The Primary Problem


How LGBT folks can find a medical home.

There’s something about being an obvious butch dyke and being out as a registered nurse that makes my brunch conversations unusual.

It’s not at all uncommon for a good friend, or even a casual acquaintance to twist around, lift up their shirt and ask “what do you think this rash is?”

I’m always glad to help with information, but there is a limit to what I can do over free- range eggs benedict. So my next question is often  “Have you shown that to your primary care provider?”

This is not infrequently met with a blank look and a halting “Um. Primary what?”

In contrast, ask the average LGBT person if they’ve talked about something with their therapist, you’ll get a much more engaged, enthusiastic response. They may well tell you what their cat’s therapist said about it.

You may think I am trotting out a cliche with the cat bit, but I’m not. I’ve had that response. Twice.

It’s not surprising that as a community we’re under-engaged with the health care system. We’re statistically much less likely to be insured. Some of us watched the better part of an entire generation of our community perish while the medical establishment did little until advocates forced action. We’ve encountered systematic oppression that makes us distrust larger systems.

But none of these issues provides a convincing argument against having a primary care provider. In fact, the more isolated and distrustful you feel from and of the medical establishment, the more important it is for you to have a relationship with a provider. Sooner or later, most people have a medical crisis that can’t be solved with reiki or rescue remedy. You’ll want someone who knows you and knows the system to help you navigate.

If you live in a large city with a designated LGBT health center, that’s obviously going to be a good place to start. However, some of these centers may be beyond capacity and unable to provide care for everyone who needs it, or you might not meet the specifications required by their funding, or you might prefer to get care somewhere you’re not going to run into twelve ex-lovers in the waiting room. You can still ask the staff for recommendations of other LBT friendly healthcare providers in the area; some centers maintain lists on their websites. Often they know of sliding scale or reduced price clinics, which can be helpful if you are uninsured.

The next step is a quick trip to the National Gay and Lesbian Medical Association online provider database. You can use the search function to find different types of health care providers by city, state or country. This will be more helpful for some locations than others: New York state results in dozens of listings, Alabama three, and Mississippi none. And the list provides few providers outside the United States.

If this leaves you still looking, it’s time to get personal. Unless you’re living on a desert island, you probably a know a few LBT folks. Ask them about where they get health care. It might seem like an intimate question, but people love to talk about their positive experiences with the medical care establishment and often their negative experiences as well.

Definitely only ask this question when you have a little time to spend.

If you’re attempting to choose from the approved provider list from your insurance company, you’ll probably have tons of names but little information. You can narrow down your list by reaching out through social media with a dozen names from the list for feedback from anyone who has used those providers. Don’t forget about physician assistants and nurse practitioners: these mid-level providers are often able to spend more time with patients than doctors. This may be especially important to you if it’s been a while since you had any consistent healthcare.

Online provider review sites can assist you with useful information as well. Some of these sites (for example, Zocdoc) include a photo of the provider. This theoretically assists you with the information you need to play “spot the queer.”  I don’t know that research has proven the relative statistical reliability of gaydar for picking healthcare providers, but it’s worth a try if other methods fail.

Community organizations like Planned Parenthood, Metropolitan Community Church (there are Metropolitan Community Churches in places there aren’t even community bars), community centers and AIDS service centers can often give you recommendations as well. And if there is an LGBT or progressive newspaper in your area, check the back for provider advertisements.

Finally, if all else fails, pick up the phone and start calling. You don’t have to say your name before you ask “Hi, I’m looking for a new primary care provider. Is Provider X taking new patients? And do you know, do you have many LGBT patients in your practice?”

It’s unlikely that the answer will be “Oh hell no, we don’t treat queers” but if the response is “um…uh…” or “huh?” or a long awkward silence, say thanks and good-bye. Hit “end call” and then go to the next number on the list. If this feels intimidating, invite a buddy over, order pizza and make an afternoon of it. Or create a game, taking turns and seeing what the most common weird answer is.

Finally, consider the advice of Ronni Hayon, a primary care physician in Madison, Wisconsin. When Dr Hayon sees patients who come from rural areas for healthcare she often offers to call and coach the patient’s primary care provider who is closer to their home.  Dr Hayon said “I’d encourage readers to think creatively about their care networks. Even if there’s not a queer health center in town, if you can find a provider who is open to learning, you can probably find one will is willing to teach!”