Healthcare is For Butches, Too

I make a concerted effort ’round these parts to not issue blanket statements about butches, femmes, or queerfolk. Most of the time, generalizations are ignorant at best and insulting at worst (generally speaking). However, there are some that I think you, my wise and worldly readers, would agree with. Examples include: there’s a tax for everything, we all will die someday, baby pandas are adorable, and butches hate going to the doctor. I’m confident about that last one, because (generalization alert!) everybody hates going to the doctor.

There’s real logic behind the old-timey saying, “An apple a day keeps the doctor away.” We all want doctors to stay far, far away. They poke us, prod us, make us put on ridiculous smocks that showcase our naked tushes, stick us with unwanted needles and fingers and **shudder** speculums, scold us about our weight or smoking or drinking habits, and then expect us to pay them for it all. Face it, MDs – nobody is jazzed to be sitting in your chilly, too bright offices with your stupid food pyramid posters from 1985. I’m sorry if I’ve hurt your feelings, but I bet your giant piles of money will ease the pain.

When it comes to seeing doctors, butches have a whole extra layer of crap-frosting on top of our double decker suck cake. Here’s a sampling of the anxious questions that plague my thoughts – and, I reckon, the thoughts of many other MOC queers – whenever I have a new physician:

“Will she think I’m in the wrong office?”

“Will she be totally freaked out/disgusted by me?”

“Will she know how to treat me?”

“Will the quality of care I receive be the same as if I were a feminine, straight woman?”

“Oh god, should I shave my legs beforehand??”

Meeting new people is nerve-wracking enough for me, especially when I don’t know ahead of time whether said new people are “accepting” of queers. (Note: I kind of hate using the word “accepting” in the context of LGBT folk, because I think it’s ridiculous that people think they can accept or not accept something that is obviously real. It’s like “accepting” that tree over here or that cloud up there. They exist, we exist, GTF over it. End rant.) So when Scary New Person will also be touching me in places normally reserved for trusted bedmates, I’m just a giant sweaty ball of anxiety and panic attacks.

This stress doesn’t even necessarily go away after I’ve become a regular patient. For years, I continued to see physicians that I wasn’t really comfortable with just because doctor-shopping is such a clusterfuck in Boston. Finding somebody who is accepting new patients and near your apartment/dorm? Awful.

Until recently, I was a patient at a women’s clinic at a major area hospital. The clinic was neither particularly nice nor convenient – my two-hour trip there involved two trains and a bus – but it was accepting new patients at a time when others were not. The nurse practitioner (it was basically impossible to see an actual doctor unless you were half-dead) was a nice enough woman, but I knew from the minute we first met that she didn’t know what the hell to think of me. I don’t know if she had other queer patients, but I do know that I never saw another obvious dyke in that waiting room. Getting the side-eye from other patients was something I came to expect.

During my first visit with the NP, after the supremely-awkward “let’s talk about the people you are fucking/have fucked” conversation that they make you have, I decided it was time to suck it up and ask for something I had been avoiding: an STD test. The NP looked confused for a moment, then said, “Well, I’m not sure what to test you for.” Meaning, of course, that she had no idea what a woman who only sleeps with other women could possibly have contracted. I was shocked and weirdly embarrassed. If she, the healthcare provider, didn’t know, how the hell was I supposed to know? I think I stuttered something really intelligent, like “Uh, I guess the regular stuff?” So she listed some of your standard STDs – chlamydia, gonorrhea, syphilis, and of course, HIV – and I was like, “Yeah, OK, all of the above.” And that’s how I got my first STD test from a woman who apparently didn’t think I needed one. After that, I had to specifically request a new test every time I saw her (which ended up usually being after a new partner); she never once suggested on her own that I get tested. Despite that, I continued to use the clinic as my primary care provider for a couple years, because I couldn’t stand the idea of starting my search all over again.

