Dear Civilities: For the past 25 years, I’ve been living in the extremely rural and conservative South, where I grew up. My doctors are all aware that I’m gay and had a longtime partner, so I’m not hiding anything, but I’m always annoyed by the “marital status” question on their health history forms. My state, even today, forbids gay marriage, but my choices are single, married, divorced or widowed. I used to check single since, legally, that’s what I was, but I wasn’t single. I didn’t want to check married, because we weren’t legally wed. My partner is now deceased, so recently I checked widowed for the first time, but I’ve been fretting about it. Was it right to call myself widowed? ~ Jonathan, Ala.
A: First, I’m sorry to hear that your partner has passed. That most definitely, although sadly, qualifies you to check “widowed,” so please don’t fret about that. But your question raises a more profound one, one that’s only metaphorically about which box to check, whether on a medical questionnaire, an insurance form or any other document requesting information on marital status. I recall a mishmash of feelings — ranging from confusion to exclusion — when filling out those forms during the years I was “partnered” but not “married” — and certainly not “single.” When I’d ask the receptionist why the question was included, the reply was either: “I have no idea” or “It’s about demographics.”
Actually, the question is largely driven by financial considerations (i.e., who other than you is responsible for your bill), as well as for determining next of kin. But it also provides important information about your support system (whether you live alone) and about who may be available to help you make medical decisions. Obviously this is imperfect, as we get help and support from people other than our spouses, but at least it’s a clue.
By omitting “partnered” as an option, health-care providers miss an opportunity to fully understand their patients’ lives. This is also true for unmarried opposite-sex couples.
According to Hector Vargas, executive director of GLMA (previously known as the Gay and Lesbian Medical Association), collecting this type of information is “extremely critical to ensure LGBT people get the care they need and deserve.” Adding a “partnered” option to the form would also signal to a patient that the doctor is welcoming to all and could open the door to conversations about sexual health that a new patient may be afraid to initiate. Not having that choice may make a patient feel invisible. (Indeed, as you wrote me separately, “It rankled. I felt excluded. No room for me at the inn.”)
Liz Margolies, founder and executive director of the National LGBT Cancer Network, agreed: “Most medical intake forms don’t give us room to say who we really are and can send an (often unintended) message of unwelcome.” A gay man in his 50s told me: “It angered me when a form was lacking the appropriate ‘box’ to define my relationship. That’s why I always did a write-in [scribbling ‘married’ even when legally not]. It was part political action but also part education.”
Yes, education. It turns out that sexual orientation matters a great deal when it comes to the physical and mental health of many in our community. Last month, the Centers for Disease Control and Prevention published its first report looking at sexual orientation, finding “clear disparities” among gay men, lesbians and bisexuals — and straight populations. These include much higher rates of cigarette smoking and drinking among gay men and twice as many bisexuals experiencing “serious psychological distress”; lesbians, meanwhile are less likely to obtain needed medical care — all compared with straight adults. The result is a greater incidence of asthma, diabetes and cardiovascular disease, with worse outcomes, according to the report.
When health-care providers don’t know our sexual orientation, imperfectly associated with our marital status, they are missing vital information that they need in treating us.
My bottom-line advice to others: When the choice isn’t there, write in a “partnered” option and list your same-sex partner’s name. (Some may also want to add, “We’re married, even though our state doesn’t legally recognize our relationship.”) That tells the doctor your relationship status and sexual orientation. Then, ask to speak to the office administrator and explain what you’ve done and why.
For those of you responsible for those forms in the first place, why not take a closer look at the options provided? Those boxes speak volumes when it comes to sending a welcoming message and one that it’s safe for a patient (or applicant) to come out.
Agree or disagree with me? What’s been your experience in doctors’ offices?
Update: My last column provoked one of the strongest responses I’ve had to date here at the Post. The question came from a lesbian who feared that her parents were financially favoring her straight sister’s family and expressing disapproval of her own same-sex childless union. Half of you thought I cozied up to the writer (“reading bigotry into the parents’ estate decision”); the other half thought I’d been grossly unfair to her (especially in quoting negative comments from Facebook). Then I heard from the letter writer:
“I don’t know if inheritance and money just hit a nerve with folks or if people are just gleeful for the opportunity to call someone entitled! It reminds me not to take things to seriously AND be grateful that my parents have been so generous to both my sister and myself.
“Ironically, the people who assumed my sister and I must have been rivals throughout life couldn’t be farther from the truth. We are twins and have always been very close. My coming out drove a wedge between us because she disagrees with my relationship (she skipped my wedding ceremony but came to the reception), but we still phone each other several times a week and try to respect each other’s choices.
“I think you were right to point out that my hurt feelings were less about the money and more about how I envy my sister’s laissez-faire approach to childbearing. I wish I COULD be more like that. I am happy to report that my wife and I recently agreed that we are going to start exploring our options with artificial insemination in the next few years, so the prospects of having a family feel closer.”
E-mail questions to Civilities at firstname.lastname@example.org (unfortunately not all questions can be answered). You can reach him on Facebook at facebook.com/stevenpetrow and on Twitter @stevenpetrow. Join him for an online chat on the upcoming Gay Games with Olympic gold medalist Greg Louganis at washingtonpost.com on Aug. 12.