LGBT issues barely taught in medical school

34 posts / 0 new

Wed, 2011-09-07 16:16

Catchfire

Quote:
44 medical schools reported dedicating no teaching time to LGBT-related content during clinical years, and in preclinical curricula, nine medical schools reported spending no time on LGBT issues, according to a study published Tuesday in the Journal of the American Medical Association.

Surveys used in the study were distributed to all 176 allopathic (conventional) and osteopathic medical schools in the U.S. and Canada, and 85% of schools responded.

Across all medical schools that participated, the median time spent on LGBT-related content was just five hours, though time spent varied widely by school.

Perhaps most surprising: 70% of responding schools evaluated their own LBGT curricula as ‘fair’, ‘poor’, or ‘very poor.’

Issues Pages:

LGBTIQ

Wed, 2011-09-07 16:47

Sineed

It could be argued that LGBT issues aren't directly pertinent to medical studies. I'd be more concerned about the short shrift they give to pharmacology.

Wed, 2011-09-07 17:30

Catchfire

Just a friendly reminder that you're in the LGBT forum, Sineed. But to answer your question:

Quote:
"It's easy to assume that because we are all humans, gender, race, or other characteristics of study participants shouldn't matter in health research, but they certainly do," said committee chair Robert Graham, professor of family medicine and public health sciences and Robert and Myfanwy Smith Chair, department of family medicine, University of Cincinnati College of Medicine, Cincinnati. "It was only when researchers made deliberate efforts to engage women and racial and ethnic minorities in studies that we discovered differences in how some diseases occur in and affect specific populations. Routine collection of information on race and ethnicity has expanded our understanding of conditions that are more prevalent among various groups or that affect them differently. We should strive for the same attention to and engagement of sexual and gender minorities in health research."

And:

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding

Quote:
From the available research, the committee noted a number of findings. Among others, these include that LGBT youth may have an elevated risk for attempted suicide and depression, and sexual minority youth may have higher rates of substance use than heterosexual youth; that one of the barriers to accessing quality health care for LGBT adults is a lack of providers who are knowledgeable about LGBT health needs as well as a fear of discrimination in health care settings; and that LGBT elders are more likely to rely on friends and others as caregivers rather than biological family members, at least in part because they are less likely to have children.

Wed, 2011-09-07 20:27

Kevin Laddle

Sineed wrote:

It could be argued that LGBT issues aren't directly pertinent to medical studies. I'd be more concerned about the short shrift they give to pharmacology.

Fuck you

Wed, 2011-09-07 23:52

Sineed

Kevin Laddle wrote:

Sineed wrote:

It could be argued that LGBT issues aren't directly pertinent to medical studies. I'd be more concerned about the short shrift they give to pharmacology.

Fuck you

Likewise.

Thu, 2011-09-08 01:41

bagkitty

Sineed wrote:

It could be argued that LGBT issues aren't directly pertinent to medical studies. I'd be more concerned about the short shrift they give to pharmacology.

And we could argue about how many angels can be found dancing on pin heads (actually I wish someone would bring this one up, the medieval philosophy course I endured "back in the day" would come in handy) -- but it wouldn't be a particularly pertinent argument either.

With all due respect to the wonderful world of pharmacology, I think attention to the cultural chasms between the LGBT communities and the heteronormative world that mainline medical practitioners have a tendency to identify with is something that should be part of the course of study of all medical students (including pharmacologists). It might give just a little pause to the medical practitioner who identifies with the heternormative world to consider whether or not their methodology. in seeking information to make a diagnosis, is the most appropriate in the circumstances (or, as many tourists would tell you, don't expect your little phrase book to cover all the nuances of the local dialect).

With particular reference to pharmacology, screening questions that are asked in hopes of avoiding bad interactions between "drugs" would probably benefit from at least a vague awareness that in certain segments of the LGBT communities (mine, for example) the recreational potential of certain pharmaceuticals is quite well accepted -- one does need not suffer from pulmonary arterial hypertension to appreciate the value of something like sildenafil citrate and its selective vasodilation -- of course I could just be a mountain climber seeking to avoid the worst effects of altitude sickness too. Would we necessarily have a prescription for it on file? Or even really consider it a drug?

