“Do you have sex with men, women or both?”
This is the way that we were taught in medical school to ask a patient about their sexual history. When we took our sample standardized patient exams, we were scored whether or not we asked this question. In my understanding, this was supposed to be a non-judgmental, non-assuming way to elicit a sexual history.
However, romantic partners generally come before sex (unless we are speaking of one night stands). In asking about a patient’s personal life, medical school has unequivocally failed to teach student doctors how to sensitively ask about a patient’s romantic preferences and intimate relationships.
I am a male who wears a prominent wedding band with diamonds, and wore an engagement ring before this (which I know is uncommon). My experience with socially awkward heteronormist doctors probably began prior to finishing med school, but it became more apparent after I got married at the end of my fourth year. On one residency interview I was asked, “What does your wife do? Do you have any children?” (it is supposed to be illegal to ask such questions). I am a gay male, and I responded that my partner has his own business. I cannot state since then how many times well-intentioned doctors when trying to make small talk ask me what my wife (or girlfriend) does. While it is somewhat more expected from patients engaging in small talk with me who are not given formal “sensitivity” training, I would hope that doctors who interact with patients on a daily basis and are taught to be non-judgmental and do not assume that as a married male I have a wife. This is especially relevant since same-sex marriage is now legal in the country.
I am now very far along into my residency journey; come another year I will have finally finished the long path and will be an attending. I am floored every time a provider asks me about my wife just by glancing at my wedding ring — perhaps it’s just that they don’t think, but if they are an MD how are they asking their patient’s similar questions? If Ms. Jones, a lesbian patient, is asked, “What does your husband do?” it is possible that she would be quite offended, uncomfortable, awkward, and not want to return back to continue care. Indeed, it is known that LGBTQ patients have higher levels of poor health behaviors (smoking, substance use) and feel less comfortable visiting health providers and sharing information with providers. In my medical school, we even had a specific LGBTQ curriculum (several lectures), and people still ask me about my wife. Perhaps in my mind, I see it as a “microaggression” (small acts of prejudiced behavior which over time affect an individual), but I am shocked when it comes from the mouth of a doctor.
I normally will ask every patient when taking a social history, “Do you have a significant other or partner?” If they say yes I will often say, “What is his/her name?” I cannot assume the sexual and romantic preferences of my patients. I would hope that such a conscious act allows patients to form a better bond with myself as a provider and show that I am indeed a non-judgmental clinician when it comes to their sexual choices. I think the “Do you have sex with men, women or both” mentality should be changed to ensure that medical students, residents, doctors and all other providers (PA, NP, RN, MAs) understand basic humanity and do not rush to make assumptions which lead the patient to feel uncomfortable, awkward and not wanting to seek further care. Every time you as a doctor, ask me as a doctor in conversation what my wife does, it makes me think less of you as provider and makes me uncomfortable, whether or not it was intended.
The author is an anonymous physician.
Image credit: Shutterstock.com
