I am currently sitting in a large lecture hall at the Gay and Lesbian Medical Association (GLMA)’s yearly conference. I came here hoping for guidance on treating my transgender patients (more on those issues in an upcoming post), to reconnect with my residency roommate, and because I have been a GLMA member since medical school. LGBT (lesbian, gay, bisexual, and trans) issues have always been an important part of my life: this is my community, after all. Due to my involvement in various organizations, my resume essentially reads super-gay, and there is nothing I could (or would) do to change that.
When I started to interview for medical residency, I was warned that programs might have a problem with my resume. My philosophy was that I wouldn’t go somewhere I wasn’t fully accepted. Let this, then, serve as my official middle finger to Cheyenne, Wyoming, and Milwaukee, Wisconsin, where the residents and faculty felt compelled to express to me that they might be “too conservative” for my ‘kind’. They would give me these concerned looks and I wondered if they actually thought that I was planning to march my own one-person Pride parade down the center of their quiet town while shouting about gay rights. (Push me far enough in a repressive residency program, and who knows what would have happened, I guess. But these programs confused my visibility with an affront to their personal beliefs.) Extend that middle finger to my med school faculty and peers, who acted worried for me because I was too ‘out’ and ‘open’: f*** them for shaming me and trying to control my sexuality.
Hate is NOT OKAY.
That is something that is never, ever, ok; but talk to any LGBT medical professional, and you are sure to hear at least one harrowing story of closeting and/or behavior-monitoring. I once had an openly gay faculty advisor tell me that I ought to tone myself down, or I would have to accept that I would experience adversity. I know he meant well, but it broke my heart a little that someone who was claiming to be out and proud would encourage such a harmful message:’ be gay, but not *too* gay.’
My mother used to say something similar to me. Once I came out to her, she would occasionally pause what she was doing, look over at me sadly, and ask why I insisted on making life harder on myself.
After a decade-plus in LGBT advocacy, I find myself asking the same questions I was asking at the beginnings of my medical career: Why is there such a dearth of health information for and about queer populations? Why are we still invisible in the scope of medicine and social welfare? Why is health care access, especially in rural areas, so notoriously terrible for LGBT-identified individuals? And, finally, why do people still believe and propagate myths and misconceptions about the LGBT community?*
Those of us who are treating trans patients today are still considered cutting-edge, and we struggle to find appropriate, relevant, and useful information. It’s this huge, glaring black hole in medicine, and is total bullshit.
Healthcare is greatly influenced by societal standards and norms, and this conference itself is a good example: I go to a couple of medical summits a year. Most of them are well-represented, well-attended, and supported by pharmaceutical industries, with free breakfasts, lunches and dinners. At this conference, every attendee has been identified in the directory, and everyone here has put forth an incredible effort. We number in the hundreds and not the thousands, and it is achingly clear that the medical community at large still treats us as a fringe group. I haven’t seen one pharmaceutical drug rep, and I’ve had to buy my own damn food.
LGBT health is an area of medicine where physicians can still get away with claiming ignorance: ‘I don’t know enough about those people, so I can’t possibly treat them.’ Medical school training is complicit in this; I have yet to hear of a curriculum in which LGBT care is fully integrated and not an outlying topic, consisting of a couple of off-hand lectures. And we do nothing to stop this behavior and culture.
Being openly gay is not sufficient when the underlying message is that there’s a right and wrong way to express your sexuality as a medical professional. Too much gayness, and the conservative medical community gets uncomfortable, which is unfathomable. I was explicitly told that it was not ok for me to divulge my sexuality to my patients, yet heard colleagues talk about their hetero partners to patients on a daily basis. I would be asked by patients on a regular basis if I was married or had any children, and I was forced to confabulate, either pretending to be straight or pretending to be too busy to date. It’s prime time we stop catering to the middle-aged, cis white heterosexual male physician, and acknowledge that turning a blind eye to LGBT care is just as, if not more, harmful than blatant homophobia.
Aww…what a nice…wait, never mind, you did it all wrong.
When a baker refuses to make a cake for a lesbian couple out of religious/moral/ethical/other b.s. principle, it makes national headlines. Why, then, do we flatly accept that some doctors will not see gay patients, and that most doctors do not prescribe trans hormone therapy?