As to the exchange of "Fuck You"s.... was that meant in the pejorative sense? or was that just flirting? (chasms I tell you, expansive and deep)

ETA: *waves to Maysie*

Thu, 2011-09-08 02:04

Catchfire

Kevin, if you felt that Sineed's comment was insensitive, there are better ways to respond. Please take a deep breath before posting in anger (it's advice we could all take!). Thanks.

And thanks for that post bk.

Thu, 2011-09-08 11:58

6079_Smith_W

For one thing, if the medical establishment informed themselves better, they probably wouldn't be taking so much time to do this:

http://www.bbc.co.uk/news/health-14824310

Thu, 2011-09-08 20:27

Sineed

bag kitty wrote:
With all due respect to the wonderful world of pharmacology, I think attention to the cultural chasms between the LGBT communities and the heteronormative world that mainline medical practitioners have a tendency to identify with is something that should be part of the course of study of all medical students (including pharmacologists).

The wonderful world of pharmacology is an increasingly crowded place. There are now 40% more drugs on the market than there were in 1986, when I graduated, and those include major classes of drugs that didn't exist before the 1990s, like biological agents to treat autoimmune disorders, and drugs to treat HIV. Medicine is becoming increasingly complex, and medical students' schedules are jam-packed.

Getting to my point: there's pitfalls to making assumptions about individuals from population-based data. For instance, if I go to an ER with chest pain, the drs are more likely to dismiss it than if I were male (happened to my boss just last wk). And since depression is more common in LGBT communities, a gay person may get a whole psychological work-up on the basis of stomach pain when what he/she needs is an anti-ulcer drug. As individuals, we are all outliers in our own way. We want our drs to consider our signs and symptoms objectively, and not make suppositions on account of groups to which we may belong. I suggest that barriers to health care for LGBT people are on account of a paucity of objectivity; namely, homophobia.

From Catchfire's link:

Quote:
"It was only when researchers made deliberate efforts to engage women and racial and ethnic minorities in studies that we discovered differences in how some diseases occur in and affect specific populations. Routine collection of information on race and ethnicity has expanded our understanding of conditions that are more prevalent among various groups or that affect them differently. We should strive for the same attention to and engagement of sexual and gender minorities in health research."

The analogy does not hold. Here's why: there are physiological differences between people of different races, and people of different genders. There are no physiological differences between gay and straight people. Physical treatments for transgender individuals aside, being LGBT is not a medical condition requiring treatment.

Thu, 2011-09-08 20:43

#10

voice of the damned

I would tend to agree. Sexual orientation, it seems to me, is comparable to religion in this regard. Seventh Day Adventists might have certain health-related issues, as a result of not eating meat. That doesn't mean doctors need to be specifically trained in Seventh Day Adventist issues, they just need to be trained in the importance of asking diet-related questions of EVERYONE. If the patient says he doesn't eat meat, for whatever reason, the doctor just takes it from there.

Thu, 2011-09-08 20:58

#11

Catchfire

Somewhat of a firmer reminder that this is the LGBT forum--that means issues are discussed from an LGBT point of view--not offering personal anecdotes which risk denying lived LGBT experience. I also encourage babblers to read the linked material--these are doctors, researchers and medical students who identify as queer who are conducting these studies...

Thu, 2011-09-08 21:26

#12

6079_Smith_W

Evidently the teaching doctors are getting isn't enough to provide adequate services.

I was surprised to learn from an acquaintance of mine that there is only one medical professional in the province who can counsel people here even part way through the transition process (or to the point where the person decides transition is not the answer). Beyond that, it means a trip to Vancouver, or another larger centre.

And when it comes to people who decide to have surgeries, those are all out of province. Another friend of mine had to go to Ontario for the surgery he decided to have.

