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Thoughts On Some Doctors' Biases On Gay/HIV Patients?

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RobbyR:
Here is an interesting and relevant question I'm wondering, as an openly gay poz guy, to what degree do many doctors have conscious and subconscious biases and negative prejudices about us? I am a pretty intuitive person, and am very fortunate to have strong, capable infectious disease doctors, but as anyone who is poz knows, sometimes unforseen health issues arise that require specialist care, or referrals.

Of course, when this occurs, the doctor looks at our sexual orientation and hiv status. When I had shingles, I went to the ER and was fortunate to have a very sweet, caring young doctor who listened to me and made me relaxed and didn't make me feel rushed or ill at ease about being openly gay or positive. In fact, in most cases, it's not an issue at all. I've been lucky in most cases.

However, a couple of times recently, I had to see a colorectal specialist, who I had not seen before, and he was a bit older, and it seemed to me he was a bit distant and brisk with me, like he was being overly scrutinizing or a bit stand-offish. He seemed competent, just a bit aloof and made me feel a bit like I was a burden. I just sort of got the vibe that he was thinking "it's your own fault your having these rectal issues, because your gay, and you took it up the ass". To put it bluntly lol.

Of course, I know some doctors just have a very distant aloof personality, but I feel like one shouldn't have to settle for that. Especially in the case of having to see a specialist for specialized care, in such a sensitive embarrassing area as rectal care, I feel like they should be much more sympathetic and understanding to gay men and for that matter hiv-positive people.

Just wondering, to what degree do you think there is bias among doctors today, particularly specialists, about gay, positive patients? Of course, if one needs some type of specialist care, as I did with rectal issues, it is ideal to seek out a gay-friendly, hiv-poz knowledgable doc. But it's not always possible to find these.

I guess all one can do is ask one's primary care doc if he/she knows any specialists who are gay-friendly if one needs that kind of care. I definately would suggest that.

I live in a very red state, albeit in a fairly blue city, but it is still a roll of the dice if specialist care is needed, in regards to finding a provider who is sensitive to gay/hiv related issues. Anyone else have some thoughts on this?

CLP1972:
Robby,

I am SO eager to address this issue...for many reasons.  You can check out a couple of my other posts on similar topics.  Being gay, poz, and a physician, I can tell you first hand, that this is a VERY real issue.  I have been looked down upon by other medical "professionals".  I can remember when I seroconverted and was in the hospital (feeling like death warmed over), my diagnosis came when an ID doc walked in at 0630, flipped on the top light, and said "well, we aren't totally sure what's going on, but I need to tell you that your ELISA came back positive"...and just that bluntly.  It should be noted that I went to a different hospital than where I practice.  He was fairly gruff with the delivery.  He didn't have to say anything further, he knew that I knew what he meant.  The feeling as if ice water had been poured into my IV, stayed with me the rest of the day.  He said that he had another doc a couple weeks prior who had a false-positive ELISA, so not to worry about it until the WB results were back later that same day (luckily, we have a quick turn-around).  That night, I overheard the nurses giving report and saying, "Yeah, that's the doctor that has HIV in there".  I felt as if I had been stripped of my humanity and was now just being referred to as my disease.  Not only that, their tone was as if they were saying "he of all people should know better, and he deserves what he gets".  That night opened my eyes to listening, really listening, to how my peers/colleagues referred to my new culture...my new brothers and sisters.  The next day the results of the WB were negative, but he said he wanted to draw a VL & CD4, "just to be sure".  I got the results 3 days later...VL >500k, CD4 256.  The next day the WB was repeated and came back positive.  I started meds 2 days after confirmation.  Anyway, since then, I've been really surprised at how some colleagues refer to patients with HIV, and it's not only hurtful, it's disturbing.  Your doc is the one person with whom you should feel comfort in sharing anything, without fear of judgment (same goes for the RN's, techs, etc).  Not always, but WAY too often, this is not the case.  Other than fear and lack of education (yes, most doc's aren't educated well on HIV), I can't explain their behavior.    As a poz doc, I feel like there are times when I have NO ONE to turn to for support.  HIV needs more "faces" representing our disease.  People that show everyone that it doesn't matter your race, religion, education level, etc...EVERYONE is susceptible to this disease.  And, although developing HIV wasn't my "perfect plan", I honestly think it has made me a better person.  As my Momma always tells me "Someone always has it worse than we do"...which is SO true!  The hard part for me is that each state is different about their regulations pertaining to poz docs...some states say that, regardless of my almost non-existent chances of exposure to a patient, that I have to advertise, in writing, my status, so that all potential patients know prior to seeing me.  And, studies have shown that if given a choice, only 30% of patients would opt to still see a doc that was poz...regardless of how good they are at what they do.  The thought of losing everything that I have spent the majority of my life training for, and the inability to repay the 200k that I owe in student loans, is very scary and concerning to me.  If I didn't have to worry about that, I would LOVE to be a face for our culture, to educate and fight the stigma.  In the meantime, until that day when the laws catch up to the reality of the disease, I have to be satisfied trying to educate other docs in a positive manner.  I want to be a doc that caters to a gay clientele and, more specifically, a poz clientele.  Our poz and gay community is a wonderful and warm group of people, with huge hearts, huge fears, huge concerns, and a huge amount of scrutiny.  PLEASE, if someone hears a medical professional talking in a derogatory tone about our culture, say something to them, or say something to their boss/partner.  Also, we need to fight the stigma of a lot of those in our gay community...the ones whom one would assume to be the most accepting of poz individuals.  We have a LOT of work, but I'm optimistic that it can be done.  Only when we stand and fight will we win.  And, together, we WILL win this fight!!  Thank you again, so much, for addressing this issue.  Take care!

