Why it’s important and how we can get it.
“Love and compassion are necessities, not luxuries. Without them, humanity cannot survive.”
—Dalai Lama XIV
Let's face it: Non-judgmental, thoughtful communications that foster open and honest delivery of healthcare is a human want and right for all, yet there is a clear and continued divide on how it is orchestrated and executed for the LGBTQI community.
Patients within any community demand a basic understanding of their values and ethics, and tend to surround themselves with others like themselves. This is a pure and comforting second nature. Specifically within the LGBTQI community is the need for physicians to dive deeper into our lifestyles and sexual practices with sensitivity and knowledge in order to truly affect positive change. The importance of medical providers who understand the intricacies and nuances of gender, sex, and all aspects of sexual relationships is paramount to the success of this deliverance.
What should my doctor know?
Asking the right questions, spending the quality and well-deserved time, and leading the discussion with a high-level awareness of continued sensitivity is crucial to enhanced services for patients.
It’s imperative for physicians and specialists to have an understanding of:
The intricacies of anal intercourse and minimization of injury
Yearly preventative evaluations and maintenance
Knowledge of the myriad types of relationships and the inherent risks of each
The best methods to approach safe encounters
Utilization and management of PrEP with diverse knowledge on its appropriate indications and the controversial ethics
These topics and more all lead to cohesive and expansive discussion—and are just a part of the important sensitivities and niche knowledge that is required not only by practicing LGBTQI physicians, but all, in order to serve the community’s needs to the fullest.
What should I be asking my doctor?
As members of the LGBTQI community, it is also our responsibility to be asking all the right questions to our primary physicians, including the following:
What medical training or cultural sensitivities do you harbor as a physician taking care of a gay or bi male or female?
How do you tailor your care to individualized homosexuality and, more importantly, a modern family and all of its dynamics?
Based on the sexual activities I engage in, what should I be concerned with and what preventative measures should I be taking?
What tests should I be getting if I’m a top, bottom, or versatile?
How can I comfortably approach a “tabú” topic with my doctor?
Despite the general consensus of sex, especially as it relates to LGBTQI relationships, being a taboo and often unapproachable subject, it’s important that we take the necessary steps to familiarize our physicians with the subject in an effort to increase awareness and improve healthcare, while also destigmatizing the subject in general. While it’s impossible to guarantee that your doctor will be comfortable speaking to the subject and will approach the subject with sensitivity and lack of judgment, the more we openly discuss the topic and advocate for affirmative healthcare, the more normalized it will become. Persistence is key and though it’s about taking small step after small step to achieve the greater goal, progress is being made.
How does this relate to the healthcare industry as a whole?
Providing sensitive care doesn't come without shortcomings or making mistakes, but analyzing these failures and addressing the issues allows for the humane side of the elevated doctor-patient relationship to develop—a lost art, yet the most crucial. This all sounds amazing in theory, but how do we do it or become a part of it? It's not an easy fix when the problem lies in the current model of healthcare.
High-quality care with thoughtful communications equals elevated costs, and with decreasing levels of insurance and the loss of government funding, how does one continue to provide these much-needed services? When you deliver care through a volume-based model, the delivery becomes clinic-oriented with single-pathology office visits that only allow for a snippet of time and corrective, mostly reactive planning. Within these clinics there are enormous amounts of moving parts—the more parts, the more errors. The more errors, the more patients who come to receive subordinate care. So, what about the aforementioned example of the quality model—the one that hits all the marks? The reality is that only a small subset of people can actually afford that model. Of course, it's the model everyone desires, but this leaves us open to ongoing affordability issues and the argument of class wars.
Can doctors and healthcare services deliver appropriate, elevated community care at all levels with the sensitivities and understanding we all need?
It’s still to be answered, but education continues to be of utmost importance to all that are involved in delivering healthcare, and it’s imperative that it goes further than just the provider.
We talk so much about these sensitivities, but it needs to be understood that it starts from the second someone attempts to make an appointment with the receptionist, to the way they are greeted and addressed when arriving at the office. Being sensitive and understanding of all this community has to offer doesn't have to be based on monetary value. Setting the appropriate tone of mutual respect with complete understanding allows for comfortable communications to be fostered. With comfort comes honesty and with honesty comes respect and positive change. There needs to be a clear line delineated between sensitive and community-specific care, with all providers and physicians being aware and educated in order to offer the best care around the nation, not just in major cities. We need this more than ever in this next unforgiving chapter of healthcare.
Header image illustrated by Marcy Gooberman
Dr. Evan Goldstein is the Founder and CEO of Bespoke Surgical, the leading private practice specializing in an elite standard of sexual health and wellness care for the modern gay male.
As the preeminent leader in the field and with offices in both New York and Beverly Hills, Dr. Goldstein offers concierge-style medical and surgical expertise to the gay community and is dedicated to not only bringing the important issues surrounding gay sexual health to the forefront, but also eliminating stigmas around gay sexuality.