Coronavirus in Context: The Importance of LGBTQ Equality in Medicine

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You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. And we spend a lot of time on the show talking about bias, talking about discrimination, but one community we haven't talked about is the lesbian and gay community. Today, I'm joined by two special guests, Dr. Jesse Ehrenfeld-- he is the immediate past chair of the American Medical Association Board of Trustees and a professor of anesthesiology at the Medical College of Wisconsin-- and Nicolas Leighton. He is a second-year medical student at George Washington University School of Medicine. Gentlemen, thanks for joining me.

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Nick, you've talked about whether or not you needed the visibility of being a gay physician. You-- you've talked about whether or not you should wear a rainbow lapel on your jacket. Why is this visibility important to you?

Yeah, I mean, becoming a physician is an incredibly personal journey for anybody. And when I started medical school, I had the mentality that me being gay doesn't define who I am or my career as a physician, and I didn't understand the importance of visibility, as you were saying. But now, I have recognized how much I search for those signals, as I try to figure out what kind of physician I want to be.

And what is good about conversations like this is that we can start thinking less about what it means traditionally to be a physician, and move to what it means to be a physician on our own terms. Not just an ER doctor who happens to be Black or a surgeon who happens to be a woman, but what does it mean to be a Black ER doctor or a gay medical student. And to me, it means that I can connect with patients, that-- it means that I can ask my patients to be vulnerable with me and to trust me, knowing that I trust them enough to be my true, authentic self.

Dr. Ehrenfeld, how is sexuality different than race or ethnicity when we're thinking about bias and discrimination?

Yeah, it's a great question. And I think the fundamental challenge is that, um, LGBT people are often invisible. And unlike the visibility that a difference in skin color, um, by definition brings to the table, um, no one knows I'm gay unless I come out. Um, and yet, as a physician, I want to do everything that I can to make sure that-- that we can get them the best possible care, um, that they're able to get. And you know, the care recommendations are different if you happen to be LGB or T, and yet if we don't ask those questions, if patients don't come in, if they're not willing to share that information about themselves, then we can't get them the best possible care.

Nick, do you feel there's still bias and discrimination? Have you or your colleagues experienced that you can share with us?

I think that there-- while there certainly are comments that are made that I think are off-putting, you know, in any sphere, I think the majority of, um, the distance that we have to go is, um, just the visibility. You know, the unapologetic visibility, as, you know, Dr. Ehrenfeld just so, you know, greatly described is you do have to kind of opt in to sharing that kind of stuff, or, as they say, disclosing that kind of information to your patients.

And you know, I think that being able to disclose that information is really beneficial to the doctor-patient relationship because I think that it is very hierarchical as it is, especially to minority communities, that, in certain situations, being open and visible can signal acceptance of themselves and, I believe, lead to better sat-- patient satisfaction and better outcomes.

Do you have enough role models?

Um, I think there could always be more, you know? I think it's something that you don't actively see or, um, you know, that is broadcast, I guess, to other people, especially in a, uh, professional setting. Um, but I just met, you know, the first gay surgeon that I have met, um, just like a-- a month ago, essentially, because I wanted to-- uh, that's a specialty that I'm very seriously considering, and just to be able to, like, see somebody that is, you know, out, gay, you know, has a rainbow flag in his, uh, in his signature, it really meant a lot to me, uh, as I consider that specialty.

But is it fair to say that he may be the first surgeon that you knew was gay? Because you-- you may have met other gay surgeons. But--

Of course.

--your point about this awareness that you want to have now. And then Dr. Ehrenfeld, you have served at the highest levels of organized medicine, as chair of the board of trustees, as a member of the board of trustees and other leadership roles. Can you share with us your personal journey?

Sure. Be happy to. And you know, it's interesting, medicine has had this complex relationship with LGBT people throughout history. And it's interesting, you think about, you know, 50 years ago, um, 25 years ago, I couldn't have been an AMA member as an out gay physician, um, because of discriminatory policy, because of stigma in the-- the DSM, um, that has been addressed.

