Do no harm: Queer patients and the med school closet

The classic image of a doctor in the US is an old white straight man. What does this mean for the rest of us aspiring or studying to be physicians? It’s difficult to go through medical school period, but what must it be like to hide your sexuality from your classmates and professors? Even if your identity has nothing to do with your proficiency in medicine?

A February 2015 study from Stanford University showed that one-third of LGBT medical students remain in the closet during med school, and 40% fear anti-LGBT discrimination from their peers. All authors on the study are members of Stanford’s LGBT Medical Education Research Group.

The average age of incoming medical students is 24, a time when most people don’t carry the risks many queer and trans youth face during coming out processes: displacement from family, loss of shelter, and other types of fallout — meaning that the fear and discomfort that LGBT medical students experience is likely in response to a hostile school environment.

What’s more alarming about the finding from Stanford is the implication for LGBT patients. I’m not a queer medical provider, but I am a queer patient, as are many of my friends. I’m hard-pressed to find even one of us who doesn’t have some wariness of medical providers—wariness that comes from being unwelcome, mistreated, and patronized on multiple occasions.

I’ve had doctors try to convince me that being queer would jeopardize my health, or that they really didn’t understand enough about my ‘lifestyle’ to treat me. Recently, a friend of mine wasn’t allowed to have her partner stay in the ER with her, even though a slew of straight couples were allowed to do the same. Specialized care is often even harder. For many of us, the search for a respectful chiropractor, therapist, or other provider usually feels like a unicorn hunt.

What does it mean for LGBT patients to attempt to navigate healthcare in a system where 40% of future LGBT doctors are afraid to be out to their own peers and colleagues? How are queer and trans people supposed to seek out consistently respectful and compassionate care? (Not just in general practice, but in high-risk situations like childbirth and emergency room visits?) What happens to patients who can’t be honest with their doctors for fear of inappropriate treatment? To those who feel consistently dehumanized by their medical providers?

These kinds of instances add up. Transphobia and homophobia among professionals responsible for queer and trans bodies in moments of crisis — everything from general checkups to surgeries — is no minor problem. If openly queer medical students can’t trust their own peers, instructors, and/or professors to treat them well, it’s no wonder that about a quarter of LGBT patients report some distrust of or poor treatment by doctors and other medical professionals. And, according to a survey by the National LGBTQ Task Force, only 28% of trans patients are out to their doctors.

Given the context — broad queer and trans incompetency among doctors — these statistics aren’t all that surprising. A 2011 medical school survey in the Journal of the American Medical Association found that the usual time allotted to LGBT-specific curricula is a paltry five hours over a multi-year program, and that about a third of med schools have no LGBT curricula at all. Even when queer issues are on the curriculum, they are given no more airtime than a guest speaker or a single class assignment.

Truly inclusive medical curricula would push back on homophobia and transphobia among doctors, and also educate them on the unique health needs of LGBT people. (Some of those needs may include access to hormones and surgery, sexuality-appropriate contraception, and HIV prevention.) At times, being a respectful doctor means just leaving patients be. (Intersex people in particular have long advocated for their bodies not to be non-consensually and surgically altered at birth.) At other times, it means not assuming that LGBT people have one specific lifestyle or sexual history. As Fusion wrote earlier this year, lesbians, for example, are chronically undertested for HPV because their medical providers assume they’ve never had sex with any cisgender men.

Medicine is actually one of the places gender and sexuality are created and regulated. The ‘normal’ patient is straight, gender-conforming, and not intersex. Rare is the doctor who listens considerately to queer patients giving an account of their sex lives. Rare is the doctor who respects patients’ right to self-determine their own genders enough to fulfill the mandate to offer care, rather than serve as a gatekeeper. Rare is the doctor who will make LGBT patients feel safe and respected enough to focus on treatment.

Navigating the world as an LGBT person, especially as a poor and/or brown LGBT person, is already difficult enough. Healthcare is expensive, and financially difficult to access — explicit homophobia, transphobia, and racism make all of that worse. According to a 2009 report by the Center for American Progress, LGBT adults are far more likely to be uninsured, encounter violence that requires medical attention, and face stigma from family members and medical providers around their healthcare needs. These disparities are even greater among LGBT people of color.

It’s not just about healthcare that is gender and sexuality-specific. Trans people should not be asked invasive questions about their surgery statuses for something totally unrelated, like a broken leg. To put it plainly: if your femur is shattered, it shouldn’t matter what your genitals look like. Medical providers should only be asking questions relevant to the crisis at hand. But about half of transgender ER patients report having been misgendered, drilled with inappropriate questions, or otherwise mistreated. What’s more, about a quarter of trans patients report avoiding the ER for fear of ill-treatment.

These kinds of assumptions and narrow attitudes about who lesbian, gay, bisexual and trangender people are, and what our respective needs include, have fatal consequences. Breast cancer is a great example. If we are to believe the marketing strategy of the Susan G. Komen foundation, only cisgender women can get breast cancer. In fact, anyone can. Transgender women and cisgender men who get breast cancer, however, often face incredible stigma surrounding the disease because of misogyny and transphobia. So do gender-nonconforming people of all kinds.

According to a 2011 study by the National LGBTQ Task Force, about half of trans people routinely have to educate their medical providers on their identities and health needs. What’s more, trans and gender non-conforming people routinely face refusal of care and verbal and physical harassment in health care settings. Doctors further participate in trans people’s deaths by maintaining bigoted and limited ideas of what trans-ness is, and how gender and health relate to one another.

Anti-LGBT bias in medicine not a problem that’s going to be fixed by adding a few diversity days or panels to medical school curriculum. To offer LGBT patients competent and compassionate care, doctors (and medical schools) need to seriously reexamine their assumptions about how gender, sexuality, and health are related, and what constitutes a healthy body. They need to regard queer and trans lives as worthy of respectful care. And doctors whose sworn profession is indeed to foster healing and life– need to stop harming people with ignorance.

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