Each week, we have a class called "Professionalism in Medicine (PPM)," in which a group presents on a topic concerning medical ethics, health care politics, or community-specific medical needs. We also invite relevant speakers to talk about their experiences navigating our vast American medical morass. For example, this week's topic was "Patients with Disabilities." After watching excerpts from "Murderball," we listened to a man with quadriplegia speak to us about, after his accident, what the doctors did that he perceived as helpful or unhelpful (Helpful: Hooking him up with other patients in a similar situation. Also helpful: Very frank and specific talk about the potential prospects and exact methods for having sex. Unhelpful: Doing anything for the patient that he could do by himself).
When the topic was alternative medicine, our school invited naturopaths, homeopaths, chiropractors, acupuncturists, reflexologists, etc. to speak to us about their practices (Regardless of what any one feels about alternative medicine, it's important for allopathic doctors to be familiar with the practioners' interventions, and to learn how to work with patients and their other health care providers in a productive manners). Next week, representatives from the McCain and Obama campaigns will speak to our class about the candidates' various health policy proposals.
About two weeks ago, my friend and I gave a presentation concerning LGBT health care to our "Professionalism Practice in Medicine (PPM)" class. I addressed basic definitions about sexuality and gender, as well as some pertinent legal issues, while my friend focused on specific health care needs and disparities of the LGBT community. We ended up meshing both our powerpoints, but, because I am not sure if she wants her work advertised on the internet, I'm only posting my portion.
Although I enjoyed giving the presentation, as I waded through some of the many websites, books, and papers dedicated to "LGBT Health Care," I've been pondering some of the pluses an minuses of codifying such a group. In general, I maintain some reservations about addressing "Group-specific Health Care," including "LGBT Health Care." While I didn't mention such concerns in our talk, I wanted to go over some of them here:
1) Higher/Lower Pre-test Probabilities. Lesbian women are at increased risk for breast cancer. If we know and talk about elevated risk of gay men and lesbians for contracting certain diseases, we will be more vigilant in screening them for such diseases.
2) Unique Mental Health Issues/Addiction. Homosexuality correlates with higher rates of depression, drug addiction, and other mental illnesses. LGBT people often face disapproving families, unaccepting religious groups, or simply their own struggles with their sexuality. Knowing this, the doctor can better engage with the patient, talk to her about her troubles, and screen her treatment with anti-depressants or referral to psychotherapy.
3) Fostering Rapport. Most gay or lesbian patients do not suffer from depression or addiction. However, for some people, if the doctor doesn't address or seem to know anything about their sexuality, they may wonder what the doctor would really think about them, if she knew, and cause some distance between the doctor and her patients.
4) Unique Legal Challenges. It's important for doctors to know the laws regarding the authority of a domestic partner over end-of-life decisions, guardianship of a partner's children, extent of insurance coverage from her partner's plan, etc.
5) Possible Extra Need for Privacy. The health records of the "happily-married" senator, who is on the dl, may need to be stored in a seperate place, not to be seen by the rest of the medical staff.
6) Early Identification of Community-Specific Pandemics. Last year, an article addressing a spike in methicillin-resistant staph. aureus among gay men with HIV caused a wind-storm. Many gay activists denounced the article, especially after some Right-wing Christian groups categorized its findings as evidence of strike upon modern Gomorrah. However, fundamentalism and feelings aside, if early identification of group-concentrated pandemics can help us thumb tag each exposure on a public-health map, we can perhaps nip the outbreak in the bud a bit faster.
7) Intersex and Transgender Health: Unique Needs. It's probably a good idea for doctors about sex-reassignment surgery or MTF hormone therapy, considering that these are common procedures for trans-sexuals. Additionally, the controversy involving intersex children have prodded many doctors to take a more "let's wait and see what gender the kid ends up preferring before we chop anything off" for hermaphrodites, and to resist performing immediate surgery on the neonate.
1) Group Identity. Some people simply do not want to be classified in some group called "LGBT." They want to just be seen as "Angela" or "Bill," and as having personal health needs.
2) Sexual Fluidity. If we accept Kinsey's notion that the binary view of sexual identity (gay vs. straight) inadequately describes American's multi-layered and diffuse pattern of sexual preferences and experiences throughout life, the border between "LGBT" and "Straight" starts to become somewhat artificial.
3) Discounting Potential Health Risks. Perhaps too much emphasis on someone's sexuality can bias against certain diagnoses. While lesbian women are less likely to contract HPV, some evidence suggests that, if a lesbian develops cervical cancer, it is often diagnosed at a later age. There are many possible reasons for this (lack of medical access, the fact that lesbians don't need birth control and, therefore, see the gynecologist less often). However, some studies also suggest that lesbians are simply are not offered a pap smear at the same rate as are straight women, presumably because doctors see their risk as being low.
4) Avoiding Social Bias. When we focus on LGBT health, we run the risk of calling, for example, HIV, a "gay man's disease." Other than the fact that this could lead to all kinds "told you sos" from the peanut-gallery, some straight people may behave more recklessly, assuming that they aren't at risk for such illnesses.
5) Focusing on Risk Factors. Lesbian women are at increased risk of breast cancer, but this has nothing to do with the gender of their sex partners. Nulliparous women (women who've never given birth), as well as obese women (lesbians are more likely to be obese) are at increased risk for breast cancer. Perhaps it is most useful to focus on individuals' specific causative risk factors, which may or not be correlated with their sexual identities.
So, now that you've heard my spiel questioning the category of "LGBT Health Care," please please enjoy my presentation on that very topic: