The Ins and Outs of Gay Sex (44 page)

Even if you are treated in a private doctor’s office, there may come a time when some of your care is turned over to a nonphysician, usually a physician assistant (P.
A.
) or nurse practitioner (N.
P.
).
Although not physicians, these highly
trained providers are adept at handling routine medical problems.
If you want to discuss your problem with the supervising doctor, just ask.
Many patients I know have come to rely on nonphysician practitioners for more personal care.
In this age of falling reimbursement levels, many doctors make up for lost income by seeing more and more patients.
They spend less time with healthier clients and/or hire nurse practitioners and physician assistants to take up the slack.
Don’t be shocked if your doctor can’t see you for that sore throat, blood pressure check, or flu shot.
The nurse practitioner or P.
A.
is well equipped to handle your problem.

You can tell a lot about a doctor by the way his or her office is run.
If your phone call gets picked up on the tenth ring by someone who yells “Doctor’s office, please hold!”
then treats you to ten minutes of Muzak, chances are that the doctor is too busy to give you the time you deserve.
If the secretary sounds gruff and uncaring, most likely the doctor will too.
The boss, in this case the physician, sets the tone of any office.

When you enter an office for the first time, look around to be sure it’s a place where you feel comfortable.
Cleanliness is key in any doctor’s office, and that is what you must look for.
If the place looks like a garbage dump, then the surroundings might be indicative of the care provided.

Look for clues in the office as to whether the place is gay-friendly.
While I wouldn’t expect to find a Rainbow flag in the waiting room, you might see other indications.
Pamphlets addressing gay health issues or gay-oriented magazines might be prominently displayed.

During a patient’s first visit, I always talk to him in my consultation room while he is fully dressed.
This is a far less threatening environment in which I get to know a patient and find out what is really bothering him.
I also don’t discuss treatment with a patient while he is shivering in a
gown seated on a cold vinyl exam table.
I tell him to get dressed and then join me back in my consultation room, where we can talk behind closed doors.

If your doctor tries to talk to you in front of other patients or even in a room with an open door, insist on privacy.
Your medical issues are between you and your physician, not anyone else in the office.
If your significant other (or anyone else) has accompanied you on the visit, it is certainly your right to request that he join you or
not
join you when you talk with the doctor before and after your exam.
But don’t expect to have company during your examination.
Most doctors, myself included, frown on having an audience other than office personnel.

And what if after your exam you don’t like the doctor or the advice?
Just because you see a doctor once doesn’t mean you have to go back or that you have to follow the instructions.
Even if he or she is registered as your primary physician within your health plan, you can always change to someone else.

Telephone medicine is usually not good medicine.
If you call for an appointment and your doctor calls in prescriptions instead of seeing you, think about finding someone else.
While some problems can be handled by telephone, many should not be.
If your doctor refuses to see you despite your belief that you merit a visit, demand an appointment or go somewhere else.

When confronted with a medical situation, it is always best to see your primary care physician:
the person who knows you best and is adept at handling a wide variety of ailments.
If that doctor feels you need a specialist, a referral will be provided.
Do not run to emergency rooms for nonemergency problems.
The care they provide is geared to life-threatening
situations, is far less personal, and probably is not as thorough as that which a regular doctor provides for more routine problems.

Most primary care specialists can treat STDs.
Patients with STDs also often turn to dermatologists first, because so many of these diseases begin as skin rashes.
Urologists are also adept at handling most male-related STDs and other genital problems.
But again, your primary doctor can treat most of these problems or refer you to a specialist when necessary.

If you are too embarrassed to see your regular doctor about an STD, most cities have clinics specially set up for these diseases.
While these are often fine, I urge you to put away your embarrassment and talk to your own doctor.
I guarantee you are not his or her first patient to catch this doing that!

As always, if you don’t think that your regular doctor is treating your condition properly or if you fail to improve, it is your right to ask for a referral to a specialist or to go for a second opinion.
Most doctors welcome second opinions for patients with difficult problems—either to confirm that their treatment plan is correct or to offer a different perspective on a complicated problem.

What do you do if your primary doctor refuses to refer you to a specialist and your insurance company won’t let you go without it?
Occasionally there is nothing you can do.
If your doctor is offering an alternative treatment plan instead of sending you to a specialist, try what is recommended.
Many primary doctors are able to handle more than you imagine.
For instance, don’t be surprised if your primary physician chooses to treat your rash with medication rather than send you immediately to a dermatologist.
If it doesn’t work, then your primary doctor will make the referral.
Getting angry and screaming will do little to enhance the doctor-patient relationship.

If your doctor flat out refuses you a referral and you still want it, most health plans have patient care representatives you can call to lodge a complaint.
You also can request another primary healthcare provider, one more willing to give you what you need.
Alternatively, most health plans with restrictive referral lists now offer what is commonly termed out-of-network coverage.
This entitles you to see any physician without a referral from your primary doctor.
But beware; you’ll probably have a deductible to meet (which can run hundreds of dollars) followed by only partial reimbursement for charges.
Check with your plan first and know what you’re getting into.
It is always less costly to get a referral or to see a doctor on your plan than to go outside.

