Navigating healthcare as a doctor, member of the LGBTQ+ community
October 13, 2022
3 minute read
MD is Medical Director of the Cedars-Sinai Cancer Clinical Trials Office. She can be contacted at [email protected]
Ayhan CHB, et al. Int J Health Service. 2020;doi:10.1177/0020731419885093.
Disclosures: Rimel does not report any relevant financial information.
“Which mom are you?” It’s an innocent question, isn’t it? I am with one of my children, and I am alone at their school to pick them up. The person asking has never seen me before, but they know we are a queer family.
I invariably respond, “I’m the mom doctor.”
Of all the identities I could link to this answer, why “doctor mom?” I could be the “tallest mom”, the “cis-gender mom” or the “mom who can’t parallel park”. I could give them what they want right off the bat and just tell them I’m the “biological mom.” But I never do.
As a medical student in the South in 1999, the vast majority of people I interacted with were kind, rational, and tolerant. I had the occasional disconnect with a patient or doctor who was less than enthusiastic about my completely different approach to my sexual orientation. More often than not, I was told I hadn’t met the right person – a role they offered to play.
In one-on-one interactions, however, most humans gave me a chance to show that I, too, was compassionate, empathetic, and capable. I was framed. I was offered opportunities to learn, present and even publish research. I got my first choice of residency in the game and again when I applied for a scholarship. Without a doubt, my privilege as a white person played a huge role in my success. Despite all of these privileges, the systemic barriers I encountered as a lesbian trying to protect my family and my spouse took their toll.
Discrimination and fear of discrimination prevent many members of the sexual and gender minority community from seeking health care. A large systematic review by Ayhan and colleagues outlines three main experiences, including discrimination in the healthcare setting of LGBTQ people, the importance of disclosure to providers, and awareness of homophobia and/or transphobia among suppliers.
The fear of provider homophobia in particular resonates with my lived experience. As an OB/GYN resident, I knew all about assisted reproduction and even had infertility insurance. To qualify for this I had to be infertile – hard to prove when your partner doesn’t make compatible gametes. But we wanted a family, and this was our chance. The doctors in the infertility practice at the faculty were all competent and I knew them because I had worked with them on rotation. I chose the one that I felt was most comfortable with me, the one that had other same-sex couples in their practice that the other residents had seen.
We tried all the usual routes but ended up with in vitro fertilization as our best option in the last month of my residency. At this point, I had matched in St. Louis and we would lose our infertility coverage, so our chance to have a family until we had a different financial situation.
The night of my graduation dinner, we had our egg retrieval. This meant that the very last week of my residency would be the transfer (this was before the days of cryopreservation). The practice model was that the doctor on call made the transfer. Of course, not everyone in practice was comfortable with same-sex couples. One provider refused to treat same-sex couples on religious grounds. If it was the custodial person, would I get the transfer?
The morning of the transfer brought the doctor who “does not treat same-sex couples”. I was certain that I would be turned away. I didn’t even bother to put the dress on. We looked at each other and he said, “Hi, I’m your doctor for today.”
Our daughter is now 14 years old. The transfer of her embryo was the first of many sleepless nights. There were more when we had a home study to adopt our daughter because the state we lived in made her parentage illegal and again when my wife ran out of a women’s toilet trying to change her . The insomnia is tempered by finding a queer pediatrician, then a Medicare extension, then an EMR upgrade that finally carries my sexual orientation as a discrete variable.
So, I own this title of “doctor mom”. I want people to know that we are a queer family and that I am part of a legacy of physicians who strengthen this intersection.