Thu, 2011-09-08 22:15

#13

Ken Burch

Sineed wrote:

bag kitty wrote:
With all due respect to the wonderful world of pharmacology, I think attention to the cultural chasms between the LGBT communities and the heteronormative world that mainline medical practitioners have a tendency to identify with is something that should be part of the course of study of all medical students (including pharmacologists).

The wonderful world of pharmacology is an increasingly crowded place. There are now 40% more drugs on the market than there were in 1986, when I graduated, and those include major classes of drugs that didn't exist before the 1990s, like biological agents to treat autoimmune disorders, and drugs to treat HIV. Medicine is becoming increasingly complex, and medical students' schedules are jam-packed.

Getting to my point: there's pitfalls to making assumptions about individuals from population-based data. For instance, if I go to an ER with chest pain, the drs are more likely to dismiss it than if I were male (happened to my boss just last wk). And since depression is more common in LGBT communities, a gay person may get a whole psychological work-up on the basis of stomach pain when what he/she needs is an anti-ulcer drug. As individuals, we are all outliers in our own way. We want our drs to consider our signs and symptoms objectively, and not make suppositions on account of groups to which we may belong. I suggest that barriers to health care for LGBT people are on account of a paucity of objectivity; namely, homophobia.

From Catchfire's link:

Quote:
"It was only when researchers made deliberate efforts to engage women and racial and ethnic minorities in studies that we discovered differences in how some diseases occur in and affect specific populations. Routine collection of information on race and ethnicity has expanded our understanding of conditions that are more prevalent among various groups or that affect them differently. We should strive for the same attention to and engagement of sexual and gender minorities in health research."

The analogy does not hold. Here's why: there are physiological differences between people of different races, and people of different genders. There are no physiological differences between gay and straight people. Physical treatments for transgender individuals aside, being LGBT is not a medical condition requiring treatment.

sineed, it's not as if medical schools could teach about pharmacology, or about the way LGBT issues intersect with health issues, but not both. You seem way too invested in the idea that of the two, pharmacology is the only thing that matters. And you're getting on really perilous ground to pit gender issues AGAINST LGBT issues. It sounds as if you're trying to set up a "women have it worse than gays" argument here re:medical training-and there's no justification for even going there.

Thu, 2011-09-08 22:55

#14

takeitslowly

Well as a transgender female identified person, my family doctor has been not just a doctor to me, but a man who treated me with dignity and kindness, and he is knowledgeable about the concerns I have with hormones therapy and many other questions, many other doctors do not have the same knowledge or compassion. I believe knowledge is needed in the medical community because doctors who understand and treat us like our health matters are really important to some of our well beings.

A doctor who cares is someone who asks questions before you even ask them. They know about your medical history, lifestyle, and they can give you suggestions to take better care of yourself. Sexual orientation and gender identity especially, are important knowledge that a doctor need to know, because they help paint a the entire picture of who the doctor is treating.

Unfortunately, i do not expect most family doctors to be understanding about my health concerns.

If a doctor is not expected to be knowledgeable about our concerns, how do we expect anyone else to be concerned about us?

Fri, 2011-09-09 13:44

#15

bagkitty

Sineed wrote:

From Catchfire's link:

Quote:
"It was only when researchers made deliberate efforts to engage women and racial and ethnic minorities in studies that we discovered differences in how some diseases occur in and affect specific populations. Routine collection of information on race and ethnicity has expanded our understanding of conditions that are more prevalent among various groups or that affect them differently. We should strive for the same attention to and engagement of sexual and gender minorities in health research."

The analogy does not hold. Here's why: there are physiological differences between people of different races, and people of different genders. There are no physiological differences between gay and straight people. Physical treatments for transgender individuals aside, being LGBT is not a medical condition requiring treatment.

I agree that the analogy is seriously flawed, but I am not certain the bald assertion that "there are physiological differences between people of different races" is the way to go in questioning it. I would use the somewhat trivial example of lactase persistence (the ability to digest and metabolize lactose into adulthood) to frame my question. The incidence of lactase persistence varies widely within and between population groups, but in general, it is relatively safe to assume to that if you are of northern European descent you exhibit lactase persistence, if you are of Han Chinese descent, you probably don't -- is this the kind of thing you are referring to when you mention "physiological differences between people of different races"?

