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.