Let’s keep it real: this is a long piece and you have to study, dear medical student. But just for a moment, I’ll ask you to think upon your own LGBT medical education experience. Do you feel prepared? Do you know what to ask? Do you know how to ask it? The answers to these questions may vary from an enthusiastic “yes” to “I have to study now” to “…no.” Regardless of where you fall, know that you will encounter a LGBT patient–there is no doubt about that. The more you expose yourself to this population, their health needs and their stories, the better prepared you will be to serve LGBT patients. So even if you only read on for another paragraph or two, know that you have done something good for your future patients.
When I thought about my own LGBT medical education, I realized I didn’t know the first thing about serving a LGBT patient. So my first year, I began a quest to learn more from patients, students and physicians about the LGBT experience and LGBT health. I first interviewed Shane Jeffers, a classmate at Northeast Ohio Medical University (NEOMED), which is located in a conservative pocket of Ohio. Shane has been openly and proudly gay, despite the social environment. This is what drew me to interview Shane about his experiences. As a media enthusiast, I’ve interviewed since the young age of 15: I don what I affectionately call my Condi Rice blazer, press record on my camera, and sit down with folks to hear their stories. Shane’s story is remarkable. His struggles and triumphs speak to the greater narrative of gay youth and gay men in our country. When you encounter an LGBT individual, make sure you ask to hear their story. Their narratives are compelling and continue to remind me of why I entered medicine.
Here, I transcribe excerpts of my interview with Shane and correlate his story to LGBT population data. In essence, this is one of the stories behind the statistics. Shane and I also discussed his thoughts on LGBT medical education, and he provided some helpful advice for you as a medical student when interviewing a LGBT patient. Thanks for reading this far, dear medical student, and I hope that you enjoy my interview with Shane.[I conducted the interview with Shane at school, and we were repeatedly booted from conference rooms due to other meetings. Finally, we settled in at a third conference room (definitely a testament to a medical student’s perseverance), which is where this transcription begins.]
SHANE: Welcome back everyone. We’ve had to change rooms because we are lowly medical students; we were booted, but we should be okay with this one [room].
MEENA: [Laughs] Hopefully! Third time’s a charm, right? You had just finished up talking about the support you had from your friends and the things you were afraid of when you were coming out. And I was thinking that that would take an incredible amount of inner strength and bravery to, you know, admit something that could potentially be so inflammatory, I guess. I don’t know what the right word is. But it must’ve taken something so strong inside of you.
SHANE: [Smiles and exhales] It felt like it.
MEENA: Yeah… Were there any specific discriminatory experiences that really hit home for you?
13 percent of LGB youth are in physical fights that require medical treatment. 19 percent of LGBT youth are threatened or injured with a weapon at school.
Findings from the Center for American Progress’ report “How to Close the Health Disparities Gap” (2009)
SHANE: I mean everybody has had some discrimination. I feel like I didn’t have that much. I know there were a few meat-headed kind of guys that lived in my dorm freshman year that, you know, they had some interesting ideas about what gay people are like. And, uh, well, I ended up pinning one kid down to the floor and dumping his squirt gun on his head. So that fixed that pretty well. But I mean there’s always some discrimination, but nothing really stands out, no really major things.
There were a couple guys at school… Somebody tried to gay bash me once when I was walking down an alley that was near a gay club. I went there with a friend and she forgot her ID so I had to walk her to the bus stop and I was walking back. There’s maybe a stereotype that gay people are weak. That’s not true. Gay people get into a lot of fights. There’s a lot of people who want to “teach us a lesson.” I think that if a gay person makes it to adulthood, then watch out because they know what they’re doing. I think people assume that gay people can’t take care of themselves. Like the time those guys tried to bash me: You know, there were three guys and one of them had a baseball bat. If they had taken me seriously, I’m sure they could have done some serious damage. The two hung back while the other tried to hit me. I don’t know how graphic you want me to be.
MEENA: That’s —
SHANE: I mean, do you want me to tell the story?
MEENA: If you feel comfortable telling it that’s —
SHANE: I mean sure. Like I said, I grew up in a poor area and to get to the library you had to walk through the park so I had some fighting experience [from that]. I actually broke the one guy’s kneecap and the other guy came at me with the baseball bat and tried to swing it at me — blocked it with my arm. I had bruises all along here. I got the bat away from them and they ran away. That was it.
MEENA: How old were you?
SHANE: Probably 18 or 19. Freshman year.
MEENA: I’m sure that was very traumatizing. I’m glad that you were safe and you made it out.
SHANE: No but that’s–life of a gay man. It’s normal.
20 percent of LGBT adults experience psychological distress.
Center for American Progress’ report “How to Close the Health Disparities Gap” (2009)
MEENA: Yeah and that’s so sad that it is normal. It really shouldn’t be but it speaks to the things that enter your mind when you’re deciding to come out and what strength it takes to be out, really owning it, knowing who you are, and admitting that to people. It means so much to do that. What do you think about our LGBT medical education that we’ve received so far in medical school?
