What specific progress could you point to that you’ve seen over the course of your training and your career so far with regard to LGBTQ health care workers’ experience and LGBTQ patients?
When I was in college, there was a case in 2007 where a woman wasn’t able to see her partner or children before dying in a Florida hospital. Since then, there’s been great strides with a 2011 executive order extending hospital visitation rights to LGBTQ families. In 2013, there was the legalization of same-sex marriage. More recently, in June 2020, the Supreme Court extended protections against workplace discrimination to LGBTQ employees.
But there are certain things that continue to be problems, such as the recent Final Rule from the Department of Health & Human Services that fails to protect our LGBTQ patients and friends against discrimination in health care.
Can you remember a specific episode with a patient who was in the LGBTQ community that was particularly satisfying or moving?
There are two that I think about. In medical school, I was working in a more conservative area of California, and there was a patient who identified as lesbian. She felt more able to talk about her fears of raising a family in a conservative area. She even said, “I feel you can understand the stuff, I can talk to you a bit more about it freely, which is really nice.” Later on, I was able to see them on another rotation I was on, after she’d had a baby with her partner. I was honored that they considered me a part of their family’s journey.
A couple years ago as an attending hospitalist, I had a gay male patient that came in for hepatitis A treatment. Although we typically think of hepatitis A as a foodborne illness, oral-anal sex (rimming) is also a risk factor. After having an open discussion with him about his sexual practices, I said, “it was probably an STI in your case,” and was able to give him guidelines on how to prevent giving it to anyone else during the recovery period. He was very appreciative, and I was glad to have been there for that patient.
What is SHM’s role in regard to improving the care of LGBTQ patients, improving inclusiveness for LGBTQ health professionals?
Continuing to have educational activities, whether it be lectures at the annual conference or online learning modules, will be critical to care for our LGBTQ patients. With regard to membership, we need to make sure that hospitalists feel included and protected. To this end, our Diversity and Inclusion Special Interest Group was working toward having gender-neutral bathrooms and personal pronoun tags for the in-person 2020 annual conference before it was converted to an online format.
Does it ever get tiring for you to work on “social issues” in addition to strictly medical issues?
I will say I definitely experienced a moment in time during residency where I had to take a step back and recenter myself. Sometimes, realizing how much work needs to get done, coupled with the challenges of one’s personal life, can be daunting. That said, I can only stare at a problem so long before needing to work on creating a solution. At the end of the day I didn’t want to run away from these newfound problems of exclusion – I wanted to be a part of the solution.
In my hospital medicine fellowship, I was lucky to have Flora Kisuule, MD, as a mentor who encouraged me to take my prior work with LGBTQ health and leverage it into hospital medicine projects. As such, I was able to combine a topic I was passionate about with my interests in research and teaching so that they work synergistically. After all, the social issues affect our medical histories, just as our medical issues affect our social being. They go hand in hand.
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