Helping a patient come out is a healthcare provider's role

Dr. Lemuel Arnold started his presentation by placing a slide up on the screen:

”Questions for Heterosexuals.”

He began:

“What do you think caused your heterosexuality?

When did you decide you were a heterosexual?

Is it possible your heterosexuality is a phase you may be able to grow out of?...”

It only got worse.

“I know this is a bit confrontational...but these are questions that our people are asked on a routine basis, except in a different context,” Arnold said, introducing the first keynote lecture of The Vanderbilt Program for LGBTI Health First Annual Southern LGBTQ Symposium.

A graduate of the Massachusetts Institute of Technology and the University of Texas Medical School at Houston, Lemuel Arnold M.D. practiced medicine for almost forty years in the Atlanta region, much of that with the Kaiser Permanente group.

Dr. Arnold helped to create “A Provider’s Handbook on Culturally Competent Care: LGBT Population” while serving on Kaiser’s National Diversity Council and was honored with Kaiser’s R.J. Erikson Diversity Leadership Award before retiring in 2016. He now splits his time with his partner on his farm while continuing to serve as a part-time physician for an underserved part of rural Georgia.

In 1973, he continued, homosexuality was officially removed from medical literature as a listed mental illness. And that was important, according to Arnold, because he had come out as bisexual three years earlier as a freshman in college, and he was really stressed out by that point in his young life, he said to friendly laughter.

After a brief overview of how the majority of health professionals have now come to view sexual orientation and gender identity in a far better light, he touched on many aspects of the treatment of members of the LGBTQ+ community during his hour-long presentation.

The highlights of his address included the following:

  • The terms “queer” and “genderqueer” have been recovered by the LGBTQ+ community as legitimate identities, because identities can be fluid in nature...just as bisexuality is not a phase in someone’s life but a very real part of who they are.
  • The way to prevent HIV infections is through dealing with the outcomes of sexual behavior, not with someone’s sexual orientation.
  • The millennial generation is literally exploding with people openly identifying at LGBTQ+ and the medical community will need to plan accordingly for this social shift.
  • Gender is a spectrum and the “transgender revolution” is bigger than we think. We have very little data on transgender issues because we have yet to truly collect any...and that is why we need to.
  • Medical professionals need to move out of their current gender-based/heterosexist ideals and treat people as they know themselves to be. A new generation of professionals who have been taught how to treat gay/lesbian/bisexual patients are now learning how to properly treat transgender and non-binary patients in a professional setting. Treating someone with courtesy and as who they know themselves to be reaffirms the individual and leads to better results that may save someone’s life.
  • Hormone therapy for transgender adults and hormone blocking treatments for minors “is not rocket science.” Not everyone in the transgender community wants to have surgery, but the overwhelming majority just want to be happy with who they are and how they present themselves.
  • Terminology is key. Be careful how you address someone in a professional situation regarding orientation and gender issues. Everyone makes mistakes, including LGBTQ+ people. Just step back and apologize if you do...and try again.
  • Sexual behavior is the public health issue, not sexual orientation. As medical professionals, they have to overcome their own discomfort to talk about sexual behavior issues. As more millennials and younger come out, it will be increasingly important to do so.
  • There is still a medical bias present in the treatment of LGBTQ+ people, but this has improved in recent years. Remember - you ask, and never assume. There are ways to do this in a professional manner that shows you care as a medical professional about someone’s health. And they need to ask. It’s important…
  • LGBTQ+ people suffer from huge measurable discrimination, especially younger transgender people. There are far too many homeless transgender youth sleeping on the streets as a result of discrimination.
  • HIV infection rates in African-American males is a major crisis and a full-blown public health emergency. The most recent estimate of African-American transgender people shows an HIV infection rate of around fifty percent.
  • Bisexuality is “not a phase” and Southern culture historically has a problem with bisexual people. Remember that the first goal of a practitioner is to do no harm. Forcing people to choose a sexual preference is not achieving that first goal.
  • So-called “conversion” or “aversion” therapies to force LGBTQ+ people to become something they are not have absolutely no place in modern medical practice.
  • We are beginning to see our first sizable numbers of openly LGBTQ+ senior citizens now. We need to find appropriate ways to help these patients and not force them back into closets in order to get decent care.
  • This is also a generation with memories of lost friends and partners from the AIDS era. There is a lot a of Post-Traumatic Stress Disorder and grief from surviving this time and for growing up in a day where being LGBTQ+ was a crime. Professionals need to keep that in mind when treating older LGBTQ+ patients.
  • Helping someone to come out of the closet “is a provider’s role.” That includes kids, and you will have to ask...probably more than once...because they are not going to volunteer about their sexuality. There are appropriate ways to do this in a professional setting and it is important to do so. This is about their future physical and psychological well being in an often judgemental world.


You can watch Dr. Arnold’s full presentation directly from our Periscope/Twitter stream.

Dr. Arnold begins at the 15:45 mark.


Keep an eye out over the next few weeks on our website for more stories from the First Southern LGBTQ Health Symposium. Please visit the Vanderbilt Program for LGBTQI Health website for more information about this program and their services.


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