33.3 percent of medical schools dedicate zero hours of their curriculum to LGBT health. On average, medical schools dedicate five hours to LGBT health education, and the quality of this education is widely variable.
Findings from “Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education” JAMA (2011)
SHANE: Well, we haven’t received any yet. [Laughs]. So I know that we are working to change this. The average time spent on this is 5 hours in medical schools and the quality of that [education] varies immensely. But I have heard other doctors say that they don’t feel well prepared to deal with — [sighs] I don’t want to say “deal with” because you don’t “deal with” people, you help people. So people feel like they aren’t well prepared to help LGBT people. They don’t know the issues, they don’t know the questions to ask, and I would like to see that change. I don’t want to add to the mass of mandatory doctoring lectures but I do feel like it’s an important skill for people to have.
MEENA: Why do you think there’s such a large gap in LGBT medical education?
SHANE: I think that medicine is typically a fairly conservative field. It’s one of the few remaining really white-collar jobs where everyone is all about professionalism and tradition, which means that it can be a bit slow to adapt to the modern world. I feel like some people don’t want to adapt. I feel like there would be a lot of people who would be actively offended if this was part of the curriculum, but honestly I feel like those people should have to learn it or they shouldn’t be doctors.
MEENA: You know, I was talking to another physician this past Sunday and he had said — he’s a gay physician — and he had said that once he entered the office, he felt there were some colleagues that he received some resistance from, and he said that over time those physicians kind of got weeded out of their office just because they weren’t able to interact with him as a colleague effectively because of their personal biases. Do you think that this is going to be part of what makes a good physician in the future?
SHANE: It very well could be. If they end up in that position, then it is essential that they are able to work with anyone. I just think it’s great that it was those physicians that got weeded out and not the gay physician. Because I know in plenty of other situations, people would have said it was the gay physician that was causing the problem.
MEENA: Let’s talk about interviewing. If you were the patient, how would you want a physician to talk to you?
56 percent of LGBT people faced refusal of care or physical or verbal abuse by health care professionals when seeking health care. These experiences were increased to 70 percent in the transgender population. In fact, there was a marked degree of anticipation among LGBT patients that they would face discrimination.
Findings from Lamba Legal’s report “When Health Care Isn’t Caring” (2010)
SHANE: Just be open. To me and to most in the LGBT community, it doesn’t matter that you just automatically know all the terminology and the PC terms. I mean, because everybody has different terms that they like anyways. Like, I know, queer is a PC term right now, and I don’t like it because the root word means “weird” or “strange” or “unusual” and I don’t think that’s a particularly flattering view, but some people love the word queer. So you should just be open and willing to ask what terms people prefer because it’s going to be different for each person. Another big part of interviewing a LGBT patient is to not go in with preconceptions. Don’t go in and, as soon as you find out a patient is gay, ask them what clubs they’ve been to or immediately ask — a really common one — ask them if they have HIV and go into HIV safety. Like we know. It’s been drilled into us, the same as everybody else throughout school. We know.
MEENA: Yeah, it’s a definite turn-off for anyone, especially when you first see them — to just assume that — to go from LGBT to “Oh, are you HIV positive?” — that is a huge and prejudiced leap to take.
MEENA: Okay, so how do you enter that conversation? How do you invite them to be willing and honest about who they are?
SHANE: I think the standard way is just as part of the History and Physical, you ask about sexual history. You can start off asking, “How many men and how many women have you slept with in your lifetime?” And that’s a good starting point because you can find out lesbian, gay, bisexual. As for the other parts, there’s so many letters; it’s not just LGBT; there’s like 27 letters now and I don’t know them all [laughs]. So you can just ask. Ask, “How do you identify?” First off, most people who are part of the community will understand what that question means. They will know that maybe you are a little out of your water and they will just supply the information. And if they don’t, if someone needs clarification, then you can just say, “Are you heterosexual, homosexual, bisexual, transgender or is there anything I should know about?” And that’s their opportunity to tell you. There’s a little potential to offend somebody if they say, “Oh, you think I’m gay?” It’s really easy to just point at the paper and say, “Look, it’s on the paper.” It’s just something we’re supposed to ask, it doesn’t mean anything, it’s just a question. I think that doctors should be willing to ask that question.
MEENA: I think a large part of the apprehension to change to be more inclusive of all of those things is that doctors are afraid of offending people. And that is a perfect way to mediate that situation, to just point at the paper and say, “I have to ask it; it’s part of the protocol.” Where do you see yourself in the LGBT health community in the future?
SHANE: If I can, I would really like to be a role model to young, gay people. I would love it if people would refer young, gay patients to me. I feel like I’ve been there. I’ve done it and I’ve gotten through a lot. I feel like I would be a good example for people — to let them know that they can shoot for the stars and achieve their dreams no matter what people think.[This interview transcript has been edited and condensed for print purposes. All changes were approved by Shane Jeffers prior to publication.]