9 Steps for Coming Out To Your Health Providers
This winter, my partner (well, the one I live with) and I were on the hunt for a new therapist, ready to give couple’s counseling another go after being ghosted by our previous “poly-friendly” therapist. After that experience — and dozens of others that collectively left a sour taste in my mouth — I was tired, irritated, and didn’t want to waste any more time or money on providers who were only going to disappoint me with their inability to handle other parts of our lived experiences. So when we walked into our new therapist’s office and sat down for our first session, I already knew what I was going to say.
“Here are some important things for you to know about us: We’re ethically non-monogamous and I’m queer," I told her. "We’re pretty happy with those parts of our lives, and have no intention of changing them. So before we go any further, we need to have an understanding that we expect you not to treat those things like they’re the problems. If we have issues around them, we will certainly bring them up, but these are not themselves problems. Are you comfortable with these topics, and do you have experience with them professionally?”
My partner, long-suffering when it comes to my big mouth, had his "Oh jeez, here she goes again" look on his face. But our therapist? She perked up and started asking questions.
There are many reasons someone who’s poly, kinky, queer, or a sex worker may want (or need) to come out to their medical or mental health providers. Maybe they often have bruises from sessions with play partners, and don’t want the doctor to think they’re being abused. Perhaps they know they need more frequent STI-testing or should be on PrEP, but have to justify it to their doctor by telling them why. Maybe they and their partner are poly and struggling with communicating about their boundaries, so they want help from a therapist. Or possibly they just want to be informed of the risks and harm-reduction strategies associated with how they like to have sex.
Unfortunately, it can be really hard to come out to a doctor or therapist, and when you do, there’s no guarantee about how your provider will respond. Many medical and mental health providers — even marriage and family therapists — receive very little training in sexuality. Instead of potentially being shamed or refused care, a lot of queer folk just go without. And while we don’t have reliable stats on kinky people, poly people, or sex workers, I hear that same sentiment echoed in those communities: “I just go without.” Or: “I just don’t tell my doctor.”
But going without healthcare is not the solution. Everyone has a right to health — regardless of with whom or how they have sex. With that in mind, I took specific steps to find our couple’s counselor, asking people in my communities about their experiences in healthcare, and about how they handle coming out to their doctors and laying the foundation for good, respectful care. A bunch of people I know — who identify as queer, trans, sex workers, kinky, mentally ill, chronically ill and/or fat— spoke up and let me know how they advocate for themselves.
While these steps are mostly focused on specific sexual identities — ethically slutty, queer, and/or kinky — many, if not all, of them can apply to people who are trans, mentally ill, chronically ill, and/or struggling with substance abuse, or folk from other marginalized communities whose health or mental health care might suffer due to that identity.
I’m not going to lie: this is a lot of work. But the end result — being able to get competent care from a respectful doctor — is totally worth it. And for my nesting partner and I, that brief but direct spiel worked out great: we saw that therapist for a few months until we worked through the issues we were having, and happily keep her number on hand for any future struggles.
1. Start At The Beginning
Most insurance companies have a database of in-network providers which you can sort by specialty, distance from you, gender, language, etc. Start there — there’s no point in getting attached to that amazing poly-friendly therapist your friend sees if they don’t take your insurance.
If you don’t have insurance, your absolute first step is to use Google to find your local community health center or other places that offer sliding scale fees, such as Planned Parenthood.
2. Check Online Directories
Many marginalized communities keep lists or databases of providers known to be friendly to their members. Here are a few well-known ones:
- For kinky folk Kink-Aware Professionals (KAP)
- For poly folk: The Open List and Poly-Friendly Professionals
- For queer & trans folk: Gay and Lesbian Medical Association (GLMA) Provider Directory, Bisexuality-Aware Professionals Directory, World Professional Association for Transgender Health, and the new MyTransHealth
How useful these are will vary widely based on where you live. When I was living in Seattle, these were incredibly handy; since moving back to Vermont, not so much. If you’re not lucky enough to live in a major metropolitan area, don’t despair: Many local kink and queer organizations keep lists of friendly providers.
3. Tap Into Your Networks
Ask your friends and people you know in your community for recommendations of providers they’ve seen and liked, particularly if they are out to their providers. Have a provider you like and feel respected by? Ask them for a referral for a colleague in a different specialty. Word of mouth is often the best way to find a provider you know will be friendly to your identity or lifestyle.
4. Make Your List And Check It Twice
Check your lists from the last three steps — hopefully you have at least a handful of names. Are there any names that appear on at least two, or even three, of those lists? If so, start there.
If not, take your list of in-network providers and “start by looking at who [those] providers advertise to. Many queer-, poly-, or fat-friendly providers mention this in their literature,” Emily, 24, who is queer and poly — as well as a midwife — recommends. “You could also look where they went to school; some schools have a more progressive agenda than others.”
