BLOG: Navigating health care as a physician, member of LGBTQ+ community
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“Which mom are you?” It’s an innocent question, right? I’m with one of my kids, and I’m alone at their school picking them up. The person asking has never seen me before, but they know we are a queer family.
I invariably reply, “I am the doctor mom.”
Of all the identities I could tie to this response, why “doctor mom?” I could be the “taller mom,” the “cis-gender mom” or the “can’t-parallel-park-mom.” I could give them what they want upfront and just say, I am the “biological mom.” But I never do.
Systemic barriers
As a medical student in the South in 1999, the vast majority of people I interacted with were kind, rational and tolerant. I had an occasional disconnect with a patient or doctor who was less than enthusiastic about my completely out approach to my sexual orientation. Most commonly, I was told that I had not met the right man — a role they were offering 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 mentored. I was offered opportunities to learn, to present and even to publish research. I got my first choice of residency in the match and again when I applied for fellowship. No doubt, my privilege as a white person played an enormous role in my success. Despite all of these privileges, the systemic barriers I have encountered as a lesbian woman trying to keep my family and spouse safe have taken their toll.
‘Provider homophobia’
Discrimination and fear of discrimination keep many in the sex and gender minority community from seeking health care. A large systematic review by Ayhan and colleagues describes three main experiences, including discrimination in the health care setting of LGBTQ individuals, the importance of disclosure to providers and awareness of homophobia and/or transphobia among providers.
The fear of provider homophobia in particular resonates with my lived experience. As a resident in OB/GYN, I knew all about assisted reproduction and even had insurance coverage for infertility. In order to qualify for this, I had to have infertility — hard to prove when your partner doesn’t make compatible gametes. But we wanted a family, and this was our chance. The physicians in the faculty infertility practice were all skilled, and I knew them because I had worked with them on rotations. I chose the one I thought was most likely to be comfortable with me, the one who had other same-sex couples in his practice who 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, thus, our chance to have a family until we had a different financial situation.
On the night of my graduation dinner, we had our oocyte retrieval. This meant the very last week of my residency would be the transfer (this was before the days of cryopreservation). The practice model was that the on-call doctor would perform the transfer. Of course, not everyone in the practice was comfortable with same-sex couples. One provider refused to treat homosexual couples on religious grounds. If they were the on-call person, would I get the transfer?
The morning of transfer brought the doctor who “doesn’t treat same-sex couples.” I was certain I would be turned away. I didn’t even bother changing into the gown. We looked at each other and he said, “Hi, I’m your doctor for today.”
‘Doctor mom’
Our daughter is now 14. 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 that we lived in made her parentage illegal and again when my wife was run out of women’s bathrooms trying to change her. The insomnia is tempered by finding a queer pediatrician, then a Medicare expansion and then an EMR upgrade that finally carries my sexual orientation as a discrete variable.
So, I own that “doctor mom” title. I want folks to know we are a queer family, and I am part of a legacy of physicians who are making that intersection stronger.
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B.J.
Rimel
, MD is medical director of the Cedars-Sinai Cancer Clinical Trials Office. She can be reached at bobbie.rimel@cshs.org.
Ayhan CHB, et al. Int J Health Serv. 2020;doi:10.1177/0020731419885093.
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