Um, and yet I was able to be an out gay person elected to the board and to serve as its chair. Um, we have to acknowledge that history. Um, we can't erase it. Uh, we need to embrace it and learn from it as we move forward, and understand the role of stigma and what it does to prevent people from coming into the profession, whether that's an LGBTQ person or another minoritized or marginalized community. Um, and there's a lot of-- there's certainly a lot of way that we-- that we have to go.

You know, Nicolas sent me this statistic that I-- I want to read and get your reaction to. 30% of non-LGBTQ patients last year said they would feel very or somewhat uncomfortable learning their doctor was gay. What's the impact of-- of that, um, statement?

Yeah, I mean, I think that you have to take that in the context that it-- that it is, and, um, um, you know, how you interact with a patient, um, is-- is critically important, right? So the relationship that I've got with any person in front of me, um, is gonna be influenced by what I bring to the table. So my identity as a gay person, my identity as-- as a person of faith, my identity as a conservative, um, all have the potential to influence the effectiveness of that interaction.

What's important, right, is that any patient who walks through the door knows that they have a-- a-- a space and a place that they can get high-quality care that they need. And what's challenging for us is that so many LGBTQ patients over the years have never found that place. Um, they have never been able to walk into a hospital and feel like they're not going to be put down, discriminated against, exposed. Um, and we have to rectify that.

And so while that just-- that statistic is, uh, certainly interesting, um, I think that it goes to the larger question about what does the interaction between an individual physician and their patient look like, and how do we make sure that we can reach across all communities so that it's not so much about me as a gay physician, it's about me as a provider of excellent care to the individual in front of me.

So [AUDIO OUT] the American Medical Association doing to protect LGBTQ patients, as well as physicians?

How much time do you have?

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[INAUDIBLE] give us what you're most proud of. And then--

Well--

--I'm gonna ask Nick what they should be doing.

Yeah. So-- so you know, from a policy standpoint, we have been fighting for nondiscrimination action, um, at federal levels. We have been working with our state partners to remove discriminatory laws. Um, it continues, unfortunately, to be--

What's an-- what's an example for our audience of what a type of discriminatory law might be? Everyone might not, you know, fully be aware of the discrimination.

Yeah, so there's been a lot in the last few months around, um, parts of the Affordable Care Act that provide nondiscrimination protections for transgender patients and LGBTQ individuals. Um, that section, section 1557, um, was basically eliminated in June by the current administration. And actually, just this week, enjoined by a federal court who has now said that it is inappropriate to remove that important protection. The AMA has been at the center, um, of trying to make sure that those protections remain. Um, and so that it is illegal to discriminate against LGBTQ people in a health care setting, uh, based on a federal statute.

Um, we've also done a lot of work around the issue of conversion therapy. It turns out it is still legal in many states today, although ethically questionable and not a valid approach medically, to perform conversion therapy. Um, we've worked with many state partners to try to get those things banned. Um, unfortunately, there hasn't been federal activity in that space, um, but more and more states, uh, two this past year, um, have said that it should not be legal to perform conversion therapy.

Nick, what do you think still needs to be done?

Yeah, I fully support everything that the American Medical Association is doing. I've been following, you know, uh, what they've been weighing in on [INAUDIBLE] uh, particularly with the 1557 waiver. I think that's a huge, uh, barrier to, um, many vulnerable patients. I think specifically what we've seen is, uh, over the past few years, that the LGBTQ community has been carved out, I would say, um, to kind of put gay people and lesbian people, um, who have become more socially accepted ever since, you know, uh, the-- you know, uh, e-- equality in marriage. And I think, in the other bucket, transgender patients.

And I think what we've seen is transgender patients being actively, um, targeted in some of these policies. So I think absolutely what the AMA has been saying, um, is, um, very strong, and it's a very important signal to providers and to patients across the country, but I also think that there is always more room to, uh, take up that fight and to protect those vulnerable patients.

