16 — Our IN THE MOUNTAINS — JUNE 1999 III‘. IDGBWII White 0|] I.0S|lii||lS' DYKE PSYCHE BY ESTHER ROTHBLUM esbians, like other women, face challenges finding affordable and quality health care. But are there particular dif- ficulties being a lesbian patient in the health care system? According to Dr. Jocelyn White, there are. ' White, editor of the Journal of the Gay and Lesbian Medial Association, has con- ducted research on les- bians’ access to health care. “Lesbians face all the typical issues such as having health insur- ance, travelling some distance for health care, finding child care while they visit a health care provider, or being able to take time off from work,” she said. “In addition, there is a spe- cific domestic partner issue: unlike heterosex- ual women who are legally married, few lesbians can be insured under their partner’s policy. But the real issue is providers’ ‘ ‘ inability to communi- cate sensitively and effectively with their patients.” Health care providers often lack knowledge about lesbian health issues. White has found that many would like to have les- bian patients but don’t have the knowledge or experience to be good providers. She and her col- leagues have traveled the country educating providers in effective communication with lesbian patients and increasing their knowledge base of lesbian health care issues. “I give a talk on the primary care of lesbian patients,” White said. “We talk about parenting, coming out, HIV, sexually trans- mitted diseases, cancer risk and screening, depression, substance abuse, domestic violence, hate crime violence, and social issues. Many doctors who come to these workshops go on to teach these issues to their students and med- ical residents, so it’s important for me to teach communication skills.” In one role-play, a workshop leader plays a Mexican- American data entry technologist who comes in to discuss parent- ing options. “The task of a work- shop participant is to detennine her sexual orientation and discuss options _ such as insemination, consider appropriate referrals, and deal with these issues sensi- tively,” White said, “The person playing the patient is scripted to present some challenges.” In another exercise, the workshop leader plays a patient with breast cancer who tells the doctor that her partner no longer wants to have sex. Other workshop partic- ipants observe and comment on what they see and feel ‘during the play. “It’s very interesting for het- erosexual doctors and nurses to heterosexual. ”’ have to play the role of a les- bian,” said White, “because they have to start trying to identify with what it feels like to be a les- bian patient who has a doctor say something insensitive. There is a perception that role plays are somewhat fake, but in fact they can be very powerful.” White suggests good opening questions for doctors who want to be sensitive to lesbian patients. “You can start by asking ‘are you partnered, married, single, or divorced?’ rather than launching right in with ‘what kind of birth control do you use?’ You can ask ‘do you have a significant other?’ or ‘who is in your family?’ in order to demonstrate that you are open to hearing about broader definitions of relationships and families.” She added, “You want to learn about the social history of the patient and be comfortable taking a sexual history, if neces- sary. Sexual questions by doctors need to make it clear to the M30888 I0 Health care patient that any response is possi- ble.” , White has surveyed lesbians about advice they would give White surveyed lesbians about advice they would give doctors. “Almost to a person, they said ‘don ’t assume I ’m doctors. “Almost to a person, they said ‘don’t assume I’m het- erosexuaI.”’ Lesbian respondents also told of negative incidents with their doctors. “One woman had severe vaginal hemorrhaging and went to the emergency room. The doc- tor, assuming she was heterosex- ual, asked about birth control and pregnancy. When she explained she was a lesbian, he flushed, got embarrassed, terminated the interview, left the cubicle, and never came back. A different woman came back and completed the pelvic exam. The lesbian patient was horrified and humili- ated. She immediately sought out a lesbian doctor.” 7 Another story comes from a lesbian who was in a motorcycle accident with a bus. During treat- ment, she told the doctor she was a lesbian. “He put in 100 sutures in her leg without novocaine. He didn’t x-ray her skull, even though she had lost conscious- ness during the accident, and missed a skull fracture. This doc- tor committed assault and battery as well as malpractice, and now he is being investigated.” In sum, White’s mission is to help doctors provide better care for lesbian patients and help les- bians feel good about themselves so that they know their rights in the doctor’s ofiice. She encour- ages lesbians to look for a good doctor and keep moving on until they find one they can be happy with. She tells lesbians to talk with friends about doctors trusted in their community, or to go to talks by doctors and ask ques- tions about affirmative practition- ers. “We deserve a good doctor. It’s our right and we should not tolerate poor health care. We should just walk out if the doctor is homophobic, and we should report these doctors to the insur- ance company or HMO.” White has found that lesbians happy with their health care tend to have high self-esteem and a sense that quality health care is their right. She hopes to teach other lesbians that this is their right as well. V Esther Rothblum is Professor of Psychology at the University of Vermont and Editor of the Journal of Lesbian Studies. She can be reached at John Dewey Hall, University of Vermont, Burlington, VT Email: esther rothblum@uvm. edu. (802) 254-8032 Michael Gigante, Ph.D. Psychosynthesis Counseling, Psychotherapy, 8 Consultation 15 Myrtle SL, Brattleboro, VT 05301 email mgiganté@together.net mil 8 V 2 Church 50, Burlington sliding foo scale Feminist Therapy I ‘ Leah Wiflonberg Licensed Mental Health Counselor Psychotherapy for individuals and couples (802) 865-4563 GAYELLDW CPAGESW INFORMING THE LESBIAN, GAY, BISEXUAL & TRANSGENDER COMMUNITY SINCE 1973 if. 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