t know anything about douching, poppers, masc4masc, or PrEP. I was a newbie completely unaware of the ins and outs of gay culture and the sexual health considerations that come with the territory.

When you first come out, there’s no instruction manual, no sorting hat that tells you “top”, “bottom”, “vers”. (If there is some sort of gay initiation ceremony that I missed out on, let me know). Yes, I was a premed student, but, in my experience, health classes provided little to no actual education regarding sex—let alone anal sex or other sex practices more common in the LGBT+ community. I was never taught about HIV, sexually transmitted infections, condoms, etc in high school. My mom still thought I was having sex with women and just told me to always use condoms. Ultimately, I was clueless.

So, at 19 years old, I decided to go to my doctor and finally discuss my sexuality openly. I was incredibly nervous that some older, straight, white man was going to judge me. My entire life up to that point was filled with a litany of homophobic experiences. Funny enough, I later realized my doctor was gay and catered to a mostly gay patient population. In retrospect, the framed broadway posters and ticket stubs around the office should have been a clue.

“Are you sexually active with men, women, or both?”
“Both” I quickly said, nervously with a mild stutter.
“Well look at you! Taking a bite from both fruit!”

I died inside. My eyes quickly shot to the ground and I immediately regretted this. Eventually it got a little less awkward. We discussed sexual health-related questions and by the end of the conversation he told me I needed to get tested for gonorrhea, chlamydia, syphilis, HIV, and get an anal Pap. My heart immediately sunk and felt like I did something wrong. I just disclosed to my doctor that I was a “virgin” and discussed my few sexual interactions—something I had never done with anyone else. Why did I need to get tested for all these things? Why was I suddenly filled with anxiety and guilt?

Looking back and reevaluating the whole encounter, I can’t help but laugh at myself. My doctor was obviously gay and I had no idea. He made jokes and comments that I was so uncomfortable with at the time, but were funny and made in an attempt to put me at ease. I just took myself way too seriously. I was young, insecure, had zero self-awareness, severe Catholic guilt, and no understanding why I needed these tests. I honestly believed I was immune from any STI due to my delusions that I was a pure, holy virgin. Again, my sex education thus far was solely based on preventing pregnancy. Eventually, I got over it and continued seeing this same doctor.

So when you ask me if you should come out to your healthcare provider, I have mixed feelings. Today, I laugh at my doctor’s jokes and get his sense of humor. At 19, I thought I was bi and “straight passing”. But now I’ve come to terms with the femme Latino queer I am today.

Essentially, it’s a two-way street. As a doctor you have to know how to read a room; a skill that many physicians lack. I wish my doctor told me why I needed those tests—explained to me what STIs were, what HIV was and how gay men are at increased risk; and why I needed an anal Pap smear even though I don’t bottom.

As a current physician, I think about how I can try to make other patients’ coming out experience better. As healthcare providers, we get stuck in this routine of just telling people what they need to do, instead of explaining why. Primary care is meant to be a partnership. You weigh the risks and benefits with your patients, and after giving your input, the patient will make the final decision.

After writing this piece, I’ve come to the conclusion that you shouldn’t have to “come out” to your doctor. You should go to a doctor who you can be comfortably out with. When you come to terms with your own sexuality, bring up these topics with your doctor. Chances are, many providers won’t bring it up otherwise.

If you want to find a healthcare provider who is comfortable with LGBT+ patients, check out the GLMA Provider Directory. And if you want to learn more about LGBT+ health topics, check out my Instagram @doctor.tellez