Then 2012 rolled around and I decided it was time to make a vague clichéd heartfelt resolution: this year would be the year of Positive Life Changes. I was going to eat better (breaking: I, Bren, ate an apple – as in, a fruit, from nature – yesterday for my afternoon snack), exercise more (still working on that one), and give back to my community (more on that in future posts). Part one of my PLCs? Find a goddamn LGBT-knowledgeable doctor. Here I have to admit my privilege: I live in Boston, a super-queer city. In this queer city, there is a big, shiny, new-ish building right near the heart of town. This gleaming tower is home to Fenway Health, a medical care provider whose mission is to “enhance the well being of the lesbian, gay, bisexual and transgender community and all people in our neighborhoods and beyond through access to the highest quality health care, education, research and advocacy.” Years ago, FH used to be in a somewhat sketchy old building downtown that honestly wasn’t the most attractive of options. But in 2009, this classy new building was completed; now the Boston queer community can access basically all medical services (with the exception of emergency care) under one roof – PCPs, OB/GYN, dentistry, optometry, rapid STD tests, counseling/therapy, pharmacy, family planning, and even transgender-focused services. It’s one-stop shopping and we’re super lucky to have it. Needless to say, when I found out that their Women’s Health group was accepting new patients, I jumped at the opportunity.

Last week, I had my first visit with my new doc. I was nervous, of course, but shockingly, I was also excited. Excited to go to the doctor? Am I a weirdo or what? (We all know the answer to that one.) Really, I was feeling the same excitement I experience whenever I’m going to a place where I know for sure there will be other queer people. I’m a total dork for community like that.

Let me tell you about my experience at Fenway. First off, for the first time in my goddamn life, I saw other people like me in the waiting room. I saw two – count ’em, two! – other butches and other dykes of various gender presentations. In the examination room, the bulletin board was covered with flyers and brochures targeted toward LGBT needs, with information on coming out support groups, artificial insemination services, LGBT partner abuse hotlines – hell, there was even a picture of a polo shirt-wearing, fauxhawked, chubby butch getting her blood drawn. It was perfect.

My new doctor is young (around my age) and seemingly quite straight (or at least very feminine), but man, did she know her shit. You guys, you’ll never guessed what happened: She actually asked me what gender pronouns I use. How cool is that? She also told me what STD tests I should have, since she actually knows how lesbians work, and gave me the first useful nutritional advice I’ve gotten in a very long time. (Sidebar: I found out that juice – even 100% juice – is actually not healthy, because of all the sugar. Juice! Bad for you! Et tu, juice?? Disappointing, but as Kate Chopin would say, “Perhaps it is better to wake up after all, even to suffer, rather than to remain a dupe to illusions all one’s life.”) Needless to say, I was the happiest butch who just had a pap smear done that you will ever see.

I’m going to wrap this rambling stream of consciousness up with a little pep talk to my fellow doctorphobic butches. Here’s what I’ve come to realize about healthcare:

1.) You deserve it. Your body and your well-being is just as valuable as anybody else’s. Don’t feel like you don’t have a right to demand better.

2.) You’re the customer; the doctor is the provider. They’re getting paid to treat you and if you’re unhappy with their service, don’t hesitate to complain or to take your business elsewhere.

3.) Get an annual pap and breast exam. Yes, it sucks. I know. I fucking hate it. But you know what I hate more? Cancer. Being around to live a long, happy, gaytastic life is worth a few uncomfortable minutes every year.

4.) Oh, and don’t shave your legs for the doctor. They can handle it.

Readers, what have your healthcare experiences been like? Do you have any horror stories or, hopefully, tales of triumph? Are you, like me, still feeling really betrayed by Tropicana? Let’s take it to the comments!

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20 thoughts on “Healthcare is For Butches, Too

  1. I think it’s important for butches to get support to go to the doctor (you’re right, it’s not always easy!), and this is a cool post.

    However, it’s also really important to not ignore the reality that many people do not have access to healthcare and this is a huge economic & racial justice issue. Furthermore, co-pays on insurances can be prohibitively high for some folks, making access difficult even when one has health insurance. It’s important to recognize that those of us with healthcare coverage and enough money to afford co-pays have a lot of privilege – it seems hard to talk about healthcare at all without recognizing this.

