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Med schools teaching courses on LGBT patient care
Lesbian, gay, bisexual and transgendered patients pose different challenges for doctors, starting with language and trust. Universities are developing courses to make doctors more effective.
The Philadelphia Inquirer
PHILADELPHIA — Take five or 10 minutes, the professor said, and write down things that you love, like, need or enjoy.
Now pair up with someone you don’t know and spend 20 minutes introducing yourself. Talk about whatever you want. But don’t mention anything that you wrote down.
Try going on for a half-hour without a word about the most important things in life. Imagine a full day.
“It might be difficult,” said instructor Robin Brennan. “That’s what this course is about. That is just a glimpse of what it is like for somebody who is LGBT” — lesbian, gay, bisexual or transgender.
The course is about LGBT health disparities, many of which — such as higher-than-average rates of suicide, drug addiction and smoking — are linked to greater stress. Fear of sharing personal information, even with a doctor, doesn’t help.
The Drexel University School of Public Health this semester began what is believed to be the second program in the nation to offer a certificate in LGBT health.
The first, started in 2007 at the University of Pittsburgh, is taught on campus there. Drexel’s certificate is granted only to online students, although it is expected to be available in the future to those who take the courses in physical classrooms.
At their first meeting on the Philadelphia campus, some of Brennan’s seven master’s level students were stumped by the opening question on a handout: What do you think caused your heterosexuality? “I don’t remember doing it,” said Lauren Orsini.
Question No. 8 — Why do you flaunt your sexuality? Can’t you just be who you are and keep it quiet? — got to Tosin Seriki: “Flaunt? I am who I am. Keep it quiet? No. That’s me!”
Another exercise asked them to classify people as heterosexual, lesbian, gay or bisexual based on brief descriptions, such as: A man who is more attracted to men than women, although all of his sexual relationships have been with women.
There was no correct answer, but the questions helped students dig into the meaning of “sexual orientation.” (It is considered to be some combination of attraction, behavior and identity. Transgender, on the other hand, the T in LGBT, is all about gender identity; a trans man or woman may be straight, gay or bisexual.)
But labels oversimplify. More than 75 percent of lesbians have had a prior sexual experience with men, according to one study. And 9 percent of men who described themselves as straight in a 2006 New York City study said they had had sex with a man in the previous year.
That study also found something that doctors would want to know: Those 9 percent were less likely than other “straight” men to use a condom, raising their risk for HIV.
“Language is important,” Brennan told her students, many of whom want to go into medical professions. Even a routine form that asks for “marital status” may suggest to a gay person that the doctor doesn’t understand and may discourage the patient from revealing details about sexual orientation or gender identity.
Creating trust — by using the right language and asking the right questions — is essential to care, said Nurit Shein, executive director of the Mazzoni Center, whose primary care clinic in Center City focuses on the LGBT community.
“If you are a new patient,” she said, “a question would be: ‘Are you sexually active?’ And then, ‘With whom are you sexually active? With men? With women? With both?’ ” Even if a young gay man “has not ever had sexual encounters, we would talk about HPV” — human papillomavirus — “and getting the Gardasil vaccine,” which most doctors would offer only to girls.
Medical schools typically teach only a few hours about LGBT health over four years of training, said Randall Sell, an associate professor who created and directs Drexel’s new program. He is hoping to educate health-care professionals and aspiring ones on the diverse needs of the LGBT community.
“For a handful of things, perhaps it doesn’t matter,” said Sell. “Like if you have a broken arm.”
Some differences are due to access to care. Most health insurance, for example, is provided by employers. Women tend to work in jobs that are less likely to provide coverage. So a couple made up of two women is less likely to have insurance. Even if one woman does, most employers won’t cover an unmarried partner.
Rates of anal cancer are higher for gay and bisexual men; breast and reproductive cancers are higher for lesbians and bisexual women.
Depression and anxiety are higher for all LGBT people, and they are far more likely to be victims of violence.
One estimate put the average age of death for transgender people at 39, Brennan said.
Still, there are almost no reliable statistics from large national studies — something that the programs at both Drexel and Pittsburgh aim to change.