buginme2:
Maybe this is a regional thing.  I have always been treated with the utmost respect.  in fact I have noticed when I tell an unfamiliar doctor Im hiv positive I get.better care.

maybe it's because I'm treated at s large urban hospital in a very blue city /state. 

Jeff G:
 I have lots of experience with doctors because simply because I have been poz so long .

I have come to the conclusion that having a competent doctor I can trust trumps personalaity . Don't get me wrong , feeling comfortable with your doctor is important also but I have found that as long as he hears what I have to say and gives me top notch care is what I look for more than other elements that could make for a cheery visit to see him or her .

One of the best doctors I ever had was an admitted cantankerous old blowhard who most people would avoid at all cost socially . He once offended me and I found a new doc for awhile . When I came back a little over a year later because of the sub par record of diagnosing my aliments by the new doc , he met me in the hall on the way to the exam room and muttered , OH its you again , I knew you would be back . He then kept me waiting for an hour ... but damn was he a good doctor .

mecch:
However, a couple of times recently, I had to see a colorectal specialist, who I had not seen before, and he was a bit older, and it seemed to me he was a bit distant and brisk with me, like he was being overly scrutinizing or a bit stand-offish. He seemed competent, just a bit aloof and made me feel a bit like I was a burden. I just sort of got the vibe that he was thinking "it's your own fault your having these rectal issues, because your gay, and you took it up the ass". To put it bluntly lol.

Of course, I know some doctors just have a very distant aloof personality, but I feel like one shouldn't have to settle for that. Especially in the case of having to see a specialist for specialized care, in such a sensitive embarrassing area as rectal care, I feel like they should be much more sympathetic and understanding to gay men and for that matter hiv-positive people.


It's not very nice if you feel that a professional person (doctor, here), who you go to for a service, is sitting in judgment of you.. 

But, on the other hand, we should avoid assuming or projecting prejudice and bias into people, because you expect it, or feel it, if in fact there has been no demonstration of it...  Right?

Its always nice to get a doc who is empathetic and sensitive...  But I'm not sure we can demand it. 

In the best of circumstances, we have insurance that permits us a choice.  Dump the jerks, and find the sensitive ones..   If choice of doctor is not an option, then its important to remember, the doc needs you as much as you need him, and if he(she) is a royal jerk, but manages decent health care, its really his own fucking loss and problem in life, and poor him...

Also, if one feels slighted or underserved by a doctor, it does pay to speak up....   About a year ago, my GP was starting to get hard to see, quickly.  His receptionist was always claiming, booked up, next week, etc etc.  Three times I found myself a nearby clinic (very chic, good care) that has walk in service.  They sent results of one test to my doc. Finally with him on the phone, I told him flat out how hard it was to see him, and that I was frustrated and couldn't there be a solution.  He quickly gave instructions that I was to booked fast, next call.  And the next call, I was.  Within a half hour....

That's not about prejudice, but it is about getting the service you need....   

Another thing is to tell your doc flat out if there is something in the care/contact that bugs you.  "I feel that you....."

People can be too damned impressed by doctors to communicate and demand an exchange...  Its a pity because doctors are in the people business and if you shake em a bit I bet most of the time the relation improves, not the contrary.

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