Justice

Why Is The Medical Field Lagging Behind Social Acceptance of Trans Patients?

Doctors and medical students are—slowly but surely—getting better at treating LGBTQ patients. Last week, the Association of American Medical Colleges released its first guide for teaching medical students about handling LGBT and gender non-confirming patients, as well as patients with differences in sex development.

Medicine has traditionally not been particularly conscious of gender and sexuality. Medical texts published up through the middle of the 20th century assumed that the straight male body was the standard and viewed homosexuality, intersex conditions (in which someone’s sexual anatomy doesn’t line up with what is typically understood as female or male), and transgender as deviant.

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While LGBT and intersex activists gained civil and political rights, the medical profession trailed behind. The American Psychology Association’s Diagnostic and Statistical Manual of Mental Disorders considered homosexuality a mental illness until 1974. The DSM continues to classify “gender dysphoria”—a term that includes many gender non-conforming and transgender people—as a mental illness. Trans advocates note that this classification means identifying as trans amounts to a disease or pathology. This ignores people’s legitimate gender identities. We see this view, for instance, in the military where trans individuals are banned from military service. (Yes, Don't Ask, Don't Tell still exists for the trans community.)

Medical institutions have also struggled to serve the health needs of their LGBTQ patients. For example, LGBTQ youth and adults have increased risk for mental illness, including depression, anxiety, suicide attempts, and substance abuse. Nonetheless, they may have trouble finding mental health professionals with experience providing appropriate care. Trans and gender non-conforming patients in particular struggle to access medical care. A recent study found that only 71 percent of trans patients who sought emergency medical care got access to the emergency room—and over half of trans patients reported negative experiences with health care providers because of their trans identity.

As a medical school professor from Northwestern University wrote last week, “These populations are already at increased risk for harm, and the last thing members of these populations need is for more harm to be accidentally added by medical professionals who aren’t well prepared.”

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The Human Rights Campaign (HRC) rates healthcare institutions on a “healthcare equality index,” which takes into account four criteria: a patient non-discrimination policy that includes sexual orientation and gender identity; a policy granting equal visitation to LBGTQ patients; an employment non-discrimination policy; and training in LGBTQ patient-centered care. According to the HRC, 427 healthcare facilities now meet all four of these criteria. Nonetheless, one bad experience with an ignorant or intolerant doctor could discourage an LBGTQ patient from seeking insurance or pursuing medical care. And, as the AAMC report notes, LGBTQ health disparities don’t exist in a vacuum. They “may be amplified by feedback loops of discrimination that occur based on age, race/ethnicity, socioeconomic status, and other demographic factors.”

On the other hand, sometimes, LGBTQ patients don’t need specialized medical care—they just need doctors who understand them as individuals. Kristin Eckstrand, a medical school student at Vanderbilt, pointed out that sometimes sexuality and gender identity just aren’t important. 

“Don’t think that because an LGBT person is walking into your office that the issue they have is related to their sexual orientation. Maybe they just have pneumonia.”

In fact, the Transgender Law Center suggests to doctors that “[i]t is inappropriate to ask transgender patients about their genital status if it is unrelated to their care.”

According to Eckstrand, doctors should ask about sexual history in an open-ended way (“How would you identify your sexual orientation? How does that affect the sexual practices you engage in?”). This may make LBGTQ patients feel more comfortable discussing their sexual history—and it may give doctors more accurate information. After all, a man who identifies as straight may have had sex with another man, and a woman who identifies as lesbian may sometimes have sex with men. Those are important details for a doctor to know when making recommendations about contraception or tests for sexually transmitted infections.

Yet universities right now don’t have any consistent approach to teaching about LGBTQ health. Some medical and public health schools do have programs that address the differing health needs of LGBTQ patients. For example, Drexel School of Public Health offers an LGBT Health certificate program, and the Stanford School of Medicine has an LGBT Medical Education Research Group. Yet most schools only include a few hours of training on LGBTQ health over the course of a four-year degree or offer an optional class or extracurricular seminar.

The AAMC’s Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development wants to change that. Their new resource guide suggests LGBTQ health can be integrated into medical school curricula across the country. This certainly won’t change the entire profession’s approach to gender and sexuality—but it may teach doctors to be more tolerant, one medical student at a time.