Photo Friday: Vermont Avenue, NW, Gateway to the Future, Washington, DC USA

2017.04.12 DC People and Places 02295
“”Whoever you are, wherever you’re from, we stand together as neighbors”- districtoflove.org” 2017.04.12 DC People and Places 02295 (View on Flickr.com)

This week’s photograph was taken at the corner of Vermont Avenue, NW and U Street, in Washington, DC (of course), in front of the African American Civil War Memorial (@AfroAmCivilWar) In 2017. The sign identifies the significance of this location in United States history.

This happened on this corner in 1941:

Rally Against DC Police Brutality on U Street: 1941
Rally Against DC Police Brutality on U Street: 1941 (View on Flickr.com)

…and for the next 76 years several of the most significant civil rights movements of our time were conducted or were born in this vicinity, including the African American and LGBTQ communities. Last year I wrote a blog series about several of them, which you can access here.

As a person fascinated with the total health of a population and optimism for the future, my perspective this street is one of the most special in the United States.

Every year its neighbors (who have previously included Walt Whitman and Abraham Lincoln), get together to keep it beautiful,so that it can continue to host the future.

If you happen to be in Washington, DC and would like to contribute with the spirits and the ancestors, feel free.

More photos of 2017 below.

Photo Friday: At Q Street and at Q Street, NW, It’s LGBTQ Communities – Plural, Washington, DC USA

2017.04.07 The LGBTQ Communities, Washington, DC USA 02171
Rayburn House Building with Q Street, the professional association of LGBT lobbyists and public policy advocates and those working for LGBT equality – 2017.04.07 LGBTQ Communities, Washington, DC USA 02171 (View on Flickr.com)

This week’s photographs were taken about 30 minutes and a few miles apart from each other.

They illustrate what I learned this week. It’s not “The LGBTQ community,” it’s “LGBTQ Communities”

The photograph above is of Q Street, the professional association of LGBT lobbyists and public policy advocates and those working for LGBT equality, at a reception at the Rayburn House Building, in downtown Washington, DC.

The photograph below was taken at Whitman Walker Health, just a few miles away, at the Capital Transpride (@DCTranspride) planning meeting, led by our Co-Chair, Bianca Rey (@BiancaRey) (and event sponsored at the platinum level by Kaiser Permanente Mid-Atlantic States – @KPMidAtlantic). Ruby Corado (@CasaRubyDC) happened to drop by, which made the meeting extra special.

Whitman Walker Health (@WhitmanWalker), our awesome host, by the way, is just off of Q Street (NW) itself, in Washington, DC.

The concept of communities plural came from from Catalina Velasquez (@ConsultCatalina) who is not pictured in the photographs below, but was in the room.

2017.04.07 The LGBTQ Communities, Washington, DC USA 02172
Capital TransPride Producers Group – at Whitman Walker Health, just off of Q Street, NW – 2017.04.07 LGBTQ Communities, Washington, DC USA 02172 (View on Flickr.com)

2017.04.07 The LGBTQ Communities, Washington, DC USA 02174
Capital TransPride Producers Group – at Whitman Walker Health, just off of Q Street, NW 2017.04.07 LGBTQ Communities, Washington, DC USA 02174 (View on Flickr.com)

I’m almost embarrassed to realize that this concept didn’t resonate for me until Catalina explained it to our group. And then I developed the digital film my camera and realized I live this concept every day.

I am more comfortable in some LGBTQ communities over others, like most humans. If you assume that I’m more comfortable in the community in the first photo vs the community in the 2nd and 3rd photos, challenge your assumptions – it’s my 5th TransPride 🙂 .

Because biology is what it is, LGBTQ communities include every race, ethnicity, gender, gender identity in the human species. As a result a member of these communities is more likely than not to connect with more of humanity. That’s been my personal experience and it’s been an asset in every endeavor I’ve been a part of. I can’t think of a better gift to be have been given.

I’m not really embarrassed that I just figured this out, I’m celebrating that this life opportunity includes a mentor around every corner, who isn’t just like me.

To enjoy this gift in Washington, DC, the most protective of the diversity of these communities in the nation, is (cream cheese, no sugar) icing on the kale. Enjoy.

Photo Friday: Are Patients Human Beings? (Answer is YES) #TDOV Washington, DC USA

2017.03.15 #ProtectTransWomen Day of Action, Washington, DC USA 01495
2017.03.15 #ProtectTransWomen Day of Action, Washington, DC USA 01495 (View on Flickr.com)

This photograph, taken in Washington, DC, just steps from the White House, reminded me of this photograph

Kaiser Wakes the Doctors Book 33949
Kaiser Wakes the Doctors Book 33949 (View on Flickr.com)

In 1943, this was actually an explicit question – (“Are Patients Human Beings?”). In 2017…. it’s still an explicit one depending on the population, and an implicit one for most practitioners taking care of vulnerable populations. This photograph begs the question of whether this should be a question for anyone in the healing professions.

Today is the International Transgender Day of Visibility (#TDOV)

The International TDoV is an annual holiday celebrated around the world. The day is dedicated to celebrating the accomplishments and victories of transgender & gender non-conforming people while raising awareness of the work that is still needed to save trans lives. The holiday was founded in 2009 as a reaction to the lack of LGBT holidays celebrating transgender people’s successes.

Click here to see the people that my generation of physicians came to health care to serve, because they are human..

Ultimately the world is learning to love better, and why shouldn’t it, diversity is what allows the human species to survive 🙂 .