Even my queer-literate family practice residency program presented roadblocks. My friend and I attempted a research project on health care access for rural LGBT-identified individuals. I completed a comprehensive literature review of all studies done up to that point on LGBT healthcare, and found many troublesome aspects (which is why I can rant ad-lib on queer visibility in the medical field without any external sourcing), including a lack of visibility in the community, several confirmation and selection biases, and a general disinterest of the medical world in LGBT care. It took several drafts of our initial project proposal to get IRB approval.
By the last draft, ‘LGBT’ in any form was all but gone. We were told more people would be receptive to our study if we ‘kept it vague’ (read: don’t be too gay), if we focused on rural populations in general (read: don’t be too gay and no one cares about gay health anyway), and if every participant gave informed consent (read: participating in a gay study is dangerous and scary for people and we need them to sign off to make sure that they’re super-extra-ok with it).
The research program director refused us approval at first because we wanted to leave anonymous questionnaires for patients to fill out in the rooms before or after regularly-scheduled doctor appointments. His concern was that older patients might be offended by the content, and that children could accidentally read the forms. Let me emphasize here that we were not displaying pornographic images or using any curse words or coded language. We even buried the ‘gay’ questions among 13 total in an innocuous survey. What was so offensive? Apparently, it was the fact that we would dare to ask patients if they ever had an HIV test, what they considered themselves to be (gay/straight/other), and who (m/f/other) they had had sex with in the past two years. Oh, and this happened in 2014.
My alma mater in 2007.
In 2006, I remember doing an icebreaker activity with other med students during my first week of medical school during which we were asked various yes/no questions, and moved around the room accordingly. Most of these questions were verbal, but a handful were written down and anonymous, and we could chose to publicly acknowledge our answers or not. I paraphrase the anonymous questions here: “1. I have shoplifted in the past-yes/no. 2. I have cheated on an exam-yes/no. 3. I have knowingly lied to someone-yes/no. 4. I identify as gay or lesbian-yes/no.”
Why was sexuality included under questions about moral and ethical integrity? And do you really think anyone decided to ‘out’ themselves that day? (Both these questions are rhetorical; if you can’t see what’s wrong with this survey, read again. If you think any LGBT medical students wanted to be stigmatized that day, try again.)
This exercise set the tone for our academic medicine years: I was the only ‘out’ member of our med school class, and became, entirely by default, the president, secretary, and treasurer of our Gay-Straight Alliance (GSA). There were other LGBT-identified people in our class, naturally, but they chose the arguably safer, quieter road.
Additionally, my med school banned the GSA during the second week of my first year there. Their reasoning was that we were religion-funded, and a gay-straight alliance flew in the face of the Boards’ beliefs. Why they chose my year to put their foot down I will never know. We saved our GSA, through lobbying with the American Medical Student Association (AMSA), and by having our small club become a chapter of GLMA, but the effects were devastating. It took a couple of years for students to get interested in joining again without feeling that they would be stigmatized. In a field such as medicine, where internalized homophobia is rampant, further poisoning of the well is calamitous.
For those who sense that my experience was unique, this Harvard Pediatrician wrote about being gay in medicine in the 70s and 80s. We have made huge strides–the experiences of the generation before mine are shocking and abysmal–but we still have quite a way to go. Especially when med schools admit that they just don’t care about us.
As we become more visible-as ‘gay marriage’ has become just: ‘marriage’, and we engage as a nation in conversations about transgender individuals, we need to continue to encourage our friends and allies to get involved. Gay rights are human rights, and none of the caring, thoughtful, and excellent physicians I see in this room belong on the fringe.
*In regards to my earlier questions about the dearth of health information, invisibility, and rural care access: I realize I barely touched on these. I plan to come back to them. This is now Day Two of a conference that is much more triggering to my past experiences than I could have imagined. If I sound angry in my post, it’s because I am. I am tired of being nice and invisible, and hearing other doctors be as complacent in this behavior. Imagine the experience, too, of someone who is more visibly different: I am a cis-gendered white female with more privilege than many. And being queer in medicine has still been a battle.