Fri, 2011-09-09 13:51

#16

Caissa

Can I respectfully ask for a few examples of LGBT related issues that people think should be taught in med school?

Fri, 2011-09-09 14:09

#17

6079_Smith_W

As well, some of the conditions that are prevalent in some communities - and ethnic groups - are due to lifestyle, diet, alcohol, tobacco and drugs, economic status, and environment. And stress - to an incredible degree.

The fact that these differences are based on something other than physiology doesn't make it any less important to pay attention to them. After all, how much of our health and disease depends on genetics, and how much of it depends on what our bodies and minds are put through?

Look at the diseases and conditions that are prevalent in different parts of the world, and in different communities. Look at the work of Hans Selye, who developed tests to determine not only how "aged" a body was from stress, but how fast it was being aged.

If you break down all the medical conditions that have to be dealt with, how many of them are a product of natural aging, genetics, and happenstance, and how many of them are a result of these other factors?

It seems to me the specific risks of all communities are even more important than basic physiology.

Fri, 2011-09-09 16:12

#18

6079_Smith_W

@ Caissa

Aside from the ones that have been mentioned, you could probably add the risk of bullying, and emotional, physical and sexual abuse.

And although it's not specific to orientation, I remember one time I was shocked that a clinic - the most progressive in the city where I lived at that time - didn't have a full slate of STD tests.

There are entire faculties devoted to the study of workplace and recreational injuries and sport medicine, even though athletes aren't THAT different from the rest of us. So there are some very big precedents when it comes to focusing medicine on specific communities - especially when there is money involved.

Come to think of it, it might be a start if medical schools pointed out to students that orientation is innate, and not a choice that someone makes, and that it is not a disease or mental illness. I think there are quite a few straights who aren't straight on that one yet.

Fri, 2011-09-09 16:23

#19

bagkitty

whoops, edit not quote, bad kitty

Fri, 2011-09-09 16:24

#20

bagkitty

To further the line of reasoning being offered by 6079... maybe we* could be considered as more likely than the general population to experience a special subset of traumatic injuries... given the tendency of bashers to really "put the boot in" (to the head specifically). Again, while not unique to the LGBT communities, the incidence would be disproportionate in comparison to that self-same general population (I would offer the recent report on the incidence of hate crimes in Canada with specific reference to physical assault as opposed to spray painting property or saying unkind things).

I am not sure if it qualifies as an actual "issue" but when presenting yourself to the medical profession with a severe throat infection (albeit accompanied by the bf at the time), it is not axiomatic that one is suffering from an STD... and that strep is (and was) the more likely diagnosis. Fortunately the treatment is the same (bend over Mr. Bagkitty, we have a long lasting pencillin injection for your gluteus maximus). Although it was passing strange that my explaining that I had a history of throat infections that migrated to my ears resulting in permanent damage and that that was actually the reason I had come in on an urgent basis -- concern about a threat to my hearing -- didn't seem to give the attending even a moment's hesitation in arriving at the STD diagnosis. Guess the attending preferred zebras to horses.

_____

*without a doubt, the royal we

Fri, 2011-09-09 17:05

#21

Catchfire

Even before we get into the kind of complaints LGBT folk are more likely to harbour, or harbour in specific ways, there is simply the case of a patient doctor relationship. A friend sent me this fantastic link on the subject. The whole site has a bunch of information on this issue. Even before the patient is through the doctor's office door, there is this barrier faced by lesbian patients:

Quote:
In a study of 98 lesbian and bisexual women in a maritime province:

38% reported avoiding routine physical and/or mental health care at least once due to their sexual orientation

32% of the women did not get regular breast screening and pap smears

As a straight man, I can conceive of dozens of particular ways doctors would benefit from more LGBT training--we have it in almost all other work disciplines, why is medicine immune? For example, how would an inexperienced doctor tell a mother her child was born with intersex traits? How do you get patients to speak openly and honestly about their sex life and health habits if their sexuality and sexual practices are shunned and marginalized by society as a whole? These case-by-case bases don't begin to breach the subject of homphobia in general, or lived experience as someone who identifies as LGBT in a medical world still operating on gender and sex binaries.

