Confronting the culture of medicine: Gay men's experiences with primary care physicians

Objective: To explore gay men's perspectives on primary health care. Design: Employing grounded theory methodology, structured interviews with 11 self-identified gay men from upper New York State were coded via the constant comparative approach. Measurement: Participants were asked open-ended questions about their past health care experiences, perceptions of the field of medicine, and thoughts regarding their relationships with their primary care providers. Results: Analysis suggested that gay men experience the field of medicine at two levels. At the macrolevel, medicine was thought to be homophobic and heterosexist, creating an unwelcoming environment for gay men. Participants believed that medicine was functioning in a state of ignorance because sexuality issues were not a priority in the training or practice of physicians. At the microlevel, gay men sought to build mutually comfortable physician-patient relationships based on open and honest communication. Participants differed in their beliefs of how the relevance of their gay identity related to health care needs. Disclosure of gay identity was not always seen as necessary for care, but being open in this regard was preferred. Conclusions: Gay men must navigate the medical field's cultural barriers to develop meaningful and stable relationships with their providers in order to receive appropriate care.