On April 1, 2011, the Institute of Medicine of the National Academy of Sciences (IOM) released a report called "The Health of Lesbian, Gay, Bisexual and Transgender People: Building a Foundation for Better Understanding." The report addresses "health" in a multidimensional way, including physical health, emotional health and social well-being. It identifies gaps and opportunities in health care for LGBT people.
As a group with minority status, LGBT people are subjected to prejudice and discrimination in health care. In the mid-1980s, I had just left my wife and daughters to begin the process of coming out. I had taken a new position as medical director of psychiatry at a large health care system in Iowa. My new position included an invitation to sit as the psychiatric representative on a committee of an HMO.
The committee was tasked with developing eligibility criteria for joining the HMO. The HIV/AIDS epidemic dominated early discussions. The woman chairing the meeting smugly announced that the HMO was designing the questions in their application questionnaire that would identify men who might be gay so that they could be denied coverage. One of the other committee members asked in a side comment spoken loudly enough for everyone to hear, "What did you ask them? ‘Do you like to take it up the ass?’"
Although several committee members laughed, I sat there in stunned silence. I had not yet come out at work, because I was afraid that I would lose my position as psychiatric medical director if my newly admitted sexual orientation became public information. Faced with significant alimony and child support, I needed that job. I wanted to speak up, but fears of the consequences of doing so paralyzed me.
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