    If you live in Massachusetts and do not currently have health insurance, you can find out if you qualify for the MA state-run/subsidized health care — MassHealth/Commonwealth Care — by contacting Health Care for All (http://www.hcfama.org) — they have a helpline (1-800-272-4232) to call (you leave a message, then someone calls you back) so they can either help see if you’re eligible, help get you signed up, and/or discuss how your health insurance can get you what you need. You can also reach them by email (click on the helpline button and it will lead you to an email form).

    Furthermore, new healthcare policies are being changed (a’ la Obama/Sebelius in 2011 – more info here: http://www.crainsnewyork.com/article/20110801/FREE/110809998) so that if you are strapped for cash, you won’t need to pay co-pays for (some) preventive care. This includes physicals! There are also free STD/HIV/Hepatitis (offered by Fenway) – http://www.fenwayhealth.org/site/PageServer?pagename=FCHC_srv_services_testing

    Also, Fenway is quite good in many ways (I get care there, actually) – but it’s far from perfect. I know lots of people in the Boston community who have had downright bad, disrespectful experiences (some around gender identity/presentation/preferred names or pronouns, some around the fact that they’re polyamorous). Holding Fenway accountable is super-important – and I believe they know that too. Milly Perea (Dir. of Client Services) is listed as the contact on the Fenway site for passing along comments on the services at Fenway or make suggestions for improvement, please e-mail Milly Perea (mperea at fenwayhealth dot org) or call her at 617.927.6178.

  2. This comment wins BC&B’s gold star for Most Informative/Helpful. Thank you for so much really important information! And you’re so right – even the best-intentioned organizations need to be held accountable. How else can things improve? When I Tweeted about my upcoming visit, the FH Twitter account asked me to let them know if my experience was less than satisfactory. So social networks are another good way to get the word out – positive or negative – about healthcare experiences.

    And man, you’re not kidding about health insurance being a pain. I know people who are uninsured and it’s a damn nightmare. While my coverage is far from perfect ($1,000 deductible for anything other than routine office visits), I know that I’m wicked lucky to have any at all. What if somebody doesn’t have insurance, but for some reason isn’t eligible for state-run insurance? Navigating the insurance labyrinth is really frustrating.

  3. Fan-fucking-tastic post. I’m not butch but I encounter parallel situations (minus the waiting room looks). I actually love schooling a physician when they are stereotyping or making assumptions. I am fairly good about speaking up in these situations and dont have problem letting a doctor know when I take issue with something (relating to sexual orientation, lifestyle, health… anything). In fact, I take pride in knowing that every person that says something helps change how a doctor may think/respond.

    That being said, I know it is uncomfortable for many people to do this and it is MUCH more critical that everyone has an opportunity to go to a doctor with whom they feel comfortable. Kudos to your PLC!

    On another note, I didn’t have health insurance or money for years and I never had a problem finding free health care with a quick internet search. I am certainly not saying that our healthcare system is not a major piece of shit but I am saying that too many people are don’t take the initiative to seek our resources that are offered.

  4. Thanks for the article. I hate going to the docs because of the same reasons. I have to be nearly dead before I will drag myself to see him. And I find myself dressing up in my most neutral clothes. (Not femme, not butch) I’m what you’d call a soft butch. At least thats how I portray myself to the outside world. Inside I’m all butch, but when I was growing up and started discovering my identiy the world around me started treating me differently. At first I ignored the stares and the comments, but eventually it started to get to me. I was going through a rough patch anyway which was causing me to loose self-esteem. My inner defence against other peoples ignorance and rudeness plummited. It turned out there was only so many times I could cope with being told I was in the wrong toilet etc. Here I was merely going about my days, being myself, doing nobody any harm, and yet every corner I turned I was being confronted with the fact that I wasn’t normal in the eyes of others. I pulled back from the world and also myself. I tried to look and act less butch. It’s taken me ten years but only now am I starting to venture out into the world again. I still don’t show my true self, but I’m getting there. More and more. My doctor is a nice guy, but I’m still not ready to present the real me. And there is no way in hell I could have a pap smear done. Anything to do with my female sex organs are off limits. Wether that’s more to do with past experiences or the fact that I can’t stand to aknowlegde that I have them, I truely don’t know. I take my cap off to you all that find the courage to have these tests done.

