Doctors must assume more responsibility in improving communication with LGBTQ patients. First, they must confront the very nature of their practice, which Nuland termed “The
Riddle” (1995). The Riddle is the doctor’s obsession; they have been trained to solve the puzzle that is pathogenesis, in hopes of reversing the disorder. Historically, medical school has taught aspiring doctors to thrive in this pursuit. However, if the right balance is not struck, a doctor risks mistaking the person for the disease: a grave mistake. Though the doctor’s intention is good, it is inherently flawed. The patient, as a person, comes first. This necessarily includes addressing and respecting their sexual orientation and/or gender identity since it is part of
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Providers who do not engage in the patient’s narrative isolate the patient and do not build the respectful, empathetic, and trusting rapport required for a restorative experience at the clinic and beyond
(Charon, 2001).
Providers should ask about a patient’s sexual orientation and behavior. Based on the patient’s answer to such questions, it is imperative not to presume the past, present, and future sexual orientation and behavior of that patient. Doing so introduces biases rooted in monosexism and biphobia that pervade our heteronormative society. Although doctors are expertly trained to recognize patterns for speed and reliability of diagnoses, mentally labeling a group and presuming their behaviors, in order to establish risk, breeds inaccuracy. In medicine, inaccuracy can be fatal. For example, it is not insensitive to ask a lesbian for birth control. Nor is it wise to
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assume that lesbians do not have STIs and that gay and bisexual men do. From the provider’s
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10! perspective, the interaction should be founded upon a sincere question: “How can I keep