Learning on LGBTQ health issues rising
Aliya Feroe recalls the flustered OB-GYN who referred her to another physician after learning that she identified as queer. For Rhi Ledgerwood, who was designated female at birth, identifies as trans and doesn’t have sex with men, it was a doctor advising about condoms and pregnancy prevention. For Tim Keyes, who came out as gay at 17, it’s when doctors automatically assumed that he sleeps with women.
Ask any LGBTQ patient about awkward doctor visits, and chances are they’ll have a story to tell.
When being heterosexual is presumed even in doctors’ offices, those who identify otherwise can feel marginalized and less likely to seek medical care, contributing to health problems that include high rates of depression, suicidal behavior, alcohol and drug use and inadequate health screenings, LGBTQ advocates say.
Now, moves are afoot to remedy that. The American Medical Association vowed in November to push for a federal ban on gay conversion therapy. Medical schools are beefing up education on LGBTQ health issues. And some schools are making a major push to recruit LGBTQ medical students, backed by research showing that patients often get better care when treated by doctors more like them.
Feroe, Keyes and Ledgerwood — all pursuing medical careers — are part of the trend.
“LGBTQ physicians deserve an equal standing in the medical community, and LGBTQ patients deserve the same quality of care awarded to anyone else,” said Feroe, a third-year Harvard medical student.
Increasing LGBTQ enrollment and training in LGBTQ health issues in medical schools can help achieve those goals, advocates say.
Exact numbers of LGBTQ medical students and doctors are unknown. In 2018, the AMA added sexual orientation and gender identity as an option for members to include in demographic profiles the group compiles. Of the 15,000 doctors and students who have volunteered that information so far, about 4 percent identify as LGBTQ. That’s similar to Gallup estimates for the general U.S. population, although LGBTQ advocates believe that the numbers are higher and rising as more people are willing to “out” themselves.
This past fall, Harvard’s entering class of medical students was 15 percent LGBTQ, a milestone that is no accident.
The Association of American Medical Colleges’ primary application used by U.S. schools began offering prospective students the option of specifying gender identity and preferred pronouns in 2018. Harvard’s school-specific application allows applicants to identify as lesbian, gay, bisexual, transgender or queer. A response is not required, but the option “sends a message that you’re wanted,” said Jessica Halem, the medical school’s LGBTQ outreach director.
“We know that doctors need to look like and be a part of the communities they serve,” Halem said.
“We have gay Muslim students. Lesbians from China. Students who are survivors of conversion therapy,” she said. “They are now out and very proud gay people, and they are healing those wounds.”
Feroe had intended to present herself as straight in medical school, fearing that doing otherwise would be off-putting for patients and make her feel like an anomaly among her peers.
But Harvard has an active LGBTQ student group on campus and coursework addressing LGBTQ medical care. Halem said that includes what screening tests are needed for women who have sex with transgender men and the hormone treatments to prescribe for transgender patients.
Feroe said she was “blown away” during a recent surgery rotation at one of Harvard’s affiliated hospitals, where a few patients were accompanied by same-sex partners. The doctors she was training with “smoothly asked about people’s lives” and were completely comfortable “when learning patients were queer,” she said, important steps toward offering nonjudgmental “patient-centered” care.
A 2017-18 Association of American Medical Colleges report found that while most schools include some LGBTQ coursework, half reported three or fewer lectures, group discussions or other learning activities.
When Keyes enrolled in Stanford University’s medical school in 2015, he was surprised to learn that he was one of only two gay students in the first-year class who were “out.”
“Because we’re here in the California Bay area, I was expecting the community to be a little bit different,” Keyes said.
Two years ago, Keyes was among six students at four universities who created the Medical Student Pride Alliance. The group has 31 chapters on U.S. campuses and works to promote recruitment of LGBTQ students in medical schools, more enlightened coursework and improvements in LGBTQ medical care.
A lecture he heard at Stanford in which a professor mentioned that nearly half of teens under age 18 who identify as transgender will attempt suicide shows why the group’s work is so important, Keyes said.
The professor went on to note that studies have shown “the risk becomes much closer to zero,” Keyes recalled, “if a physician simply counsels them and offers affirmative care.”