As a fourth-year medical student applying to psychiatry programs, I knew my attendings felt justified in giving me every “difficult” patient. Difficult could mean anything from emotional to experiencing deep psychosis, from withdrawn and offering little information to experiencing advanced dementia. So, I was unsurprised to be assigned a patient who was an otherwise healthy 65-year-old woman who had been snapping at and demanding of other ER employees.
I was prepared to get yelled at for not being the doctor, but when I entered and her eyes fixed on me, she burst into tears and reached her hands out to me. While I held her hands, she looked up from the ER gurney, saying, “You are a blessing from God” between sobs. Now that was something that I hadn’t heard before. As she calmed down, she started to tell me that it was the rainbow heart pin I wore on my white coat (one of several that attendings said made me look like I work at Disneyland), that she knew God had finally sent her someone who could understand. Then came the story of the most difficult year of her life. She had come out as a lesbian, and her world had vanished. Her family, including her children, wouldn’t talk to her, so she started leaving her home less due to grief. This caused her friends from church to check in on her, women she thought she could trust, but when they were told the truth, they abandoned her as well. So here she was, in this rural ER concerned she was having a heart attack, without any support. I guess if I were her I would have cried too.
Truth is, I could never fully understand what it is to come out late in life as gay, but I know what being afraid of your community is like. I know what it is like being afraid to discuss with your doctors the specifics of your personal life. Before the move for residency, I lived in the same community I grew up in. A local family still owned the grocery store and it was 30 miles to a movie theater, Walmart or any chain besides Mobile, McDonald’s and Burger King. On the last day of high school some of my classmates rode tractors to school. I was miserable as a teen, but I kept my head down and worked hard to leave. Coming back to work in neighboring clinics was difficult to bear.
I was lanky, with an undercut I wore with some pomade, and dressed in men’s slacks and floral button-up shirts. I got stares in the grocery store, sometimes sneers. I was not yet out as non-binary, not yet using they/them pronouns. And upon being introduced to patients by my attending: “This is Dr. Lyons, she’s a medical student helping me,” several patients exclaimed “That’s a woman?!” Following this they would generally not talk to me. One of them told me I was going to hell. She looked disgusted. My attendings generally took it in stride and redirected, and one attending took it as a learning opportunity about gender (shout-out to Dr. Weeks). Most of the time they would ask if it was okay if I was still present during the visit. The disgusted patient was the only who emphatically stated, “Are you serious?” As my attending asked if I wouldn’t mind stepping out, I tried not to cry.
I had heard in moving for residency that it would be better, people would be more accepting. I, however, have always been one to prepare for the worst and hope for the best. I was completely out to all my friends and family. I had been out at every residency interview, as I desperately wanted to end up somewhere more comfortable for me — or at least avoid somewhere less accepting. Interestingly, one program I interviewed at was upfront that their transgender patients did not feel safe in the community and had experienced hate crimes. At my Drexel-Tower Health interview I had been assured it was an inclusive community. Despite this, when starting my own medical care, I didn’t tell my doctor. I was seeking a gender affirming double mastectomy, and instead of asking my PCP for a medical evaluation letter, I used an online service designed for trans people to access health care. I trusted my doctor with my medical care, and I needed someone to treat my chronic medical concerns. But I didn’t know if I could trust her to still take such good care of me if she knew I was trans. Or if she would know what nonbinary is or if she would misunderstand and assume I’m a “tomboy” or a man or had some sort of internalized misogyny. And she never asked. Her forms never even asked. I was just afraid.
And it wasn’t without reason. I have heard doctors I work with call trans people dehumanizing things behind their backs — it, shemale — use slurs, and blatantly misgender them to their face. It wasn’t everyone, but it was enough for me to want to avoid being ridiculed by people who are basically my colleagues.
Fear of misunderstandings, slights, and overt discrimination are what prevent GRSM (gender, romantic and sexual minority) people from seeking medical care. I’ve been lucky to have avoided transphobic doctors as my physicians (to the best of my knowledge), while 70% of transgender and gender nonconforming people report experiencing discrimination in health care. Half of transgender patients have been refused specific transgender health services, and 65% encountered health care professionals that were unaware of the specific health needs of transgender people. Nearly 27% have been refused needed care and 21% have been subjected to harsh or abusive language by health care providers. 8% were denied needed emergency care (lambdalegal.org/health-care-report). I have it better than most, but trans people deserve better.
To learn more about these disparities, and those of other members of the LGBTQ/GRSM community — and receive information on best practices for their health care — please consider attending the Drexel-Tower Health LGBTQ+ Healthcare Symposium on June 30 from 9 a.m. to 5 p.m. Register at: eventbrite.com/e/drexel-tower-health-lgbtq-symposium-2021-tickets-150799767163.