Why Doctors should meet patients (and each other) where they are: My intersection of #LGBTQ , #LCHF, and #LetPatientsHelp

I received this unsolicited email from Mark Kellett (who’s given me permission to republish):

Hi –

I am looking for a personal care doctor that understands the low carb approaches and also is more likely to be aware of the limits of statins to address cardiovascular disease. I live in Bethesda….Do you have any recommendations? I am not pre-diabetic but working to get my weight down a bit more. The doctors I have been to push statins even though my TG/HDLC ratio is excellent.

Thanks much,
Mark

And it reminded me of a few things –

  • The time a woman, who happened to be a lesbian, told me that her OB/Gyn told her, while on the exam room table, that she wouldn’t care for her because of her sexual orientation
  • The times people like @ReginaHolliday were told that they would not be able to understand, or shouldn’t have access to their own medical record
  • The times I was told that transgender person care is experimental and not medically necessary
2016.06.13 From DC to Orlando Vigils 06103
When people need us to meet them where they are. 2016.06.13 From DC to Orlando Vigils 06103 (View on Flickr.com)

These are all examples of doctors not meeting people where they are.

I couldn’t recommend a specific doctor for Mark. I also acknowledged that I have challenges in discussing my metabolic health with my physicians. Because I am one, though, I am better able to have the conversation.

What clicked for me from Mark’s message is that I have chosen to investigate modern approaches to nutrition (LCHF stands for “low carbohydrate, high fat”), in part because I value a medical profession that’s non-judgmental, curious, and always wants to improve itself for the people it serves.

Here’s why:

We (I) saw what happened when doctors didn’t meet people where they are

During my medical training:

And more recently:

Remembering Jess Jacobs

Sometimes the Patients are Right

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Reminder of a generation of physicians before mine, when doctors were always right. 2018.01.14 Pharmaceutical Ads from the 20th Century 226 (View on Flickr.com)

These are a few examples of things that I was not supposed to learn as a physician:

  • Patients seeing what’s in their medical records is better for health
  • Lesbian women should receive cervical cancer screening
  • People can live with HIV/AIDS; We can have an AIDS-free generation
  • Transgender person care is medically necessary
  • Lesbian, gay, bisexual, and transgender people are human beings

The entire time, the patients knew better.

Maybe what we’re going to add is

  • A low fat diet is not better for health

People in these communities experience significant bias, which is only made worse by not listening

Explicit attitudes among medical students 54441
Explicit attitudes among medical students 54441 (View on Flickr.com)

Obese people and LGBTQ people are the two populations most likely to experience open and explicit bias against them in medicine today.

Despite best intentions, doctors, as humans, have difficulty with introspection. There’s science behind this (see: Just Read: Moral Self-Licensing – a continual challenge to eliminating bias in health care).

I described my experience with the failure to listen in this TEDx Talk with ReginaHolliday (@ReginaHolliday), and also wear it on the beautiful walking jacket she painted for me.

Healing happens in both the physician-patient and physician-physician relationship when we meet people where they are

  • It was stated as far back as the creation of my specialty, family medicine, that our role was to understand the depth of the patient.

..he is acknowledged as a good doctor because he meets the deep but unformulated expectation of the sick for a sense of fraternity…It is as though when he talks or listens to a patient, he is also touching them with his hands so as to be less likely to misunderstand; and it as though, when he is physically examining a patient, they were also conversing.Now Reading: A Fortunate Man: The Story of a Country Doctor, by John Berger (1966)

  • This happened in 1973, subjected to scorn and ridicule, 40 years before it became accepted practice (!):

Now Reading: “Concern that sharing information with patients may cause sustained psychological distress is probably unfounded”

  • This is happening in 2017:

‘What, then, is the response by experts?’ she (Nina Teicholz, at the trial of Dr. Tim Noakes) asked rhetorically. ‘To deny his work, to make fun of him, to pretend his work is full of errors, instead of reckoning with him and saying: “Okay, here are a number of observations that our hypothesis does not explain. We need to explain it.”’Noakes, Tim; Sboros, Marika. Lore of Nutrition: Challenging conventional dietary beliefs (Kindle Locations 6943-6945). Penguin Random House South Africa. Kindle Edition.

Our observations are not matching our hypotheses

We may need to re-evaluate what we were told was true and and by whom:

We have a responsibility to embrace curiosity, and be accountable for learning

Patients don’t want to teach their doctors & it’s not their job to, either. In LGBTQ communities this is a significant issue:

Or as I recall Valerie Spencer telling the audience – “the exam room is not the place for your continuing medical education”

We shouldn’t waste opportunities for our patients to be are our allies as much as we are theirs

I am seeing how, in online conversations and even in peer-reviewed spaces that people are denigrated because they are journalists or don’t have doctorates, or the right kinds of doctorates. Health is multi-dimensional, and multi-professional. Diversity is additive (as I say, it allows the human species to survive 🙂 ). When there are hidden conflicts or we cannot see our own lack of diversity, a different perspective is protective.

2018.01.14 Pharmaceutical Ads from the 20th Century 238
A less expansive view of diversity, when doctors were always right, circa 1966. 2018.01.14 Pharmaceutical Ads from the 20th Century 238 (View on Flickr.com)

See also the section above – “sometimes the patients are right.”

Patients can heal doctors, too.

This is a painting produced by Regina Holliday in 2013, who listened to the stories I told about working to be an ally for people who are transgender.

It was calming and affirming to be recognized by someone who knows what it’s like not to be listened to.

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2013 HealthFoo Day 3 22669 (View on Flickr.com)
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2013 HealthFoo Day 3 22675 (View on Flickr.com)

We are in store for unlearning & relearning on a variety of health topics in our generation.

And PS. The nutrition topic in 2017 has finally made the pages of JAMA as the transgender person one did in 2015 – note the similarities of the titles:

  1. Abbasi J. Interest in the Ketogenic Diet Grows for Weight Loss and Type 2 Diabetes. JAMA [Internet]. American Medical Association; 2018 Jan 16 [cited 2018 Jan 16];319(3):215. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2017.20639
  2. Buchholz L. Transgender Care Moves Into the Mainstream. JAMA [Internet]. 2015 Oct 14 [cited 2015 Oct 27];1–3. Available from: http://jama.jamanetwork.com/article.aspx?articleid=2463347

Every interaction is really an opportunity to be there for the people we serve and our colleagues, where they are.

I’ve compiled a a gallery of images, including some of the ways the profession has viewed itself and its patients in the past, along with some of the outcomes.

Thanks for reading. Comments are always welcome.

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