Keep in mind that queer-friendly can indicate kink/poly-friendly, but that's not always the case.
5. Rehearse What You're Going To Say
It sounds silly, but it can be really difficult to talk, out loud and to a professional, about the things we like to do in bed. Practice having those coming out conversations, whether with partners and friends who already know, or by coming out to providers you already have and feel comfortable with. The more you have that conversation, the easier it gets, and the more confident you’ll feel about it.
6. When Possible, Screen By Phone Or E-Mail
If they allow it, call or email with your initial questions to screen out negative providers. It’s a timesaver as well as a money-saver, and you can ask questions over the phone without having to give your real name.
What you’re really looking to figure out is if this provider is both willing and able to see you as a patient. Willing means comfortable and interested in working with you, and able means that they have professional experience with people like you.
Here are some questions I’ve used in the past for phone and email screening:
- “Does this provider have any ____ patients?”
- “Is this provider ____-friendly?”
- “Is there a religious orientation to this practice?”
Keep in mind that being “friendly” to something doesn’t mean they have a lot of experience with it. Different communities have different health needs, and a lack of experience with your community may translate into not being “able” to work with you properly. As Dylan, a 31-year-old queer man, experienced: “ ...until I saw a physician with training in queer health, I was never told about the existence of PrEP or that receptive anal sex partners should have regular anal pap screenings. With insufficient care I am putting myself at undue risk. So if possible, I strongly encourage putting in the extra effort to find a PCP with experience treating your group."
If you end up with a provider, and you’re not sure whether they’re giving you the best medical advice for your risk factors, consider getting a second opinion from another doctor or doing your own research through identity- or medically-specific hotlines, medically-sound web resources, or reaching out to your community. And don't give up if your first doctor interview is a flop! As Ruthless, a 22-year-old poly and queer kinkster, put it, it can take “a lot of different visits and chats, aka kissing a lot of frogs.”
7. Treat The First Appointment Like A Job Interview
Treat your first session like an interview — because it is! You are interviewing them to see if you want to hire them as your provider.
Prepare questions beforehand, and bring them to your appointment. We tend to be afraid of questioning doctors and other authority figures, but you have the right to ask questions of your provider. Asking questions first allows you to get a feel for them before you “come out,” so if you already get a bad vibe at the mention of your sexual identity, you don’t move on to the next step. Instead, you just thank them for their time and leave. No need to explain yourself — you don’t owe them anything more than a thank you and that you don’t think they’re a good fit for you.
Not sure what to ask? Here are some questions that may help get your brain juices flowing:
- “Do you believe someone can be both _____ and healthy?”
- “Can you talk about your views on _______ (as it relates to health/mental health)?”
- “How do you define health sexuality?”
- "Do you believe safe, sane, consensual BDSM is a healthy expression of sexuality?"
- “Are you comfortable discussing _____?”
- “What do you know about _______? What are your thoughts on it?”
- “Do you feel competent dealing with issues around queerness, queer communities, poly relationships, sex work, BDSM, etc?”
8. Just Lay It All Out
This is the scary part. Don’t get me wrong — my hands were shaking and my heart was thumping like you wouldn’t believe when I came out to our therapist. But this is the ultimate test of whether or not they can be a good provider to you, and it is way better to find out at the beginning rather than after seeing them for five years that they think you should just try not being gay because it’s bad for your health.
If you’re concerned about being outed, keep in mind that even if they react poorly, they’re still bound by patient confidentiality. They may be homophobic or sex-negative, but they can’t share your personal information with anyone without serious risk to their career.
Crista Anne, a 33-year-old queer and poly sex writer with a chronic illness, always takes the direct route, despite any anxiety she might have: “[I] plainly lay out who I am, what I believe and what I need help with. [I] let them know that I respect their credentials and the work they've done but that I am the expert on my life and often my conditions. [I] verify that they are willing to be challenged and respect the work that I've put into finding myself quality care.”
Not sure what to say? Remember to touch on who, what, and why. Here’s a sample script that might help:
“Dr. X, I’m Kathleen. I am here to see you because I am trying to establish a new primary care physician, and I think you should know that I’m queer and poly. I’m telling you this because these are important parts of my identity, and I’d like to be able to discuss any risk factors I might have, but also don’t want my queerness or poly lifestyle to be interpreted as symptoms of something or problems in themselves. Do you have any questions or need any recommendations for resources on any of these topics?”
9. Remember, You Are Entitled To Respect From Your Doctors
Maybe you have sex with lots of people, for money or just for fun. Maybe you like sleeping with people with the same genitals or gender as you. Maybe you like your sex with a side of pain.
It doesn’t matter. You have a right to culturally-competent, respectful, and accurate health care. You have the right to ask for what you need without being shamed.
Bottom line: if your medical or mental health provider doesn’t respect you, find a new one. It might take a bit of work, but it’ll be worth it in the end.
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