The Future for LGBTQ Physicians is Bright

In the over 50 years since the Stonewall riots, the United States has made dramatic progress in the way LGBTQ + people are viewed and embraced. More strikingly, in just the past five years, LGBTQ + Americans have had these changes reinforced into legal protections. Both in the landmark 2015 marriage equality Supreme Court ruling and most recently the title VII ruling that ensured federal protection in the workplace, change has been brisk. While the country as a whole has made tremendous progress in LGBTQ + rights and acceptance, the culture in medicine has seemed to lag. Medicine, in general, has been a straight, white, male profession. It wasn’t until 1973, the American Psychiatric Association (APA) removed the diagnosis of “homosexuality” from the second edition of its Diagnostic and Statistical Manual (DSM). These theories regarded adult homosexuality as a disease, a condition deviating from “normal,” heterosexual development. With language like that in the medical literature, it is no wonder why it took so long for the culture in medicine to change. While we have made considerable progress, I’ve seen firsthand—as a patient, student and young physician—areas where we have room to grow. I distinctly remember being a premed student and going to get a routine physical. The physician was going through sexual history and used tones and phrases to insinuate I was straight.

I didn’t correct him. It was a minor and brief encounter, but I remember that feeling of “not being normal” and the awkwardness that accompanied it. I reflected on that experience and realized if I felt that way during that simple history taking, I can’t even imagine what other folks have experienced in health care. I vowed at that time that I would do my best to ensure my future patients didn’t have similar feelings that I did, regardless of sexual orientation, race, or any other culturally sensitive topic. As I started medical school in 2012, I initially didn’t disclose my sexual orientation to my classmates or faculty. I didn’t want this part of me to potentially affect my career. I initially feared discrimination from my peers, faculty, evaluators, and even patients. I then reflected again. If I wasn’t honest and open about myself, what example am I setting for my patients? So, I slowly started to open up to my classmates. When someone would ask if I had a girlfriend, I would correct them and say “boyfriend.” They usually apologized. I never was offended; I just didn’t want to propagate something that wasn’t true. Being able to speak casually about your personal life or loved ones may seem trivial to some, but feeling comfortable to do so is so incredibly important and it reaffirms that you matter. I was in medical school during the time when LGBTQ + curricula started to gain traction. I could sense there was meaningful change happening. However, these changes weren’t embraced by everyone in the medical community. I remember hearing an elderly attending comment that he thought that it was a “waste of time” and “unnecessary.” Regardless, it was positive change both for the culture within medicine and the care we provide our patients. Still, I struggled with if it was possible to be “out” in medicine. I sometimes believed in the false dichotomy of having to choose between being a physician and being openly gay. As I progressed through medical school and started to think about possible specialties, I wondered to myself if certain specialties wouldn’t be possible as a gay person. There were certain specialties that further reinforced the straight, white, male stereotype. If I wanted to be a surgeon or have a career in academics (areas traditionally straight males dominated) would I have to hide who I was? Being gay was just one part (a wonderful part) of who I was, and I didn’t want it to limit my future career opportunities. In some ways I felt a way that perhaps many women or people of color feel—that a

certain career path wouldn’t be an option simply because of who they are. There was a constant internal battle between being honest and true to myself and risking potential negative effects on my future career. I decided on Internal Medicine and moved to Washington, D.C. to start my residency. While there, I had my first interactions with openly gay faculty and administrators. While the District of Columbia in general is LGBTQ + friendly, having the visibility of LGBTQ + folks being open and proud about who they are was an important and refreshing sight. Having that visibility is so incredibly important, particularly to medical students. Homophobic comments among staff and co-residents were infrequent, yet there were still signs that we had progress to make. I remember one patient making a comment about a medical student who had just rounded on him, stating to me (after the student left) that he thought the student was “obviously gay” and that he “didn’t agree with that.” I didn’t know how to react. I was internally torn between my role to provide objective, impartial care to my patient and my own self-worth. Forming a human connection with your patients is critical in building a trusting doctor-patient relationship. When I’m having a conversation with a patient and they ask, sincerely, if I have a wife or girlfriend, do I correct them? I still, to this day, deny the existence of my partner if I feel that it would elicit an unwelcome interaction. It hurts. We have, however, made tremendous progress in many areas, especially in visibility. As the country as a whole has more LGBTQ + visibility this trickles down into our patients, healthcare workers and other physicians. Health systems from a corperate level are making LGBTQ + issues a priority, whether it is education for its employees or supporting resources for the unique health needs of LGBTQ + patients, you can palpate the concerted effort. As I started my first job out of residency, I was happy to see openly LGBTQ + physicians not only among staff but also in leadership roles. The rapid positive changes, even in just the past few years, has been inspiring to see. We need to continue to propel this powerful momentum of change to ensure that our future continues to look so bright. And colorful.

Barrett Holen, MD grew up in rural Minnesota. He did his undergraduate training in New York City prior to receiving his medical degree from the University of Minnesota. He completed an Internal Medicine residency at The George Washington University Hospital with a concentration in underserved medicine and public health. Upon completion, Dr. Holen accepted a job as a full-time Hospitalist at North Memorial. He enjoys travel and adventurous foods.

est. 1978