Episode 1: What Clinicians Should Know About LGBT Health
“It was something of a perfect storm,” said pharmacist and professor Marcus Ferrone describing the circumstances that led to the first LGBT Health Forum at the University of California San Francisco (UCSF) ten years ago. Students, faculty and staff felt that the existing curriculum failed to adequately address LGBT health issues in the populations they were serving, and UCSF, which consists only of health science graduate programs, happened to be undergoing a major curriculum shift towards interprofessional education. In the subsequent decade, the forum evolved to become a one-day elective for students in all of the schools at UCSF.
In this episode of the Op-Med Podcast, we spoke with student organizers of the forum about what drew them in and how their experiences have changed their career trajectories.
This year’s 10th Annual LGBTQIA+ Health Forum put a spotlight on transgender health and included educational opportunities for undergraduates. Speakers included Janet Mock and UCSF trans health specialists Drs. Madeline Deutsch and Stephen Rosenthal, the latter of whom we’ll hear from in Episode 2.
For trans students in the health professional fields, Dr. Deutsch offered the following advice:
Don’t be discouraged by the lack of visible trans providers in the field. It can be difficult to feel alone, but we are out there. Go to conferences like WPATH or GLMA (there are student memberships/discounts) and network with others.
Additional resources and a full transcript of the episode are below.
The Fenway Institute: This is the go-to resource for Stanford Medical School as they develop their LGBT health curriculum.
The UCSF Center of Excellence for Transgender Health: Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People
The AMA’s Guide to Creating an LGBTQ-friendly Practice
Transcript of Episode 1
Doximity: Welcome to the Doximity Podcast, where we talk to people who are transforming healthcare. This is part one of a two-part special on LGBT health. In this episode, we talk to two student organizers of UCSF’s Annual LGBTQIA+ health forum. The 10th Annual forum took place at the end of February.
Mark: My name is Mark Jeng. I’m currently a second year medical student at Stanford.
Doximity: Mark is also the President of LGBT-Med at Stanford. Before entering medical school, Mark received his PhD in Biomedical Sciences at UCSF. It was during this time that he attended his first LGBT health forum and later helped organize it.
Mark: It was one of the first times I started envisioning myself in the role of a healthcare provider — you know, putting on that white coat and now talking to a patient. I know it was just role play at the time, but it started to dawn on me that there’s this very vulnerable power dynamic between a patient and doctor. I began to see how impactful that is.
Doximity: The forum is structured to include both formal lectures and breakout sessions, some of which allow students to practice interacting with LGBT patients. Another important part of the forum is the patient panels. Patients are invited to share their experiences with students and health professionals in attendance.
Mark: I remember the stories from this one transgender patient. She spoke about the whispers and the comments she would hear behind her back from the healthcare staff, some doctors being so uncomfortable about who she was that they just didn’t want to treat her. She talked about how that experience shaped her relationship with the healthcare community moving forward, as obviously it would.
Michaela: It’s such a simple thing, but it means a lot. When the doctor or the nurse calls you into the room just to see you, you know, the name that they use, the pronouns they use — that matters. And sometimes they don’t get it right.
Doximity: That’s Michaela Taylor.
Michaela: I’m a 4th year pharmacy student at UCSF. What really hit me close to home is at the pharmacy, they would call my old name instead of my right name at the pharmacy window. They would shout it out because that’s how they do it at the pharmacy — they shout out the name to come to the window. I had to say, “Can you not say that name?” Little things like that, little microaggressions, really add up, and they can make or break a patient’s day. And if you are a healthcare provider, and you hurt someone in that way, they might never come back. They might become very sick as a result.
Doximity: Michaela was one of this year’s co-chairs of the forum. She was not the patient Mark was referring to, but to some extent, she understands the struggles described.
Michaela: Being trans, I was interested in doing the LGBT forum. Trans healthcare is just starting to get off the ground. It’s something that’s still not even widely accepted among society in general, and so healthcare providers need to be understanding about that. And of course, trans patients who decide to transition have a whole slew of issues with regards to hormonal matters and what other drugs they might be taking…
Doximity: As a pharmacy student, Michaela has a unique perspective on issues pertaining to pharmacists that aren’t addressed in school.
Michaela: From the trans perspective, hormone therapy is something that we don’t even talk about pharmacologically. And that’s problematic because it’s a very real situation that pharmacists are going to have to deal with.
Doximity: As Michaela explained, the intricacies of hormone therapy go beyond just how they might interact with other drugs patients are taking.
Michaela: Pharmacists do a really good job of knowing drugs — we know the little intricacies and the details about them — but a lot of the time you lose sight of the patient. In some cases, for example, a trans patient might have to be careful about how they have their medicines around. So if an underage or a minor trans patient were taking hormones, and they didn’t want their family to know, perhaps a pharmacist could be cognizant of that and be careful around family members in trying to ensure confidentiality.