So what do you say to those lesbian, gay, transgender viewers who are interested in medicine? Will-- will they be embraced? Are they embraced? Nick, let's start with you.

Yeah, I mean, I think it's-- as I said at the beginning, medicine is an incredibly personal journey. And it is-- you have to make it whatever, uh, it means to you, you know? So you can go into that space and you can just get by and you can just be gay. If that works for you, then that's great. If you want to be more visible, if you want to disclose that information to your patients, then that also is a very awesome-- that's a great step, too.

And I think that there is a need for LGBTQ providers in this space. And I think that is only-- that medicine is going to really change when more of us enter this space, because even though the field of medicine has made room for div-- for diversity over the past few decades, I also think that we need to respectfully elbow our way into some places to make room for ourselves, and to make room for others to-- that follow.

But Dr. Ehrenfeld, doesn't an implicit bias still exist in-- in some specialties, in some areas of the country? It's great that, you know, Nick is saying people should, you know, come out and disclose, and that's an important point, but we also have to address some of those issues when there will be, then, implicit bias, sometimes explicit bias. It still exists, so there's still work to be done. Is that right?

We'd-- we'd be fooling ourselves if we didn't think that explicit and implicit bias, um, wasn't there, um, against Black people, against LGBTQ people, against lots of folks. Um, and you know, I-- I think, um, you asked the question, you know, should LGBTQ people consider a career in medicine. Um, the answer is yes. Uh, we need them.

Um, we won't ever have, um, health equity, uh, across LGBTQ communities, uh, unless we have more LGBTQ providers, um, unless we create practices and facilities and hospitals and clinics that are welcoming, that embrace LGBTQ health, that have the cultural competency and the skills needed to take care of, uh, all of those people. Um, and that starts, uh, in many cases, with those who come from the community. We-- we know that, um, minority and underrepresented physicians often-- not always, but often-- uh, go back and serve those communities at a higher proportion. Um, and so, uh, you know, we absolutely need LGBTQ people in medicine.

Now, Nick, you're just starting your career. Dr. Ehrenfeld and I are old. We've been around for a while.

Speak for yourself.

Older. Older. Older. So tell us, what are you hopeful for?

I'm hopeful for, uh, making those spaces, and to encourage other people to be more visible. I think that that is something that, you know, I'm not gonna say your generation, but I'll say generations that preceded mine, I think, uh, just to be in those spaces is a privilege. And I think that there is a larger journey for us to go on, and I'm excited about-- to see where that goes, and to really explore what it means to be a physician of an identity that, you know, was traditionally not included in what a, uh, professional physician, you know, means. So I'm really excited to see where it goes, to explore what it means, what it means to be a gay physician, a gay surgeon, whatever it is that I choose to do, um, and see where it takes us in the medical field.

And where can viewers go to get more information? Dr. Ehrenfeld, does AMA have resources online?

Yeah, the AMA has got great resources. We have a very active, um, committee on LGBTQ issues, um, that has, uh, great links to lots of things. Um, the only other thing I-- I just-- I have to talk about because, you know, we're in the middle of a pandemic and it's becoming a-- really a growing issue, um, is the issue of data. And we-- we started our conversation about visibility, and how, you know, it is different being an LGBTQ person because, often, that visibility isn't there until you actively do something, come out.

Um, we have such little data today about what's happening across the LGBTQ communities with respect to COVID-19 and its impact. Uh, we think that it's disproportionately impacting LGBTQ people because they're at higher risk, and there are lots of, um, structural issues that have led to health inequities, but until we start to get data about LGBTQ people and health care and LGBTQ in medicine and LGBTQ patients, we won't have an understanding. And that's an issue that, I think, uh, hopefully will move forward in the coming months.

Well, gentlemen, I want to thank you both for joining me. We certainly have to address all forms of bias and discrimination, and I know we all appreciate the insights you've given us today.

Thanks for having us.

Thank you very much.

And thank you for watching Coronavirus in Context.

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