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I hope that you already include the patient's
significant other in major decisions if that is the patient's
desire, despite the relationship's legal status. Sometimes
it is difficult to ferret out the relationships that are
important to your patient. Your patient may have a wife
and a master, or two significant others. It is appropriate
and desirable to ask the patient who they would like
present.
Dealing with the mistrustful patient. Many sexual
minority patients mistrust traditional medicine. Some of
this mistrust is understandable: many alternative sexual
behaviors are also psychiatric diagnoses, and in some cases
may be illegal; many patients have had less than pleasant
interactions with non-accepting physicians. Reliance on
alternative medicine and folk remedies, and avoidance
of traditional medicine, are common. Sexual minority
patients tend not to take care of health care maintenance
or even simple problems. So when they finally seek medical
care, there can be serious medical concerns.
For similar reasons, many sexual minority patients
also mistrust mental health professionals ­ so a suggestion
that your patient see a psychiatrist or psychotherapist may
be greeted with skepticism or hostility, particularly if the
patient believes that you are suggesting such therapy to
"cure" the patient's sexual behavior.
I hope it goes without saying that consensual and
satisfying sexual behaviors among adults that do not
interfere with the patient's functioning do not need
curing. Nevertheless, depression, personality disorders,
stress and other psychiatric problems are at least as likely
among sexual minorities as the general population. Due