ACOFP Blog

By Kurt Schroer, DO

Every physician has unique influences on their practice. Whether it be inspiring experiences with great educators, significant life events or even distinctive cultural and societal experiences, there are many factors that mold different types of physicians and the approach they take in medicine. My story is no exception.

I was raised in a conservative, Catholic household in Kansas. It took me years to come to terms with my own sexuality. Like many LGBTQ+ youth, those years of persistent stress and internal conflict about my identity were a detriment to both my physical and mental health. Not only was this stress self-imposed for not fitting the norm, but also from external interactions.

I vividly remember seeing my family doctor for the first time on my own. Routine history-gathering became painfully awkward once we were on the topic of sexuality. Looking back, I now know that he not only failed to ask follow-up questions essential to properly managing my health, but also tried to quickly change the subject. I can still see that physician clearly—wide-eyed and uncomfortable—telling me hastily, as if on a recording, “to practice ‘safe sex’ as I have a high risk and probability of contracting HIV in my lifetime.” This was his only response. I found this automated, knee-jerk reply brash, dismissive and judgmental. I was embarrassed, and frankly fearful, to share any more of my history. The fear of feeling judged and the physician’s lack of empathy and compassion that day created a significant barrier to me receiving good medical care.

Many years later, after a long day at work during my intern year of residency, my ex-boyfriend and I were talking while eating dinner together. He casually mentioned that one of his best friends had been informed by a new sexual partner that he had tested positive for HIV. Out of concern, his friend went to be tested immediately and received a negative result. My ex-boyfriend expressed how relieved he was. Feeling uneasy, I asked my partner if he knew exactly how long ago his friend’s exposure was prior to being tested. After some digging, we found out that his exposure was about 11 days prior to his HIV test. Now truly concerned—and knowing that a negative test too early can be falsely reassuring—I advised my partner that his friend should pay for additional testing to be sure; I counseled that his specific options were an HIV RNA (viral load) test, which may be positive around 11 days post-exposure, or a series of re-tests two and 12 weeks after exposure. His friend paid for a HIV RNA test the next day—it was positive. Simply put, this news was devastating.

This was the first time I felt responsible for a life-changing diagnosis. I felt fortunate to be able to provide counseling, reassurance and compassion to someone at their most vulnerable moment. However, as a near-miss, this diagnosis highlighted the large gaps in knowledge that not only exist within members of the LGBTQ+ community, but also among healthcare providers trying to provide care for this population.

While it is important for healthcare providers to understand disparities that face the LGBTQ+ community—the increased risk of violence, the increased risk of mental health disorders, etc.— nothing is more powerful than the clinician’s ability to provide a welcoming environment in their office. The ability of the physician to keep an open mind and approach each patient with respect breaks down significant barriers. When caring for LGBTQ+ patients, it is paramount not to be afraid to respectfully ask questions, to request feedback, to communicate clearly and honestly, and to make a concerted effort to learn from and about patients. Providers should consider that many LGBTQ+ patients have probably experienced healthcare discrimination and may approach a doctor’s visit with hesitation. After all, the desire for nonjudgmental, thoughtful communication and medical care is not a new concept, nor is it specific to the LGBTQ+ community. Every patient deserves to be seen through the same human lens.

As a gay physician, I am fortunate enough to be able to relate to my LGBTQ+ patients on a level that other physicians simply cannot. The discomfort I have felt as a patient has undoubtedly made me an even better and more aware physician today. Only through awareness of health disparities can clinicians provide the best possible environment to care for all patients, regardless of what makes each unique. Simply put, empathy, compassion and patient comfort breed honesty, and honest communication reveals the information needed to provide care. Good care. Care that every human being deserves.