2017 Enterprising Women, Washington, DC USA

2017.03.21 Tagg Magazine 2017 Enterprising Women, Washington, DC USA 3904
With 2017 Enterprising woman Bianca Rey – 2017.03.21 Tagg Magazine 2017 Enterprising Women, Washington, DC USA 3904 (View on Flickr.com)

Tagg Magazine’s (@TaggMagazine) 2017 Enterprising Women, including Bianca Rey (@BiancaRey), Executive Producer of Capital TransPride.

This will be my 5th Capital TransPride (@TransprideDC), run by a fantastic team, in an even more awesome venue in 2017, Washington, DC’s legendary Studio Theatre (@Studio_Theatre)

Equality is the future. And the future tends to be born here. Washington, DC USA

Additional photos below.

Tagg Magazine's (@TaggMagazine) <a href="https://taggmagazine.com/features/2017-enterprising-women/">2017 Enterprising Women</a>, including Bianca Rey (@BiancaRey), Executive Producer of Capital TransPride. #theta360 – Spherical Image – RICOH THETA

Just Read: A Transgender Military Internist’s Perspective – #WhatADoctorLooksLike

This article, published in JAMA Internal Medicine describes the personal journey of a physician who is now serving as their authentic self:

…today I serve as a female physician in every respect within the Department of Defense. Last month, I graduated the Army Medical Department’s Advanced Course with honors, and now I look forward to the sec- ond half of my military career being treated like any other capable military physician.

The commentary, by Jamie Henry, MD (@MAJ_JLee_MD), concerns another paper in the journal

Schvey NA, Blubaugh I, Morettini A, Klein DA, KL M, G B. Military Family Physicians’ Readiness for Treating Patients With Gender Dysphoria. JAMA Intern Med [Internet]. 2017 Mar 13 [cited 2017 Mar 16];104(7):e5–6.

which, sadly, shows an important part of our profession unprepared, and in some cases, unwilling to provide care to their patients in need.

Depending on how full your glass is, the figure that 76% say they can provide “non-judgemental care” is either good or bad.

  • Good, because 24% admit that they have bias. To not admit bias leads to more harm and errors, multiple studies show this.
  • Bad, because 24% of physicians will provide care in a biased fashion, which is harmful
  • Good or bad: The 76% who say they can provide “non-judgemental care” may have hidden biases. The literature here is also helpful – there is the “illusion of objectivity” which describes the idea that people who believe they are not biased can be the most biased in their behavior (see these posts on my blog about this).

As Dr. Henry states, there is still a long way to go.

At the same time, how incredible is it that a person can have this aspiration, and fulfill it, because the only prerequisite is that they are human.

I went to medical school for a number of reasons, but primarily I wanted to heal—myself and others.

  • heal society too, which is what will happen, as we change forever #WhatADoctorLooksLike

Also noting the work of Jesse Ehrenfeld, MD – @DoctorJesseMD – working to be an ally for the LGBTQ community.

Love this century 🙂 .

Just Read: #WhatADoctorLooksLike – Implicit Bias in Academic Medicine – via JAMA

Where I went to medical school (University of Arizona College of Medicine), we had the typical “wall of fame” of all the previous graduating classes prominently mounted, covering the history of the school’s first class from 1967 to the present.

It was amusing to note that as you walked along the wall that the number of women in each class steadily increased, to the year after mine, when for the first time there were more women than men in incoming class.

Except that in retrospect, it wasn’t really funny.

The other thing I noticed was that the Nursing School building, erected a few years after the medical school building next to it, didn’t seem to have very many men’s rooms…

The wall showed another thing, that there were no LGBTQ human beings enrolled in this school. Except that there were. However, all the signs and signals in our curriculum and the behavior of our faculty conspired to keep this just an “allegation.”

And so…we can now measure the impact.

This issue of JAMA Internal Medicine includes three studies looking at sex and racial bias in academic medicine, and as it has been shown in many (many) other studies, the profession tends to mirror the society around it. No more, no less. This is a link to the editorial accompanying the studies, written by Molly Cooke, MD (@mollymcooke) at the University of California, San Francisco.

Cooke M, AJM A, RA G, E M, M N-S. Implicit Bias in Academic Medicine. JAMA Intern Med [Internet]. 2017 Mar 6 [cited 2017 Mar 15]; Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.9643

This wouldn’t be a problem (actually, it would always be a problem, but maybe not as high-stakes) if our society’s health didn’t depend on physicians who understand the life experience of the communities they serve (It does).

Another bank of studies show clearly that people learn better from people who resemble their life experience more closely. It’s just science, not an opinion. And so, when people are selected to present at grand rounds:

To the extent that those role models do not mirror the sex and racial composition of the trainee pool, we are delivering the implicit but powerful message that these leadership roles and examples of excellence are for someone else. Women, blacks, Asians, and Latinos need not apply.

I have previously posted on the environment around LGBTQ trainees, also studied, and also with outcomes that parallel these.

Just Read: Sexual and Gender Minority Identity Disclosure: “In the Closet” in Medical School

This gendered quote from a general practitioner in 1966 (the ancestors of my medical specialty, family medicine) is relevant here:

S/He does more than treat them when they are ill; he is the objective witness of their lives. They seldom refer to him as a witness…that is why I chose the rather humble word clerk: the clerk of their records.

If this is what doctors do (it is), then we have an interest in examining our biases and modulating them. And there’s science to show that can be done, too. Isn’t this century grand 🙂 .

One more from Shania Twain, because it’s my RSS feed.

She’s a geologist, a romance novelist
She is a mother of three
She is a soldier, she is a wife
She is a surgeon, she’ll save your life
She’s, not, just a pretty face
She’s, got, everything it takes

I’ll post again on the actual studies referenced.