LGBT

Ready to be moved? Take a few minutes to read this touching essay, which CommonHealth posted today, on being gay in the medical field. Written by Mark Schuster, MD, PhD, the William Berenberg Professor of Pediatrics at Harvard Medical School and chief of general pediatrics at Children’s Hospital Boston, the text is based on a speech the author gave in 2010 at the Children’s Hospital Boston GLBT & Friends Celebration.

Schuster records incidents of discrimination he faced or observed during his medical education in the 1980s and in his early career. He also remarks on how the field has progressed in its treatment of gays and lesbians and brings to light issues that still need addressing. From the piece:

It may seem odd that I didn’t complain to anyone, but there was no one at the medical school or the hospital to whom I or my gay classmates thought it was safe to complain. There were no policies to protect us; no grievance boards; no mechanisms in place. Times have changed, but I still have undergrads ask me if they can come out in their medical school applications and medical students ask if they can come out in their residency applications. Yes, times have changed, but they have not changed enough.

…

I could not believe that in a mere two decades we had gone from “I’ve decided not to write you a recommendation” to “Your job is to get this guy’s partner a fellowship.”

…

It’s easy for me to think that my experiences two decades ago are ancient history. For me, they are. I’ve been lucky enough to construct a life that does not involve a daily fear of being outed, of being beaten, of being fired, or of having my children taken away from me. But many people still live with such fears. My experiences wouldn’t sound so quaint to them.

Coming out isn’t always a party. It gets better, according to a project that aims to inspire hope among LGBT youth facing harassment, but the teenage years can still prove painful and lonely. Last week’s episode of Glee, in which the former bully Dave Karofsky (played by Max Adler) attempted suicide after being outed as gay by his high school peers, voiced the issue on a major media platform. The fictional TV show’s winter finale surprised viewers with its heavy subject matter.

Today, an article from The Atlantic reports the real-life statistic that LGBT youth are twice as likely to commit suicide as their heterosexual peers. And it discusses new research (subscription required) published in the American Journal of Preventive Medicine that followed 246 LGBT participants, aged 16-20 years, and found:

General and LGBT-specific risk factors both uniquely contribute to likelihood of suicidal ideation and self-harm in LGBT youth, which may, in part, account for the higher risk of these phenomena observed in this population.

In the piece, Brian Mustanski, PhD, lead author of the study and a psychologist at Northwestern University, also lists ways that parents can demonstrate support of their gay children. He asserts that family love can provide the most important protection from the path toward suicide and even lessen the effects of bullying at school:

If your child does come out to you remember that he’s sharing a core part of his identity, so react with acceptance, not judgment. This lets him know that your love is unconditional and that you’re available for support as he faces the trials of growing up as a minority.

Bullies: Stand down. Dave Karofsky: Life gets better after high school.

Previously: Medical schools neglect LGBT issues, Gay, lesbian, bisexual and transgendered health issues not being taught in medical school, Apple employees tell bullied teens “it gets better”, Advances being made for LGBT medical students and Tim Gunn speaks to depressed LGBT youth in ‘It Gets Better’ video
Photo by Eddie S.

Yesterday on Well, Pauline Chen, MD, recounted the story of a doctor who unknowingly treated a transgender woman. Because of a lack of communication between doctor and patient, it wasn’t until the physician began an operation on the patient and pulled down the sheets that he discovered she had male genitalia.

Not a confidence inspiring story for any physician. Chen writes it’s a story that continues to haunt her and other colleagues because it could have happened to any one of them. Medical schools need to do a better job of training students on how to care for transgender, lesbian, gay, and bisexual patients.

Chen refers to a recent Stanford study that showed one-third of all medical schools in the U.S. and Canada have no training at all for this population and, on average, schools provided only five hours of curriculum devoted to the topic.

Chen describes her own medical education:

While we had been trained well in treating cancer with the best chemotherapy regimen, curing flesh-eating infections with the most powerful antibiotics or transplanting organs with the greatest of ease, when it came to caring for patients who were transgender, we were lost. For many of us, the same could be said for lesbian, gay and bisexual patients as well. The only thing most of us knew how to do was ask about a single issue: “Whom are you having sex with? Men, women or both?”

Previously: Gay, lesbian, bisexual and transgendered health issues not being taught in medical school

In 2007, four students at Stanford medical school founded the Lesbian, Gay, Bisexual and Transgender Medical Education Research Group with plans of working toward bolstering LGBT curricula in medical schools. They approached one of the deans at Stanford who showed some interest but wanted to first know what exactly was being taught elsewhere.

“We found that that information was really hard to find because it didn’t exist,” said Mitchell Lunn, MD, an internal medicine resident at Brigham and Women’s Hospital/Harvard Medical School who was a medical student at Stanford at the time. “It just wasn’t known what exactly was being taught in medical schools, so we decided to do some research and find out.”

Four years later, results of that research are being published in the Journal of the American Medical Association. Based on data from a survey sent to deans of all the medical schools in the United States and Canada, Lunn and his colleagues show that the average medical student spends just five hours in medical school learning about the health-care needs of the lesbian, gay, bisexual and transgendered community.

And this is despite evidence that LGBT patients often face a unique set of health risks, which as I explain in a release, include increased risk factors for breast cancer among lesbians, higher rates of depression and anxiety due to homophobic discrimination, and increased rates of hepatitis among gay men.

