A doctor for LGBTQ+ health needs

As a queer, nonbinary, poly, and kinky person, medicine has been a challenging field to fit into, both as a patient and a physician.

While a first-year med student, I was misdiagnosed and inaccurately treated for an STI due to my physician’s biased and discriminatory views. A week after my painful injection, I had to go back and ask why I wasn’t getting better. He then – in his office, not an exam room –  lectured me on my “lifestyle choices.” I listened to said lecture. Before leaving, I asked, “but why have my symptoms not improved?”

He casually responded that I had been misdiagnosed and needed a different prescription. I didn’t have an STI at all. He offered no apology, no acknowledgment of potential harm done. To this day, I don’t know if he would have told me about the test results and prescribed appropriate treatment if I hadn’t asked him why I wasn’t getting better. He gave his morality lecture and was moving on.

I have yet to be consistently gendered correctly as a patient at any medical encounter. Recently at the dermatologist, the physician said, “I heard you mention partners, as in more than one; how does that work?” To which I responded, “How do your relationships work?” I was there for an elective cosmetic procedure that had nothing to do with my sexual health. She asked me a personal question unrelated to my health care appointment because she was nosy, and she did it while performing a painful procedure on me, where I was to some degree “trapped” in the exam room.

As a physician, my femme gender identity and expression have led to chronic issues. Patients and colleagues struggle with my lipstick, nails, and attire that meet the dress code requirements but do not try to blend into bland “professional norms” or camouflage my figure. I experienced an internal investigation at one employer because I wore a crinoline under a dress that went past my knees. There was nothing inappropriate about my vintage dress other than daring to take up (literal) space.

My queerness is intrinsic to who I am, and I find deep joy and strength in it. Celebrating who I am was hard-won as I was raised in a tradition that declared queerness unacceptable. Growing up with this central dilemma taught me to question everything, including my own privileges. My queerness demands that I acknowledge and challenge the narratives that inform my biases.

Once I started questioning my privilege (and my marginalization), the scope of those questions grew. I could no longer tolerate how health care systems systemically oppress marginalized communities. I couldn’t stop seeing the wrongs. Nor could I stay silent. As you might imagine, consistently being vocal about the ways health care mistreats and abuses marginalized populations, can make it hard to stay engaged and employed.

Layers of daily minority stress made functioning full-time in the field of family medicine impossible for me. Uncertain of what I wanted to do with my career, I cobbled together part-time work. Even in a metropolis such as Seattle, our LGBTQ+ community is small. I wasn’t sure how to navigate the mix of my community becoming patients and patients becoming community, so I intended to avoid LGBTQ+ health once out of training. However, being recognized as queer led to sustainable work within my field, even though the route was via workplace disparate treatment. At a locums position, I was asked to cover the PrEP program and provide trans health care, not because of my training (very limited at the time) but because of my identity.

The highlights of my day turned out to be providing care to LGBTQ+ patients. So in 2017, I had the wild idea to open a telemedicine-only private practice focused on LGBTQ+ health care. Now that practice has grown enough to be my only job. I took a massive pay cut. I lost my benefits and my access to PSLF. And I got to be fully me at work.

I get to present as femme, as queer as I want. I am celebrated. Every day, I do meaningful work: I serve my community, help people be who they are, and treat marginalized groups with dignity and respect. I get the joy of knowing that my young patients see a queer, gender-diverse person with an advanced degree doing fulfilling work.

When I grew up, there were no representations of people like me visible to me outside of bars. My health care providers shamed me for who I was. I have never had faculty, an attending, or a mentor who shares my identity. Now I provide a completely different experience to my patients, and I am a mentor to other queer people pursuing health care careers.

bell hooks defines queer “not as being about who you’re having sex with; but queer as being about the self that is at odds with everything around it and has to invent and create and find a place to speak and to thrive and to live.” I had to invent a space within the field of medicine to thrive. I am grateful for the privilege that allowed me the resources to do that. By continuing to share my story, I hope that the younger generation of physicians will have to invent less and get to be more.

It is uncomfortable to be publically vulnerable with my story. I wish the statistics and research were enough to change the field of medicine for patients and physicians. I want people to care about the experience of their patients and colleagues enough to examine their own implicit bias and privilege without having to hear my traumalouge, but we aren’t there yet. People often need to connect with an individual to reflect and consider change, so I hope you take this moment to consider creating a more inclusive, affirming health care system.

Crystal Beal is a family physician.

Image credit: Shutterstock.com

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