Marc M. Beuttler (L3)
Pushing the body out of bed to meet a sleepy reflection in the mirror is a morning routine most people take for granted. Yet this ritual can be daunting to those whose gender identity does not match the sex they were assigned at birth; the figure in the mirror may not be the one they inhabited in their dreams minutes before. If such a personal moment is problematic for a transgender or gender non-conforming individual, then navigating the impersonal complexities of our health care system can be perilous.
At the LGBT Health Care Symposium this past April, the first of its kind in LSU’s history, four experts from the fields of medicine, law, and LGBT advocacy explored the obstacles transgender and gender non-conforming individuals face while seeking respectful and effective health care. Brandy Panunti, MD, Jamie Buth, MD, Chris Otten, JD, and Sebastian Rey, director of the LGBT Community Center of New Orleans, came together to share their experiences and insight on the unique role that health care providers play in the lives of lesbian, gay, bisexual, and transgender individuals.
The acronym “LGBT” represents a diverse community. The first three letters, L, G, and B stand for sexual orientations – lesbian, gay, and bisexual. T represents gender identity – the internal perception of one’s own gender. It may be said that sexual orientation describes who you go to bed with, and gender identity describes who you go to bed as. LGBT individuals exist across every race, age, ethnicity, religion, and socioeconomic status. One common thread tying this community together is a shared set of challenges in accessing quality health care services from understanding, respectful, and culturally competent providers.
If the fundamental role of health care is to increase fulfillment in life by augmenting the health – both mental and physical – of the individual, then we cannot deny that the health care system is failing our LGBT community. Men who have sex with men (MSM) account for nearly half of all people living with HIV in the United States, despite making up only two percent of the US population (CDC 2010). Forty percent of transgender people attempt suicide at some point. This number increases to sixty percent for those individuals rejected by their physician (US Transgender Survey 2015). Homosexuality was considered a textbook mental disorder until 1973, and transgender identity was listed as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) until 2013. As health care providers who take an oath to stand on the side of our patients at the intersection of science and society, we can and must do better.
Though they described many disparities and difficulties that LGBT people face, the panelists also shared successes, including some personal stories about the path to accepting and affirming their own gender identity or sexual orientation. They also made suggestions for how to provide better LGBT-conscious care: changing intake forms to allow for a preferred name and gender, designating gender-neutral restrooms, asking which pronoun patients prefer, and above all, not being afraid or embarrassed to ask relevant questions. These small but critical practices respect the whole person, and in turn nurture the trust that is central to a successful physician-patient relationship.
A central theme of the night was the idea that one’s anatomy and identity are independent variables; that we must provide anatomy-driven health care (e.g. prostate cancer screening in male-to-female patients); yet maintain a patient-centered view that respects the person as a whole. For many in the audience, conversations like these were entirely new and introduced an important vocabulary with which to address an often overlooked population’s health needs, identities, and preferences. The take-away was uplifting: health care services for the LGBT population are improving, but much work remains. While biases are human, the medical community must strive harder to treat patients as they present themselves, and not as we expect them to be.
Whether your patient is a transgender individual who knew early on that they were born in the wrong body, or a self-identifying girl who likes girls when all her friends at school like boys, or someone who does not conform to a binary notion of gender or sexuality, the fundamental goal remains the same: to align spirit and body. What nobler mission can health care have?
Special thanks to:
Dr. Brandy Panunti, Dr. Jamie Buth, Mr. Chris Otten, Mr. Sebastian Rey, LOCUS co-presidents Brandon Jones and Louis Monnig, Dr. Randy Roig, and especially to the LOCUS faculty liaison, Dr. Andrew Hollenbach, for making the night such a milestone success.