    I live in the Netherlands. On paper it is a tolerant country. Gay men and women have the same rights as everybody else. We can even get married and adopt. Yet never have I seen a brochure either at the doctors or at the pharmacists that dealt soley with health issues directed at gays. All that type of information has to come from gay organisiations, mostly only found in the bigger cities, and websites. This of course means the younger generations can easily get answers and help, and I’m happy for them, but they should also be able to have this on offer at their health clinics.

    With regards to health insirance. We are obligated to pay health insurance. Those that can’t afford it get a SMALL reduction from the goverment, but it is by no means enough. Many people I know are in debt simply because they can’t pay their health insurance. The nasty thing is, you can’t say, “oh well, I can’t afford it so I’ll do without.” because you are forced to have it. The poor are getting poorer and the rich? Well they can afford all the premium health insurance they want and continue to create the polices that allow for it.

    This is not a rant. I am all to aware of how lucky we are to have what we have. So many people die every day because even the cheapist medicine is denied them. And lets not forget the countries where women can be stoned to death for showing a mere hint of “gayness”.

    • Hi Linds,

      Thanks so much for reading and for sharing your experiences with us. I’m always interested in hearing the stories of butches in other countries.

      I had no idea that healthcare was like that in the Netherlands! Over here in the States, where both universal healthcare and gay rights are divisive political issues, I’ve always been jealous of European countries – like the Netherlands – that seemed like bastions of liberalism and fairness. I’m really surprised to learn that people there are *in debt* because of it. Wow.

      Listen, I get your fear of pap smears, and I also get your detachment from your female organs. Sometimes, I feel the same way. But cervical cancer is a fucking awful way to go. I hope you’ll reconsider your refusal to have a pap done, because your health is worth it. Trust me.

  5. Allow me to second the praise for Fenway Health. I took my girlfriend there after a terrifying, shaming lecture from another doctor at a free clinic in her city. It was such a relief to be somewhere where you didn’t have to educate your doctor, or get any static about your sexual preferences or relationship configuration.

    It should be that way everywhere — but it ain’t. I’m stunned at how many GPs just don’t know very much about STIs and sexual health.

    • I’m glad your GF was also able to have a positive healthcare experience at Fenway! We’re really, really fortunate to live in a city where a resource like that exists. I think about queers in parts of the country with smaller/almost non-existent LGBT populations and I worry about what going to the doctor is like for them…

  6. Yay! I’m glad you like Fenway Health as much as I do!

    I’ve also been happy with the absence of fat and slut shaming that I’ve experienced from other doctors!

  7. Yeah. This is a great post, and I’m so glad you’ve got Fenway Health and a doctor with a brain as well as a medical degree. I’ve got great health insurance and access to free healthcare at the large, midwestern university I work at–for which I’m very grateful–but at my last pap smear at the gynecology clinic the nurse *refused to do* an STD check I requested because “oh, you don’t sleep with men at all? Then you’re fine!” I was flabbergasted, complained to the director, and have since switched to seeing my primary care doctor for gyno needs (never been so happy to be lectured for not using a dental dam). But HELL. What if I were 18 and newly out and not educated about gay sex because, hello, this is America and we don’t believe in sex ed OR gay people? To have qualified medical staff running around at a university health clinic giving out such false information breaks my little gay heart.

  8. If I was more androgenous I would hate going to the OB/GYN. I’ve had very few problems, except when I got a male doctor that was really dismissive and just wanted me to take birth control pills as if that would magically solve all my problems. I kept telling him that I didn’t want to mess with my hormones if I didn’t have too, especially since I’m a big ol’ lesbian. But he didn’t care at allll. He did tell me that sleeping with other women didn’t mean you can’t get STDs. After reading your story and some of the comments he doesn’t seem so bad.