ETA: And can I ask that straight-identifying folk at least do a bit of googling to try to widen their perspective before posting in the LGBT forum about how LGBT people have no specific health needs?

Fri, 2011-09-09 18:17

#22

bagkitty

To toss one more thing into the mix, I think we should also acknowledge the formal barriers faced in accessing medical services -- less of a problem up here in Canada with single-payer, much more prevalent with our friends to the south. Although when one has to get along without employer sponsored benefits the actual treatments prescribed when one "gets through the gate" can be equally out of reach on both sides of the border.

Mon, 2011-09-12 09:23

#23

Caissa

catchfire wrote:

ETA: And can I ask that straight-identifying folk at least do a bit of googling to try to widen their perspective before posting in the LGBT forum about how LGBT people have no specific health needs?

I hope this wasn't aimed at my question. My question was merely looking for an examples on a question I have never reflected on. I'm glad for all the answers it garnered and appreciative for that information.

Sat, 2011-09-24 00:58

#24

Red Tory Tea Girl

Here's the sum total of the T curriculum that most General Practitioners need to have:

All the indications and contraindications we just gave you for Hormone Replacement Therapy apply equally to trans people... if someone comes in and requests HRT, the only reasons you should legitimately refuse them are if they have contraindicated cancers or liver conditions, and remember that a progesterone is reccommended to balance any estradiols you prescribe... the optimal ranges are the same, though your patient is of course, the one who knows best what works for them.

Bam. Biggest problem in trans health care covered in less than a minute. You're welcome doctors.

Sat, 2011-09-24 11:22

#25

Sineed

Red Tory Tea Girl wrote:
All the indications and contraindications we just gave you for Hormone Replacement Therapy apply equally to trans people.

This is how I practice. My point is, medical people don't need special training to address the needs of various groups of patients. What they need to do is strive to treat patients with absolute objectivity. Where medical care has been poor, the shortage of resources aside, it's where medical practitioners allow their personal predjudices to colour the care they offer patients. IMO, all sensitivity training does is preach to the converted.

If physicians are encouraged to practice evidence-based medicine and leave their personal biases at home, this benefits all patients and not just specific groups.

Sat, 2011-09-24 11:25

#26

Catchfire

Your assessment appears contradicted by LGBT patients, doctors and medical instructors. Perhaps it needs re-evaluation.

Sat, 2011-09-24 12:07

#27

Red Tory Tea Girl

I'm with you on that one Sineed... on top of that we need to stop letting a subset of psychologists (for a condition that's treated with HRT and/or surgery when treatment is needed) dictate artificial roadblocks to treatment, especially HRT, which is relatively cheap, reversible, and a treatment, which when undergone, provides the patient the best indicator of whether they are actually suffering from gender/sex-based dysphoria.

Sat, 2011-09-24 12:45

#28

6079_Smith_W

When have members of any profession - ever - reached a state of absolute objectivity?

Of course the medical profession should strive for that goal, but somehow they keep missing stuff they should catch, and treating stuff they don't understand like it's a sickness - from hysteria to misdiagnosed ADHD.

Sineed, I am sure you know far better than me how much of illness has to do with environment rather than physiology. How can we expect to catch these mistakes if our focus is on equality, rather than looking at how our experiences are all different in many ways.

And I don't see the problem with doctors learning that by actually being shown some of those differences. That is what school is for, after all.

Sat, 2011-09-24 14:04

#29

theleftyinvestor

As someone who once went to the world-renown Rudd Clinic and watched a proctologist, of all people, squirm when I asked him a question about anal sex... I can vouch for the fact that LGBT patients have health needs that are not addressed by standard medical training.

