June 12, 2018
By the looks of my Instagram feed and this month's events calendar, everything is going great for LGBTQ people. The bright colors and loud music are a good balm to ward off the extra stress we carry with us as sexual and gender minorities; lesbians; gay men; and bisexual, transgender, non-binary, and intersex people. What bad day couldn't be helped by a little glitter?
We celebrate Pride in June to commemorate the uprising against police violence that occurred at the Stonewall Inn in New York City on June 28, 1969. Our people had already been organizing politically, protesting discrimination, and fighting for basic human rights for many years, but most see this night as the "spark" that galvanized the large-scale movement you see today. The colorful parades are a clapback to the hiding of the past.
The almost 50-year trajectory from when the uprising began to this month's festivities is not a smooth line. Many of us carry with us the scars of childhood bullies, family rejection, and religious persecution -- perhaps buried deep or, for some, reopened daily. Fighting for our rights and respect takes a personal toll. We might be smiling today, but that can easily hide the exhaustion and work it took to get here.
Doctors and the medical profession were some of the culprits who stoked the stigma around same-sex sex and gender variability for far too long. The fight to remove homosexuality from the American Psychiatric Association Diagnostic and Statistical Manual (DSM) in 1973 was a crucial move away from treating homosexuality as a disorder. But we continued to suffer the anxiety of being legal and moral outcasts. Until 2003, laws still existed in 14 states criminalizing same-sex sex between consenting adults, when the Supreme Court finally struck down sodomy laws.
Related: The Patient as Partner
"Diseased" and "criminal" defined us for far too long in the eyes of doctors, nurses, psychiatrists, police, and judges. This history and stigma results in our feelings of shame and loss. We develop coping behaviors to get by -- smoking, alcohol abuse, drug abuse, disordered eating, and self-harm -- sometimes causing ourselves more harm.
The LGBTQ community needs health care providers to open their eyes and commit to our health, well-being, and healing. We need them to be aware of our history and the reasons why so many of us don't trust that doctors and nurses will treat us with respect. We need them to refuse to go along with historic or religiously based attitudes that belie our humanity. We need them to embrace their role as a positive, powerful force in mitigating the discrimination and shame felt by patients. Seeing and healing this foundational pain is the first step to our health and wellness today.
So many barriers exist to real truth-telling between doctors and LGBTQ patients. No easy tests or visual cues will reveal your patients' full sexual histories or hopes for their sex lives, sexual identities, and gender identities or expressions.
They might gladly check a box on your intake form or tell you how they fit into the LGBTQ community. Or maybe they don't fit in at all. What trauma of the past can be learned by a box they check today? What about those who don't check the box or whose most important truth does not appear next to any box? They may have never told anyone about their sexual experiences, gender identity, or feelings they have yet to put into words.
How will you ask about these things? And what have you done to help make it easier for them to trust you? How have you indicated your understanding of and respect for the LGBTQ community? Your LGBTQ patients may have real concerns about confidentiality or privacy. Telling providers the truth may be a moment of both anxiety and liberation. This is the tension of Pride for many of us. My smile on the outside might belie great pain and fear on the inside.
In fact, for many LGBTQ people, a visit to the doctor may cause the worst stress of all. Your patient might have already encountered painful moments walking the halls of your hospital or sitting in your waiting room, from dirty looks to misgendering, to casual heteronormative chitchat: They might feel unwelcome and unsafe before you even enter the exam room. In their lifetimes, your patients might have already had multiple doctors who treated them "rough during the pelvic exam," said "you must be confused," or walked out of the room and refused to treat them (all stories I've personally heard).
Doctors are failing their patients because the system of medical training has failed our doctors. We have failed to teach you the truth about sex and gender. We failed teach you the difference between sexual orientation and gender identity. It's not surprising that few people learn of these things from their parents or high school science teachers. It's a bit more distressing that college-level courses in psychology, biology, and chemistry don't make this material routine. It is not acceptable that medical schools routinely fail to equip future doctors with this basic information. But now that you know there are important things you don't know, it is your responsibility to learn not only about sexual orientation and gender identity but also how contemporary LGBTQ people and communities understand them.
Let the month of Pride be the antidote to this history. Let Pride inspire you to educate yourself, to learn about the LGBTQ community -- our terminology, our history -- so that you might better understand your patients. Let this be the time you become a healer of our pain and learn what was previously unknown to you. Let this inspire you to you ask all your patients about their sexuality and gender identity. Find out more. Ask a follow-up question.
The words you speak and actions you take in the exam room have the power to begin healing a lifetime of pain. I picture a sign hanging in your office that catches your eye to remind you at the start of every visit: Today Is the Day. Today is the day your patient tells you the truth, today is the day your patient asks for help, today is the day your patient starts a journey with you. Today is the day that you ask.
Jessica Halem, M.B.A., is the founding LGBT program director for Harvard Medical School, where she directs inclusion and health equity efforts throughout the school and hospitals. Previously, she led the Lesbian Community Cancer Project in Chicago, where she transformed the volunteer-led support organization into a national leader in cultural competency training. She serves on the Board of the Tegan and Sara Foundation, which fights for health, economic justice, and representation for LGBTQ girls and women. Follow Halem on Twitter: @jessicahalem.
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