MILES PARKS, HOST:
Medical care for the LGBTQ community has become politicized in this country. But at the heart of it, there are thousands of people who health care advocates say are not getting the care they need. They also say that medical students are lagging behind in getting the training they need to care for the LGBTQ community. To understand better what it is that medical students and patients need, we turn to Dr. Alex Keuroghlian. They're a psychiatrist and director of the Division of Education and Training at the Fenway Institute. Alex, welcome.
ALEX KEUROGHLIAN: Thank you for having me.
PARKS: So in 2014, the Association of American Medical Colleges released a call that said to U.S. and Canadian medical schools essentially they need to provide better training for LGBTQ people. Has there been an improvement over the last 10 years?
KEUROGHLIAN: There has been some improvement. We have a long way to go. Certain medical schools have really picked up that call, and other schools have done less. And there's also variation across coursework, the core clinical clerkships where people rotate through, say, surgery and internal medicine and pediatrics and psychiatry and OB-GYN and then advanced courses. So there's a lot of variability across the country.
PARKS: Tell me what - in a perfect world academically, what this would look like.
KEUROGHLIAN: From the time medical students arrive in their first year in every course that they take, wherever there's an opportunity or need to frame medical education in a way that's inclusive of the needs of all sexual and gender-diverse people, that would be happening. There would be clinical opportunities to engage with a high volume of LGBTQI+ patients. There would also be involvement of LGBTQI+ community members in teaching the medical students. For example, with patient interaction simulations, we would have people with authentic LGBTQI+ identities with whom students could do histories, perform physical exams and then get feedback about how culturally responsive they were being and a way to process microaggressions and other challenges that come up.
PARKS: How is the current situation, this disparity between doctors who have this training and most of those who don't - how does that actually affect patients?
KEUROGHLIAN: LGBTQI+ people have negative experiences accessing health care, either being mistreated overtly and denied care in many cases - and that's well documented - even harassed within health care context, or being given care that's not skilled and technically harmful to the patient. They may avoid going to seek care or returning after they have an initial experience because they don't feel safe.
PARKS: On first glance, some people may think, well, this is more of, like, a social issue, but I could totally imagine it. At a time when I've gone to the doctor, the moment a doctor says something that kind of contradicts my personal experience, even not on purpose, like, I immediately kind of am skeptical of the entire experience.
KEUROGHLIAN: Yeah, absolutely. There are two parts to it. One is culturally responsive care, things like working through our own implicit bias against LGBTQI+ people, sensitive and effective communication, how to apologize when you make a mistake. The other piece that's not unrelated to that is that I'll often hear doctors say things like, well, I treat everyone with respect. I treat everyone the same. The reality is to treat certain populations with respect and to provide high-quality care, we don't do exactly the same thing we do for everybody else. It needs to be patient-centered, tailored and population-specific.
PARKS: I wonder how politics play into this issue just in terms of all the states that have been making inroads to ban gender-affirming care. Does that affect how colleges see whether it's necessary or even whether it's potentially allowable to teach medical students and physicians to care for this community?
KEUROGHLIAN: It definitely does. I'm in dialogue with colleagues in various states - in Texas, in Mississippi, in South Carolina and Florida - who have had their programs shut down that were running for a while within academic medical centers, who've been told that they can't keep doing what they're doing and, frankly, who are asking me what job openings there are in Massachusetts right now. And it's also having an effect on medical students deciding to pursue much-needed careers in, say, gender-affirming care for transgender and gender-diverse people.
PARKS: I guess look ahead at the next 10 years. Do you feel like this is a short-term problem, or is this something that's going to take decades to kind of get to where you want it to be?
KEUROGHLIAN: This is definitely a backlash to the enormous progress that we made in recent years. I didn't necessarily expect it to be as widespread, well-organized and violent in opposition to the health rights of transgender and gender-diverse people, as it very tragically is right now. That being said, this is, within medicine and science, extremely fringe opposition to care, but that is what's being centered within policy. So we need to be vocal as a medical profession and as medical educators. We can't stand on the sidelines in this case. And I think if we're unified, vocal and persistent, we can counteract this.
PARKS: Dr. Alex Keuroghlian is the director of the Division of Education and Training at the Fenway Institute. Thank you so much for joining us.
KEUROGHLIAN: Thank you. Transcript provided by NPR, Copyright NPR.
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