The doctor responded by telling me something about how he's seen patients who have put "all sorts of things" inside there, and God just didn't design the body for that, end of discussion. wrote in the report back to my GP something like: "The patient had questions about the homosexual lifestyle, and I assured him that this was not a good idea."

So when I moved to Vancouver and looked for a doctor, the first thing I did was set up an initial meeting. I told him straight out, "I need a doctor who can talk to me about ass". Five years later he is still my doctor and I'm glad I found him. He was willing to prescribe me the HPV vaccine (Gardasil) back in the early days when it was only approved for women, because he knew that studies in other countries had shown it would be useful for men too, whether gay or straight. Several years later it was approved and even recommended for men.

Sat, 2011-09-24 15:16

#30

6079_Smith_W

Because of course straight men never have anal sex. What an absurd thing for a doctor (especially a proctologist) to say. Sounds like he has a few things to learn about heterosexuality as well.

Or maybe his schtick is that it is just for making babies, and you aren't supposed to enjoy it.

And I have wondered about the strategy around the HPV myself. What is the sense in leaving half the population unvaccinated and active carriers just because they are (as far as as we know) asymptomatic. It is as weird as the notion that birth control is only women's problem.

Mon, 2011-09-26 19:39

#31

Sineed

Catchfire wrote:

Your assessment appears contradicted by LGBT patients, doctors and medical instructors. Perhaps it needs re-evaluation.

I don't disagree with your assertion that the care provided to LGBT patients has been substandard. What I disagree with is how to improve the situation. What we all want are physicians who provide appropriate care to all people. And the best way to do that is for medical schools to continue to encourage the practice of evidence-based medicine, where absolute objectivity is encouraged, and "expert opinion" (ie, the older guys whose clinical judgement is coloured by personal biases) is de-emphasized.

To be blunt, some sort of sensitivity training won't work - medical students think these sorts of courses are a waste of their time in an already jam-packed curriculum. What you want is for them to realize that saying to a patient that their sexual preferences are a violation of God's law is an unprofessional lack of objectivity, a betrayal of the patient's trust and a violation of the duty of care owed to all their patients.

Tue, 2011-09-27 07:43

#32

Maysie

World Professional Association for Transgender Health announces new standard of care for transgender and gender nonconforming people.

Quote:

WPATH revision committee chair Eli Coleman launched the 7th version of the standards of care to some 300 people who attended the symposium as part of a partnership with the Gay & Lesbian Medical Association and the Southern Comfort Conference, the largest transgender conference in the nation that takes place annually in Atlanta.

....

"We've made a clear statement that gender nonconformity is not pathological," a pronouncement greeted with another round of applause from attendees.

"We've set a whole different tone. It's more about what the professionals have to do" and not about transgender people having to prove their health needs to the professionals, he explained.

And when Coleman announced that the new standards of care state in no uncertain terms that "reparative therapy is unethical," there was even more applause.

"This is no longer about hormones and surgery - it's about health in a holistic sense," Coleman said.

...

The WPATH conference in Atlanta, along with the Southern Comfort Conference and the conference of the Gay & Lesbian Medical Association, was a joint effort to show the world what is being done in the area of LGBT health.

Tue, 2011-09-27 19:04

#33

CMOT Dibbler

David Ruffin - Smiling Faces Sometimes
http://www.youtube.com/watch?v=tqrJBdAMEkc

Great Pick-Up Lines in Science
http://www.youtube.com/watch?v=pdXCFFYHjYk

Fri, 2011-09-30 15:25

#34

Red Tory Tea Girl

@Maysie

This of course, after years of making hazing-before-transition, via what they laughably call the "Real Life Test" or a few thousand dollars in psychiatrist fees, a requirement for basic treatment... and they STILL haven't embraced the informed consent model, because WPATH is dominated by practitioners who have no earthy reason to be dealing with trans health: Psychiatrists.

We will not have equality in medicine, something the torpedoed C-389 would have guaranteed, until trans people requesting HRT face no greater discrimination in medical access than cis people do... and cis people typically get their HRT handled at a GP's office, not going through an endless queue for something as simple as a script for estrogen...

That said, it's improvement.