Awareness of the difficulties lesbian, gay, bisexual and transgendered (LGBT) individuals face has increased in the last 20 years, but much more progress remains to be made, according to Professor Jen Hayashi of the Hopkins School of Medicine.
Hayashi, an assistant professor of geriatric medicine at Bayview Hospital, discussed the issues facing both patients and care providers in a speech on Monday.
Hayashi discussed a wide range of topics including homophobia and heterosexism in the medical field, methods of dealing with discrimination, and her own personal experiences.
"I can tell you at Bayview when I came to geriatrics I had never felt any iota of being treated or seen differently," she said.
In 1982, 70 percent of respondents said highly qualified LGBT individuals should be admitted to residencies. By 1992, this number had increased to 98 percent. While polls certainly show a dramatic increase in acceptance of LGBT individuals, it is still difficult to gauge the real progress that has been made in attitudes in the medical field, due to individuals becoming more closed-mouthed and hesitant to voice their true opinions, according to Hayashi.
Hayashi described her own coming-out experience in detail. By trying to fit in she suspected she was not like everyone, suspicions which developed into much more by the third year of medical school. By a twist of fate, the one man she dated in college turned out to be gay. Originally planning to be a Navy doctor for life, Hayashi was hit by the realization of what that entailed.
"I was just busy taking care of patients, taking care of life, so I didn't notice all the Navy lip service stuff. The longer I stayed here the longer I was going to be like those people and I couldn't deal with it," she said.
For Hayashi, it was essential that she find a residency that accepted her as a lesbian. Among the choices that were open and accepting was an opening at Hopkins.
"I got trapped because Hopkins is a really fun place to work," Hayashi said.
She said that her sexuality did not impact her job placement opportunities, but it did impact her day-to-day mental well-being and her sense of self.
Hayashi spend significant time in the speech discussing the studies on sexual awareness in the medical field which have been undertaken in the last two decades. Many studies confirm the fact that medical students are afraid to tell others that they are gay, in part because of perceived risks of negative effects on their grades or their residencies. In the most "touchy" specialty, family medicine, 25 percent of directors said they would be hesitant to accept openly gay students into their programs.
She mentioned a study of internal medicine residents reported half of them had heard or witnessed homophobic events or remarks in the workplace.
According to Hayashi, support groups are not necessarily a good place for LGBT individuals to come out due to the focus of coping with the arduous training of such groups. Because of this, LGBT physicians run an increased risk of losing referrals and employment.
For patients, the wear and tear of coming out to new people is an often overlooked aspect of the LGBT doctor-patient relationship. Homophobia and heterosexism harm both patients and caregivers. For patients, it is hard to make a difference. In such cases, Hayashi encouraged active intervention when even minimal discrimination is present. To illustrate this concept, she suggested that a form asking for marital status simply include the options single, married or divorced.
"You can say it doesn't have to be like that. It can be more inclusive. This does not make me feel welcome. This does not make me want to come to [this hospital]. When people fill in that blank with something that is not an M or an F it gives the doctor an opportunity to talk to that person," Professor Hayashi said.
The reception of students in attendance, the majority of whom were LGBT individuals interested in the issues that they will have to deal with in their future careers, was unabashedly positive.
"I viewed it as an accurate portrayal of LGBT patients and physicians. It highlights the discrimination the community does have to face out there in the world. We're still waiting for that one day when you can just be respected for being human regardless of your sex orientation," said Keshav Khanijow, president of the JHU Diverse Sexuality and Gender Alliance.
Hayashi's speech instilled in students a sense of the importance of LGBT issues in health care.
"I felt that a lot needs to be done and that it's an issue that people don't know about and don't necessarily think is an important issue. I thought the presentation was really cool because a lot of people showed up and they got to hear about this issue that matters to a lot of people," said sophomore Karen Chen, who attended the speech.
