SUPPORTING OUR PATIENTS BY SUPPORTING EACH OTHER
Since my Scholarly Project involves transgender health, I routinely peruse some of the new research that comes out involving health disparities in the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. The articles usually include information about disparities in HIV, preventative screenings, cancer care, and a myriad of other health outcomes. These things, unfortunately, usually do not surprise me. Health disparities in the community are more far-reaching than any change in laws can correct overnight. It will take a wealth of research, interventions, and continued improvement to correct biases that have interwoven their way into medicine over the course of decades.
This past semester, however, I stumbled upon a new study published in Academic Medicine that examined the experiences of LGBTQ medical students nationwide. They found that almost a third of medical students who identify as something other than heterosexual concealed their sexual orientation in medical school. Furthermore, nearly two-thirds of students who are gender minorities (individuals who have a gender identity that does not match their sex assigned at birth) conceal their gender identity while in medical school [1]. As someone who has been privileged enough to have the environment and support to live my life authentically, this data definitely made me pause and reflect.
The medical students in the study noted a multitude of reasons why they concealed their gender identity or sexual orientation. The reasons included fearing discrimination from faculty, particularly with the subjective nature of grading during third and fourth year. Other reasons included personal social or cultural factors—that coming out added too much stress on top of medical school and that they thought it would limit their ability to apply for residencies in certain areas that (at least traditionally) have not been the most supportive of LGBTQ individuals. Finally, students noted that they heard sexist and homophobic remarks from physicians, and this provided an unsupportive environment for coming out. One student even noted an experience on a surgery rotation where a transgender patient was treated like a freak and joked about by residents and attendings.
As a medical student, I obviously have an interest in improving the health and well-being of my patients. I went into medicine with the goal to help ameliorate suffering in those who need it most, and I try to keep that goal in mind every time I interact with a patient. This study, however, served as a stark reminder that with our continued focus on helping our patients, we may be forgetting some people—our colleagues. It reminded me that, perhaps, in order to improve the environment and framework in which we treat patients, we have to go back to the basics—how we treat and interact with each other. After all, if we cannot trust our colleagues to treat us with respect and empathy (as this study suggests), how can we reasonably expect that our patients will trust us to be non-judgmental and treat them with empathy and respect?
The unfortunately reality is that, many times, they don’t. Evidence suggests that a strong history of discrimination and stigma in the healthcare setting has lead to a great deal of distrust of the healthcare system within the LGBTQ community [2-4]. Despite recent progress in achieving equality in some realms, implicit biases against non-heterosexual individuals are still pervasive in medicine [5]. Consequently, some LGBTQ patients do not disclose their sexual orientation to their healthcare providers, despite recognizing that this information is important to their health. This mistrust undoubtedly contributes to numerous poor health outcomes, including delaying care until it is an emergency, obtaining care from street sources, and receiving inadequate screening or preventative care [6-7]. As individuals invested in improving the health of our communities, this should sadden us all.
I am sure we can all agree that medical school is challenging. The days are often long, taxing, and filled with more to do than we can fit into a day. Burnout, anxiety, and depression are real problems among medical students, and are even more common among LGBTQ medical students than their heterosexual peers [8-9]. However, one enormous strength that we have in medicine is a sense that we are all in this together. Nearly every medical student, resident, or physician I have encountered has mentioned how they could not have gotten through training without their peers. This is not a new concept, either. The notion of a duty to show respect for and care for your fellow physicians dates all the way back to the time of Hippocrates and Thomas Percival, two individuals who played a crucial role in articulating the duty and responsibility of physicians. In some ways, it is an integral part of the culture of medicine.
As we all continue on along the challenging journey to achieving our goals, I urge you to not just care for your patients, but for your colleagues as well. Not just during Diversity Week, but every day. Traits like empathy, respect, and kindness are not things we should just “turn on” when we walk into an exam room. They should be things that we bring to our interactions with each other as well. Our diverse backgrounds and identities allow each of us to bring strengths and perspectives to patient care that others simply cannot. It is only through nurturing a culture of respect that is free from judgment that we can rebuild trust with the communities who need us the most.
- Mansh M, White W, Gee-Tong L, et al. Sexual and gender minority identity disclosure during undergraduate medical education: “In the Closet” in medical school. Academic Medicine. 2015; 90(5): 634-644. doi: 10.1097/ACM. 0000000000000657
- Bradford J, Resiner SL, Honnold JA, Xavier J. Experiences of transgender-related discrimination and implications for health: Results from the Virginia Transgender Health Initiative Study. Am J Public Health. 2013;103(10): 1820-9. doi: 10.2105/AJPH.2012.300796
- Kosenko J, Rintamaki L, Raney S, Maness K. Transgender patient perceptions of stigma in health care contexts. Med Care. 2013; 51(9): 819-22. doi: 10.1097/MLR.0b013e31829fa90d.
- Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, Cherry C. The role of stigma and medical mistrust in the routine healthcare engagement of black men who have sex with men. Am J Public Health. 2015; 105(2). doi: 10.2105/AJPH.2014.302322
- Sabin JA, Riskind RG, Nosek BA. Health care providers’ implicit and explicit attitudes toward lesbian and gay men. Am J Public Health. 2015; 105(9). doi: 10.2105/AJPH.2015.302631
- Xavier JM, Hannold JA, Bradford J, Simmons R. The health, health-related needs, and lifecourse experiences of transgender Virginians. Richmond, VA: Virginia Department of Health; 2007.
- Barriers to Care. National LGBT Cancer Network. http://cancer-network.org/cancer_information/cancer_and_the_lgbt_community/barriers_to_lgbt_healthcare.php
- IsHAK W, Nikravesh R, Lederer S, Perry R, Ogunyemi D, Bernstein C. Burnout in medical students: A systematic review. Clinical Teacher. 2013; 10(4): 242-245. doi: 10.1111/tct.12014
- Przedworski JM, Dovidio JF, Hardeman RR, et al. A comparison of the mental health and well-being of sexual minority and heterosexual first-year medical students: A report from the medical student CHANGE study. Academic Medicine. 2015; 90(5): 652-659.
Alex Geiger is a medical student at The University of Arizona College of Medicine – Phoenix. He completed his Master of Public Health (MPH) at Arizona State University and his BS in biological sciences at the University of Connecticut. He is passionate about public health, policy, and health economics with a particular interest in how these issues impact underserved communities. Feel free to contact Alex at amgannon[at]email.arizona.edu