Making sure my partner has rights?

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Question from One of Two: I want my partner to be accepted as an equal, just as the husband of a heterosexual woman would be accepted. How do I make sure she gets the information, concern for her well-being, and visiting and next-of-kin rights that she deserves?

Answers —Lisa Weissmann, M.D.: To the extent possible, include your significant other in the doctor visits so that the physician or health care provider will know who's important to you and in your life. There are many legal steps that we as lesbians should be taking to protect our relationship. Specifically, we should all look to having durable power of attorney health care proxies and wills so that our relationships are validated in law as well as in love.

Marisa Weiss, M.D., president and founder: A good way to start this respectful relationship between your partner and your doctor is to make sure that you introduce your partner to your doctor on every visit until your doctor gets to know her. And when you do make this introduction, make it clear that this person is very important to you. And make it clear that the doctor can feel free to share private information to both of you—if that's what you want.

Cheryl Pearson-Fields, M.P.H.: I think all of those are very important. We have had instances of patients trying to bring their partners to health care visits, particularly to hear results from cancer screenings and have had their partners not allowed in the room.

Marisa Weiss, M.D., president and founder: How did they handle that?

Cheryl Pearson-Fields, M.P.H.: They ended up hearing they had cancer alone. They weren't allowed to bring their partner in the room. One thing that's important is not only to have patients advocate for their own health care and their own comfort while accessing health care, but to work with providers around their patients and what's important to lesbians, and that any gay relationship is as valid as a heterosexual relationship and that partner should be included.

Marisa Weiss, M.D., president and founder: I am a straight doctor, but I do take care of many women who are gay, and I feel very comfortable in that setting. But I have to say that as a doctor I feel like I have been the one to invite them to feel open with me. I have not yet had the experience of having a lesbian patient say to me that it's important that you know that I am gay and that I have special needs. And I think it would be easier for me to take care of such patients if they were so forthcoming.

Lisa Weissmann, M.D.: Marisa, you make a really interesting point, and it reminds us of the first question of this evening concerning whether it is safe to come out to your provider. Even though I'm a physician, as a lesbian I also feel anxiety when I go to my doctors and have to come out to them for the first time. Therefore, I can empathize with other lesbians who may be less comfortable with being in a doctor's office and that it would take a great deal of courage for someone to then educate the health care provider about what their needs are.

Part of this problem is trying to be dealt with by educating physicians about their own internal homophobia and the homophobia of the medical establishment. While this certainly is changing particularly in the major cities, it remains a problem for many of the physicians that patients need to see.

Marisa Weiss, M.D., president and founder: I struggle with this because I'm not sure how to create the right feeling and atmosphere that will put this tough issue at greater ease. It is a delicate give and take. On one hand, I want to create an open environment that invites them to feel more comfortable, but on the other hand I'm not always sure what the preference is of the woman who is in front of me and what the relationship might be. I hope tonight that I will learn more from the participants of the conference so I can do a better job.

Cheryl Pearson-Fields, M.P.H.: One way we can do that is to ask questions of our patients.

Lisa Weissmann, M.D.: This is actually one of the areas where the Mautner Project has been looking at how to bring down the barriers to access to health care for lesbians and Removing the Barriers Program which is really looking as to how to sensitize health care providers to the presence of gays and lesbians in their practice and to be sensitive to their needs.

Marisa Weiss, M.D., president and founder: Cheryl, do you think it's best to ask this question of each patient verbally or on an initial personal information form?

Cheryl Pearson-Fields, M.P.H.: I think so. It should be on the form because often that's a first thing that a new patient encounters in your practice, and so it will set the stage for a perception of your openness to talking about these issues. The fear of some providers is that if they ask some patients may be offended by the question. But I think it's easy to explain you want to provide the best care possible to all of your patients, so you ask the same questions of everyone.

Marisa Weiss, M.D., president and founder: That's an excellent point.

Lisa Weissmann, M.D.: Speaking as a breast cancer specialist, one of the ways that I ask the question of whether my patient is gay, bisexual, or straight is who do they turn to for support and who would they like me to include in the conversations. I find that often feels very open-ended, which really allowed them to tell me where they turn. It's a great question for me when I'm talking to my straight patients because I may find that their support does not come from their husband or partner, but may come from other family members or their friends. And it's a wonderful way to allow my gay and bisexual patients to identify who's important to them.

Marisa Weiss, M.D., president and founder: Do you ask this in front of the person they're with?

Lisa Weissmann, M.D.: If they introduce me to their partner and have told me this is their significant other, and unless they've made that very clear and explicit, I will ask them who I should include in the conversation.

Cheryl Pearson-Fields, M.P.H.: Other ways that you can show your openness to discussing this issue is by displaying in your office a non-discrimination policy statement that includes sexual orientation, along with a host of other characteristics such as race, ethnicity, age, disability, gender, etc. Another way is to have available lesbian health education information. Mautner has education pamphlets for lesbians that people can put in their offices. It's important to put information where it is accessible and where patients can get it. So, instead of putting a lesbian health information display or brochures in the waiting room, maybe put them in the exam room, so people can grab it. It also sends a message and they can get the info they need.

Marisa Weiss, M.D., president and founder: Can individual patients get the brochures from Mautner and bring them into doctor's offices for other women?

Cheryl Pearson-Fields, M.P.H.: Yes. Absolutely.

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