Miss Diagnosis
“We’re Both Dad”
Health care’s LGBT blind spot
Melanie, born during the death throes of the second Bush administration, was all of one hour old when I arrived at the newborn nursery at the busiest hospital in Dallas.
After giving Melanie her first bath, I tucked her into her bassinet and wheeled her out of the nursery back to her parents. I knocked gingerly on the door to Patient Room 302, hoping I wasn’t disturbing a sleeping new mother exhausted after the trials of labor.
Two men in plaid pajama pants and old sweatshirts opened the door. “Delivery!” I exclaimed. The men looked at each other, and then to the bassinet, and back to each other, beaming.
“Which one of you is Dad?” I asked, peering beyond them to the bed, where I expected to see a tired mom resting. But the bed was empty and neatly made, hospital corners undisturbed.
One of the men arched his eyebrow at me and laughed a little. “We’re both Dad,” he replied. They held out their wrists to me, and I saw that they wore hospital ID bracelets matching the baby’s.
“We’re adopting her,” the other man explained when I didn’t reply.
“Oh!” I exclaimed, finally orienting to reality. “Oh! Cool!”
Cool. God, I cringe when I think about that.
Like all new parents, they marveled at Melanie’s tiny feet, smelled her fuzzy baby hair, and counted her fingers and toes. Melanie yawned adorably and stretched out her arms. Then she puckered her little mouth, knit her brow and, with absolute predictability, filled her diaper with a quantity of poop large enough to call into question the first law of thermodynamics.
John and Zach looked at one another in shock. Then denial set it. “She didn’t just ... did ... no! Did she?!”
Zach and John had read every parenting book in the library. While Zach reviewed the step-by-step instructions for changing a diaper aloud, John disappeared into the giant, stuffed diaper bag that they had brought. He emerged with a pack of diapers in one hand, a fistful of wipes in the other and a tube of diaper cream between his teeth.
I always get a kick out of watching brand-new parents fumble with the first diaper change, nervous and unused to the mechanics of maneuvering a 6-pound human.
Considering all I’ve witnessed in my career—dramatic resuscitations and miraculous recoveries included—it’s a little funny that teaching a couple of dudes how to wipe a baby butt stands out in my mind as one of my proudest moments as nurse. But I met Melanie, John and Zach years before "Modern Family" would air on prime time and the president would finally evolve enough to voice his support of gay marriage.
John and Zach had struggled to adopt for more than a decade. Getting to teach them how to change a diaper felt like being at the epicenter of a seismic shift in culture.
Yet it also got me thinking about how I had greeted the couple with the assumption that only one of them could be Melanie’s dad. What happens when millions of these assumptions occur every day in almost every corner of health care across the country?
Dr. Edward Fancovic is the director of LGBT Equity and Inclusion at the University of New Mexico Health Sciences Center. He says lack of awareness and insensitivity to LGBT issues can harm patients: Many folks encountering discriminatory behavior within the health system avoid seeking care all together. Those who do make it into the doctor’s office may withhold information if the clinician comes across as judgmental or uninformed.
Fancovic says that only about half of gay men and one-third of gay women declare their sexual orientation to their doctor up front, so training clinicians to take the initiative and ask these sensitive questions helps minimize the Don’t Ask, Don’t Tell mentality in health care. “When you ask questions that are neutrally phrased, that describe behavior without any labels or judgment, you’ll get an honest answer,” he says. Over the course of his career, Fancovic has seen progress in this area. Things aren’t perfect, but newer clinicians do use the tools that are being taught, he says, and tend to show greater sensitivity.
While the climate for LGBT patients has improved considerably over the last 30 years, huge gaps in care still exist. “When I began my career, there was nothing that represented me as a gay man in the medical establishment. That needs to change,” he says. Mentoring helps open the door for others within the LGBT community to find their way in medicine: “If there are people out there who are interested in a career in medicine, they can do it, they should do it, and they’ve got the support to do it,” he says.
As visibility increases, the whole concept of LGBT health broadens. Fancovic says fixating on certain topics is overly simplistic. “You hear ‘gay’ and want to talk about HIV and suicide.”
These issues, while important, don’t fully capture the complexity of a person's health. He cites immunizations, cholesterol screening, tobacco use, weight reduction, and care of the aging and elderly as just a few examples of other major LGBT health needs.
Health care providers who make assumptions about their patients may not ask the right questions or offer needed services. For instance, lesbians may have a lower risk for developing cervical cancer and sexually transmitted infections. Yet many women identifying as lesbian have a history of heterosexual intercourse, and certain lesbian sexual practices can still transmit infections. Because of this, Fancovic says women identifying as lesbian should be offered pap testing and STI screenings.
When it comes to talking about health issues, LGBT patients need a strong voice in the conversation. To help facilitate the discussion, Fancovic points patients to glma.org. The website has lists of topics and talking points for gay, lesbian or transgender people to bring up at their doctor’s appointment. As families like John, Zach and Melanie become more common, I’m looking forward to the day that diaper changing makes it on to one of those lists.
