When patients are faced with the difficulties of disclosure, family physicians have a pivotal role. The data reported here extend previous work by Geddes on what factors (eg, attitude, sex) are important when lesbian or bisexual patients choose their physicians. Over and above this information, however, this study shows that lesbian and bisexual women must constantly monitor the effects of coming out to their health care providers. A family physician’s reaction to disclosure can profoundly affect the quality of health care in the short term and, in the long term, the trajectory of health care.

Participants themselves provided concrete examples of, and suggestions for removal of, barriers to health care. In this way, these data contribute an empirical base to our understanding of the ramifications of lesbian and bisexual invisibility in the Canadian health care system. These ramifications have been discussed more in theory than in actual fact.

The interviews emphasized that providers must educate themselves about sexual orientation on two levels at once: in its application to specific health issues and in the overall stresses of living as lesbian or bisexual women. In this sense, HIV-prevention education for lesbians and bisexual women could prove particularly challenging. Half the participants said they had never discussed HIV risks with any physician. Women in general are an understudied group when it come to HIV, but lesbian and bisexual women specifically are the least studied and most elusive population affected by HIV infection. In order to counsel women properly, we need information about women’s risk-taking behaviours, constraints to activating safer sex practices, gaps in knowledge, and strategies employed in reducing risk. Lacking a body of research on this topic, the onus is on health care providers to pursue these important issues individually with their patients. omnicef 300mg

This study was restricted to lesbian and bisexual women in one province and also to those who seemed to be relatively well educated, raising the issue of generalizing the findings. We have no suitable demographic data about lesbian and bisexual women against which to compare our findings, and are, therefore, hesitant to speculate whether members of a specialized group self-selected themselves for this study. At the same time, we have very few Canadian data of any sort on this topic.

Key points
• Lesbian and bisexual women wanted their family physicians to be “gay positive,” that is, open-minded, knowledgeable about their health needs, and able to create and sustain a safe space for disclosure.
• A most important barrier to good care was the common heterosexist assumptions physicians reflected in their history taking and health advice, particularly in the areas of relationships and sexual behaviour.

Preliminary results have been presented in Ontario, Alberta, and British Columbia. Patients and health care providers have recognized the salient issues, especially about the role of the health history. Two questions that were reported to be especially useful were: “What do I need to know about your life or relationships that will help me to best meet your needs as your physician?” and “Are you having unprotected sex with men, with women, or with both?” Several chapters in Women’s Health Care: A Comprehensive Handbook are useful references. We believe that our findings have validity, having described experiences of women and of physicians in other parts of the country, whose own stories have been reflected to us during dissemination of our data. generic ampicillin

Conclusion
Lesbian and bisexual women are receiving less than optimal health care in a Canadian health system that prides itself on equal access. Family physicians are in a position to address this problem by recognizing barriers to care and using gay-positive strategies. Practice patterns that promote heterosexism must be challenged and changed. This includes self-education, reviewing how we take health histories, and placing appropriate, supportive materials in clinics. Creating and sustaining a safe, professional space where women can disclose draws on the very principles of family medicine, that is, continuity of care in the context of a long-term relationship.