The authors’ next step, they told me, is to take this information and move forward with their original hope of bolstering LGBT curriculum in medical school:

“This is really about visibility and partnering with other organizations to get a better sense of how we can train a next generation of providers to be really sensitive and competent in meeting the needs of the LGBT community,” said first author Juno Obedin-Maliver, MD, a Stanford graduate now doing an ob/gyn residency at the University of California-San Francisco. “These issues are something that every health-care provider will encounter.”

Related: Advances being made for LGBT medical students

One of my current projects is an upcoming Stanford Medicine article on cancer survivorship. (Given a recent report showing there are more than 12 million former patients in the United States, I thought it was a timely topic.) I took notice, then, of a new study in the journal Cancer describing the differences between straight and gay cancer survivors. Among them: Lesbian and bisexual survivors are more than twice as likely to report fair or poor health after cancer than are heterosexual ones.

MSNBC.com has a nice write-up here.

I’m a couple of days late to this, but earlier this week Apple, Inc. employees shared a message for the It Gets Better Project. I thought their message was so touching and so perfectly stated that I’m sharing it here.

Previously: Tim Gunn speaks to depressed LGBT youth in ‘It Gets Better’ video

The most recent issue of the AAMC Reporter has an interesting article on the treatment of lesbian, gay, bisexual, and transgendered (LGBT) medical students, physicians and patients. Included is a discussion of the historical challenges facing gay medical students – such as “underprepared faculty and staff, negative comments in and out of the classroom, and limited LGBT content in the curriculum” – and steps that schools are taking to aid these students and respond to any incidents:

…Some medical schools have changed their reporting systems to make them safer. Drexel allows a student to anonymously submit a complaint and be quickly transferred, if necessary, to a new clinical training site. Offending clinicians can receive sensitivity training and education or, in extreme cases, be banned from working with students. Stanford provides students with the option to delay faculty notification, in case they feel more comfortable waiting until after evaluations are complete.

…

Medical schools also are working to better support LGBT students. At UCSF, an “out list” publicly lists openly LGBT students and faculty to help facilitate collegiality and networking. Open LGBT faculty members “send the message that they can advance academically and rise to high-ranking positions at an academic institution,” [Samuel Parrish, MD, associate dean for student affairs and admissions at Drexel University College of Medicine] said.

The most heartening part of the article? The fact that experts say things are better now than they were just five or ten years ago. Commented Jonathan Appelbaum, MD, director of internal medicine education at Florida State University College of Medicine: “Many medical students don’t even see it as much of an issue because a diverse learning environment seems only natural to them.”

Via @AAMCToday

Same-sex marriage is one of the most hotly debated topics to date. Often a matter left for legislators and religious groups to mull over, a number of physicians and prestigious medical organizations such as the American Psychiatric Association, the American Psychological Association and the American Academy of Pediatrics, have also weighed in on the issue.

In an opinion piece published in today’s Inside Stanford Medicine, Stanford physician Gabriel Garcia, MD, is calling on all health-profession schools to make a commitment to support marriage equality. And he describes how permitting same-sex marriage could help eliminate health disparities that exist among lesbian, gay, bisexual, and transgender populations:

Married people live longer: As young adults, married men may have mortality rates two-and-a-half times lower than single men. Married people lead healthier lives: They have lower levels of depression, substance abuse and suicide. They earn more money and have greater rates of promotion and productivity at work. They do not have to explain their relationship to others. They do not suffer discrimination in employer benefits such as health insurance or retirement plans. Their children are healthier and better adjusted.

The piece also ran in Friday’s issue of the San Jose Mercury News.

Project Runway mentor Tim Gunn released a heartfelt message today to lesbian, gay, bisexual and transgender youth encouraging them to seek help if they are depressed or having thoughts about committing suicide.

In the above video, Gunn shockingly reveals he attempted suicide at age 17, pleads with teens to talk to someone if they are in despair and advocates The Trevor Project, a national crisis and suicide prevention organization for lesbian, gay, bisexual, transgender and questioning youth. He says:

There are people who can help you. You cannot do this alone, that is another profound message that I want to give to all of you. It really requires a collaboration between you and the people who love you-the people who you can depend upon, no matter who they are, as mentors. In my case, it took a very serious intervention to help me. And, it was a result of the botched suicide attempt to be blunt.

The public service announcement was filmed as part of the It Gets Better Project campaign.

Via Huffington Post

Lambda Legal, the gay rights organization, has filed a federal lawsuit that could challenge policies at hospitals nationwide.

The suit against Jackson Memorial Hospital in Miami was brought on behalf of Janice Langbehn and her three children, who were not permitted to visit their mother – Langbehn’s same-sex partner, Lisa Pond – after she collapsed during a Florida vacation. That’s in spite of the couple’s living trusts, advanced health-care directives and power-of-attorney documents. Pond died eight hours after being admitted to the trauma center with an aneurysm.

“We want to send a message to hospitals,” said Lambda Legal lawyer Beth Littrell. “If they don’t treat families as such, if they don’t let patients define their own circle of intimacy and give them the dignity and care to be with their loved ones in this sort of crisis, then they will be held accountable.”