Ask the question June 3, 2009

Today I performed a physical exam on a new patient. He appeared to be an average man in his 60’s. We went through the Review of Systems, then moved on to Social History. In addition to the smoking and drinking questions, I try to ask all of my patients about their sexual history. I don’t need to know the exact number of patients that you’ve had in your life, nor do I need to know your favorite sexual position. I do need to know whether or not you sleep with men or women, whether you are sexually active now (or in the recent past), whether you’ve had multiple partners and what kind of pregnancy or STD prevention you use.

I was going through my usual routine when I said, “I ask everyone this question: do you sleep with men, women or both?” My patient, looking a little taken aback, said “Men.” I’ll admit, even I–Lesbonurse!–was a little surprised. He just didn’t look gay (whatever that means). But I forged ahead with my next question: “How often do you use condoms when you have sex? Some of the time? All the time? Barely ever?” My patient stopped me by looking me in the eyes and saying “No one has ever asked me that before.” “Oh,” I said, preparing to move on. “No,” he said, “I mean, no doctor has ever asked me that before.” I dropped the social history questions for a little while, and we talked about his experience as an older, closeted gay man. The experience was a good reminder that even me, a super-gay healthcare provider, makes assumptions. And even me, super-gay healthcare provider, needs to ask the question every time. You never know.