I’ve just gotten back from a physical and I just had to write you. My health plan forced me into seeing a new doctor who doesn’t know me. He asked me all the routine questions when suddenly he veered into sex. I told him I was gay and he was real cool with that. But then he says, *”What do you like to do in bed?”* I didn’t know where he was going with this, so I just kept it vague. He seemed frustrated at my evasiveness and he blurts out, *“Do you like getting f–ked up the a–?”* I couldn’t believe it! I told him it was none of his business and that he could at least come up with a more diplomatic way of asking such a personal question. God, I hate HMO’s. Anyway, I’m writing because you’ve often complained how crass gay men can be about sex. Don’t you think my doctor’s behavior was just as bad?
— Shocked and angry
Actually, I think your pigtails are tied a little too tight. Your doctor was asking you blunt questions because he knows that the more indirect he is in questioning sexual habits the more likely he’s going to get false data and lose the opportunity to educate you about safe sex.
They know that terms like ‘intercourse’ are too vague. “Intercourse means different things to different people,” one director of a large AIDS group told me. “But everyone knows what ‘f–king’ means.”
You’d think you couldn’t get any more direct than asking a guy if he’s gay. But that’s actually considered an indirect question by AIDS scientists. Dr. Alvin Novick, Yale professor of Biology and founder of the scholarly journal AIDS & Public Policy knows first-hand how asking for somebody’s sexual identity misleads prevention experts and misses opportunities to educate.
“This man came into the free clinic where I was conducting studies,” he told me. “And I asked him the standard questions, one of which is “Are you gay?”
“I’m no f–got,” he snapped. “You calling me a f–got?!”
“After he calmed down, once I established some trust, I asked him non-chalantly if he had sex with men. ‘All the time,’ he said. And that’s when I knew my whole approach had to change.”
Dr. Novick’s experience also helps explain why CDC studies have a category labeled “heterosexual” but not “homosexual.” Instead, the category is “MSM,” men who have sex with men.
Dr. Novick says doctors have to be trained to ask impertinent questions if they’re going to be effective. He remembers teaching a seminar on HIV when a doctor raised his hand. “I have a husband and wife I think are at risk for HIV,” he said. “But I don’t really know to ask him if he’s, you know, having back-door sex with his wife. What would you say to him?”
Dr. Novick said, “I’d say, ‘How often are you f–king your wife up the a–?’” The intern was so flabbergasted he actually left the room. “I wasn’t there to teach politeness,” Dr. Novick told me. “I was there to teach doctors how to stop the spread of HIV. And you can only do that by asking blunt questions.”
Dr. Novick wasn’t always this blunt. But he learned that patients would not be offended as long as you look them in the eye and ask the questions with sincerity and concern. And most importantly, “without judgment.” You know, the way I write this column, you over-wrought drama queen.