Doximity: That confidentiality is something Mark struggled to find when he was younger.
Mark: I didn’t feel comfortable going to my primary care physician at that point. I didn’t want to see the physician my mom took me to. I would google “free HIV testing clinic,” and it was really scary. I never had done that before. Honestly, I was not even comfortable saying that I was gay to my friends at that point, and to be able to say that to a complete stranger who I had no idea how they were going to react was really, really scary.
Doximity: On average, LGBT populations, like any minority group, are at higher risk for a number of health issues, including HIV. Because of stigma or lack of awareness, they receive poorer quality of care for these conditions. And as a result, as Michaela mentioned earlier, they become less likely to seek care in the future. Fortunately, Mark didn’t have this negative experience.
Mark: The nurse who was taking my admission at the time was actually really great. I think she had a lot of experience, obviously, being at an HIV clinic that probably dealt with a lot of people like me. I know a lot of LGBT people don’t have that experience as their first encounter. A provider may not be malicious in the way that they interact with LGBTQ individuals, but even just being uncomfortable or ignorant on some of these topics can make a patient feel really uncomfortable.
Doximity: Can you give me examples of ways that nurse made you feel comfortable?
Mark: She would just ask like, “Okay, well, are you sexually active?” And I was like, “Uh, like yeah yeah.” And she’d be like, “Okay, are you sexually active with men, women, or both?” And she just said it in such a normal and benign way that it just felt so easy to answer. I was like, “Whoa. Okay, well, you know, men.” And she just said, “Okay.” And she just didn’t bat an eye, and she continued to ask very personal questions, but I think it was the way she asked it that made me feel at ease — like A. She had done this a million times and B. The fact that I said men rather than women was not a big deal at all.
Even them having a box for you to identity as this gender identity or this sexual orientation — knowing that that’s something that they want to know about you was already putting me in the mindset that this is something they care about, and this is something that they are going to address. So that’s, I think, actually a very easy way for a lot of healthcare professionals to make that point clear even before the patient interacts with the doctor, kind of setting the tone.
Doximity: Michaela gave another example of how to (and how not to) interact with LGBT patients.
Michaela: It’s a casual thing. Queer people are just people. I was calling a patient, and she was talking to her wife, and I was like, “Oh.” It had really nothing to do with anything. But I could imagine someone else being in my position who wasn’t used to that might have a weird reaction, like, “Oh, who was that talking?” And it’s like, “Oh, that’s my wife.” And like, “Whaaat.” You know, it’s little things like that. For me, it’s such a normal thing. I think that’s how ideally it should be. It shouldn’t be seen as anything special. Ultimately you should just treat us like you treat anyone else, just with sensitivity and understanding of specific issues. I’m sure I’ve seen plenty of patients who are gay or lesbian or even trans without even knowing. And ultimately it’s none of my business.
Mark: A lot of healthcare providers are just not knowledgeable about these issues. And I’ve also heard a lot of patients feeling like, “I’m coming to a doctor to seek healthcare advice, and I’m finding myself ending up educating my healthcare provider on this.” It’s honestly the responsibility of the healthcare provider to be knowledgeable on all of the populations they’re seeking to serve.
Doximity: And that’s exactly why the LGBT health forum exists at UCSF — to educate. We’re also linking to some resources on Doximity for those who couldn’t attend this year or who don’t have similar resources at their home institutions.
Mark: Unfortunately, a lot of young LGBTQ individuals — they are scared, they feel like they are going to be discriminated against, and so they don’t go to their healthcare providers. And I get this, because I did the same thing. So I think changing that interaction and changing the perception of how the healthcare community does interact with the LGBTQ individuals is really important, because that’s the first step. We’re not going to be able to help people if we don’t ever interact with them.
Michaela: Thankfully, I think most healthcare professionals, because they have such level of empathy and because they do want to help people, they’re willing to accept and understand. They just need to be exposed. I see the good in healthcare providers. We want to help everyone. But unless we actually are doing it, the end result is that people are not being helped.
Doximity: Michaela gave the example of a fellow future pharmacist and his thoughts after attending the event last year.
Michaela: He’s originally from Rwanda. He’s seen a lot in his life, but he hasn’t really seen a lot from the queer population because that’s not as much of a thing in Rwanda. He was just so excited and happy to learn about it. It made me feel so good that someone who lived through something so significant could still learn something about our community, and I’ve learned a lot from him about what he went through. We always can learn from each other.
Doximity: Thank you to Michaela Taylor and Mark Jeng. Thank you also to Dr. Madeleine Deutsch, Marcus Ferrone, Maxx Malloy, Alina Kung, and Sheyda Aboii, who we did not hear from but contributed to this podcast. Thank you to UCSF and the organizers of the LGBT Health Forum. And thank you for listening to the Doximity Podcast.