As a surgeon, many of my patients come to me by referral from their internists.
Other patients come because of family or friend recommendations.
I hate it when patients ask me not to tell their primary doctor I saw them because I’m not the surgeon who was recommended.
There is nothing wrong with seeing a specialist different from the one your doctor advised.
You are not betraying your doctor, but please keep all doctors informed of who is caring for you.
Communication among your various physicians is crucial and can’t occur if you hide one from the other.
Doctors need to discuss your medical situation so that diagnostic steps are not duplicated and treatments are coordinated.
Many conditions and treatments impact one another and could cause dangerous consequences if your doctors are unaware.
Let your doctors decide when it is important for them to talk.

I treated a patient who had a slight bleeding problem that, although not serious on a day-to-day basis, could have been life threatening during surgery.
My patient did not understand the illness and felt that because it never bothered him, there was no need to disclose it.
Although he
asked me not to call his internist, I refused.
Fortunately for my patient, I learned about his blood disorder from his primary doctor and took the necessary steps to ensure that he didn’t bleed excessively during surgery.
Most patients do not understand what doctors need to learn from one another.

Some gay men also try to keep their HIV status hidden from various specialists.
Even if you are sure that your HIV status has no bearing on your treatment, it is important to tell the doctor, because
you
never know.

When you call to make an appointment, don’t be afraid to ask questions regarding cost and insurance.
Remember:
You’re the consumer.
You wouldn’t walk into a store and take something from a shelf to the cashier without even looking at the price.
(Then again, maybe you would!
) Don’t let yourself be surprised when you’re presented with a huge bill and the secretary points to the sign stating “Payment is expected at the time services are rendered.”
You should have known this from the time your appointment was scheduled.
If the secretary answers your telephone questions regarding usual fees with “It all depends on what the doctor does for you,” he or she might be giving the best answer possible.
Many times if you see a doctor for a specific problem he or she may want to perform various tests.
Some are done in the office and billed at that time, while others are carried out elsewhere.
When faced with this type of predicament, try asking the secretary about standard fees for consultations as well as the price for office tests.

If you are a member of a managed care plan or HMO, be sure to ask if your prospective physician participates.
If so, you will be responsible for, at most, a small copayment.
If you contact a specialist on your own and determine that he or she is a member of your group plan, check to find out if you need a referral from your primary care doctor in order for the visit to be covered.
Some plans require prior approval or else your treatment won’t be reimbursed.

If you are not a member of a managed care or HMO plan, then chances are you will be responsible for some portion of your office visit.
Many plans typically cover only 75 to 80 percent of reasonable and customary charges.
If your plan covers 100 percent, you might think yourself lucky and then be surprised when you still get a bill for a balance owed.
How can this be if your plan covers 100 percent?
The answer lurks in those three little words, “reasonable and customary.”
Your plan determines what “reasonable” fee doctors should charge for any given procedure and reimburses accordingly.
Your doctor, however, has no obligation to go along with that fee scale.
If your doctor charges $100 for a visit but your insurance company said that $80 was a reasonable rate, you’ll be billed for the difference.
When you call your doctor, inquire about standard fees and then call your insurance carrier to determine if discrepancies exist.

Men frequently find themselves switched into new insurance plans because their employer changed coverage.
If your new plan has a restricted provider list, your original primary doctor may not be a member.
Unfortunately, usually this means that you need to choose a new primary care physician.
This situation is particularly troublesome for patients with chronic illnesses like AIDS who have long-established relationships with their physicians.
If your new plan has out-of-network benefits, ask your old doctor if he or she will accept whatever your insurance pays.
Many doctors will agree rather than lose you as a patient.
Even if your doctor accepts your insurance with the proviso that you
cover your deductible, it may be worth it to spend a little money and maintain a relationship that has worked over years rather than switch to someone new.

No matter what type of insurance policy you have, never go to a hospital or emergency room (unless it’s a true life-or-death situation) without first checking to be sure that you don’t need prior approval.
If you go without the required approval, you may be responsible for the entire fee (and it’s never cheap)!
Whenever you’re admitted to a hospital or scheduled for a test or surgery, either call your insurance company yourself or have someone do it for you.
Many policies must authorize medical procedures and hospital stays or else they won’t cover your bill.

The biggest problem in healthcare today is the large number of uninsured patients.
If you have any health insurance whatsoever, you’ll probably be able to find a physician who will accept it as full payment (although it may be at a clinic).
Many young men have no idea how costly healthcare can be, nor how at risk they are for illness.
When we’re young we never think about sickness or hospitalization, and often we don’t have money to “waste” on health coverage.
Some gay men truly can’t afford insurance and don’t qualify for disability or public assistance.
For anyone in this situation, it is imperative that you research fees before you see the doctor.
Most won’t react kindly to a patient who after treatment suddenly finds that his credit card is maxed out or there’s no money to cover a check.