    • Oh man, you had a male doctor? I think having a dude examine me would make my experience about 100x more nerve-wracking, so I give you props for handling that AND for sticking up for yourself!

  9. Wow, I’m sorry to hear about your past negative experiences with the health care system, but, not to sound cliched, things are getting better. Now it’s pretty standard in med schools to get a lecture series or at least one seminar dealing specifically with LGBT health. Of course this is by no means sufficient but it’s a step in the right direction. We also have to do mock clinic sessions with fake patients and they always have 1-2 cases that involve LGBT-relevant health issues. For instance, forgetting to ask a bisexual or gay lady if she wants an STD test is an automatic fail. This probably explains why the younger doctor at the new clinic was so knowledgeable. I’m pretty sure nursing school hasn’t caught up to med schools in terms of cultural awareness.

    Some general tips for those who want to increase their chances of finding an LGBT-friendly doctor:
    1. Look online at your doctor’s resume before just making the appt with whoever’s available. Most clinic/hospital websites have a “find a doctor” link that will feature the doctor’s picture and where he/she went to medical school. Try to pick someone who’s graduated within the last 7-8 years.
    2. Avoid physicians older than 50. Older doctors can be great, more experienced and all that, but they were trained in a different era that didn’t emphasize being sensitive to differences in belief, cultural practices, gender expression, etc. Now that kind of stuff in drilled into med students.
    3. Avoid nurse practitioners. Again, they’re great for basic primary care for the “average” person, but LGBT awareness is way outside the scope of their training. (Unless you happen to get a gay nurse practitioner)
    4. Go to the website for the Gay and Lesbian Medical Association. It’s a group made up of gay physicians and medical students. Several of my friends and classmates are members. Anyway, they have a great link that gives you a list of LGBT-aware physicians in your local area:
    http://www.glma.org/index.cfm?fuseaction=Page.viewPage&pageId=939&grandparentID=534&parentID=938&nodeID=1

    Look, all healthcare providers SHOULD be LGBT-friendly, regardless of their personal beliefs. We’re a service industry in which professionalism is paramount. It’s a travesty that the burden falls onto the patient for having to find someone who is LGBT-friendly, like it’s a rarity – which it apparently is but is not supposed to be. If you feel that your doctor isn’t totally cool with you being gay or genderqueer or whatever, then they are essentially providing substandard care. You should find someone else immediately.

  10. I always read your blog so when I had an experience on Friday at the gyno I had to come share it. A little background-I am fairly new to the Atlanta area and needed to find a doctor for a check up. I have pretty great insurance and I am near a large teaching hospital downtown so I just picked a name from the insurance website and hoped for the best. I am always nervous when seeing a new dr because I do not want to explain my sexuality in depth with a Dr that just doesn’t understand. Anyways…i get there early and right behind me to get on the elevator is The Cutest Butch Girl I’ve Ever Seen. I check her out for the 12 floor elevator ride and think how I hope she gets off on the same floor so I can find a way to talk to her while we wait in the waiting room. And she did! I go straight to the bathroom to check out my hair and when I come back she was gone:( I think oh well and sit and wait, get called back, go through all the exams with the nurse, the nurse leaves me to get completely undressed and put on the backwards robe while I wait for the doctor. A few minutes later, sitting naked on the table, IN WALKS Cutest Butch Girl I’ve Ever Seen!! I’m pretty sure I died a little. It took me a few minutes to recoup from her being Cute Butch Girl I saw on the elevator to Dr. Gyno. As a side note, she turned out to be really great and was able to diagnose some things I have going on….even if I did feel like you probably shouldn’t have a gyno that could potentially be someone you would date given a different scenario.

      • Thanks, my friends also thought this experience was pretty hilarious at my expense. And I have heard ALL the jokes 🙂

    • This is the best story I’ve heard in AGES. I think I would literally drop dead if my gyno were a hot femme. Oh god, oh god. Nope, please keep giving me middle-aged housewives and straight women!

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