Why we need better LGBTIQ+ education in the health sciences

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No one should have difficulty accessing quality, compassionate health care. At Texas A&M Health, an interdisciplinary group is working to better prepare our students to care for LGBTIQ+ patients. We talk about some of the health disparities LGBTIQ+ patients face, reasons behind those disparities, and how we can do better.

Episode Transcript

Lindsey Hendrix:

We bring you advice and compelling insight on the latest in health, medicine and scientific discovery. From tips for getting better sleep to discussions about major issues like health disparities in America, we’ll talk about it. You’re listening to Texas A&M Health Talk, part of the Texas A&M podcast network.

Lindsey Hendrix:

Hello and welcome to Texas A&M Health Talk. I’m your host, Lindsey Hendrix. I hope you’re all doing well as we continue to navigate the COVID-19 pandemic. Here at Texas A&M Health, we’re doing our part. We’re wearing our masks when we’re out in public, physically distancing, washing our hands and doing everything our public health professionals have advised, and I hope you’re all doing the same and that you are staying well.

Today we’re going to veer away from the COVID-19 topic a little bit and talk about an ongoing effort at Texas A&M Health, and that is addressing health disparities. Nobody should have difficulty accessing health care or receiving quality care in the United States. Unfortunately though, that is a reality faced by too many Americans. We’ll talk about many health disparities that are impacting various different populations in episodes to come, but today we’re going to focus on the LGBTIQ+ community.

My guests today are amazing. They’re working on an exciting and very important project here at Texas A&M Health to address LGBTIQ+ health disparities and I’m so excited about my conversation with them. Dr. Alison Pittman is a clinical assistant professor at the College of Nursing, and Dr. Faizan Kabani is a faculty member and assistant director for diversity and faculty development at the College of Dentistry. We had a terrific conversation. I learned a lot. I hope you learn a lot from this discussion as well, and I’d like to see the entire community move this issue forward and make progress toward a better health care experience for our LGBTIQ+ friends and family members. I hope you enjoy listening to our discussion.

Thank you both for joining us, welcome.

Dr. Faizan Kabani:

Thank you for having us.

Dr. Alison Pittman:

Yes, thank you. We’re looking forward to the discussion.

Lindsey Hendrix:

Awesome. Well, I think let’s just go ahead and dive right on into it. We’re going to be using these terms throughout the show, so I want to start by defining some of these terms that we’re going to be talking about.

First of all is LGBTIQ+. This is a term that has evolved as awareness has been risen throughout the nation and the world. So, help define that for our audience.

Dr. Alison Pittman:

Well, it’s kind of an alphabet soup and it changes a lot. There’s not a full agreement about what the full acronym should be, but you’ll see a lot of times LGBT is probably the most common. Each of those letters stands for a subsegment of the population that we’re talking about. So, L is lesbian, G is gay, B is bisexual, T is transgender. We in particular like to throw I in there before the Q. I stands for intersex, so someone who genetically or biologically is not binary in their gender. And then Q stands for queer which is really, a lot of times, is perceived as an umbrella that represents everyone in the community, so that is often included. The plus is often there just for anyone else who maybe doesn’t fully identify with any of those possibilities but still identifies as part of the community, for example an ally of the community. Does that, you know? And you’ll see lots of different alphabet soup. Sometimes not all those letters are included, but that’s the one that we typically use.

Lindsey Hendrix:

That’s very helpful. That’s very helpful, and I know it continues. It continues to evolve as time moves on. Then the next very important term that we’re going to talk about is health disparities. I know that can be a little confusing from time to time. People have heard health inequities, health inequalities, but we’ll be talking specifically about health disparities, so help define that for us.

Dr. Faizan Kabani:

Sure. Health disparities in general are pretty much health differences between different groups of people, and it can include a variety of different elements such as premature morbidity or sickness, mortality or death. It can include aspects such as even access to care and more. It’s really not just focused, although popularized with race and ethnicity, it also includes other aspects such as geography, sex, gender, sexual orientation, disability, socioeconomic status and more.

Actually, back in 2016, the LGBTQ community was actually identified as a health disparity population by the National Institute on Minority Health and Health Disparities of the NIH. Particularly, part of it at least, that they identify is because the group has been shown to have less access to health care.

Dr. Alison Pittman:

In addition, the Institute of Medicine, which is really a governing body in the United States in terms of health care providers and physicians, came out with a large report in 2011 that also identified this community as being underserved and a vulnerable population in terms of health. So, the discussion’s been out there for a while.

Lindsey Hendrix:

Yeah. What does the data tell us about health disparities and the LGBTIQ+ population in America? What are some of the disparities that this group faces?

Dr. Faizan Kabani:

Well, we know from both research as well as from practice, that LGBTQ+ communities actually experience quite a disproportionate amount of health inequalities including negative experiences with some health care providers in the system, inadequate health insurance coverage and benefits, social violence and bullying, higher psychological distress and more. Unfortunately, as we’ve come to learn through the literature as well as in our practice that there is actually quite a bit of lack of knowledge among health care providers on these unique health disparities.

Lindsey Hendrix:

Why do we think these disparities exist? We like to think, or at least I like to think, that all people are created equal, that they’re all treated equal. I know unfortunately that is not the case, so what are some of the issues that have led to this?

Dr. Alison Pittman:

The one that I think is most concerning is that a lot of studies have come out in the last 10 years or so, maybe not even that long, looking at the literature that we’re using to improve our practice is that a lot of folks in this community have experienced discrimination when seeking health care. This can vary from just nonverbal discrimination, like looking people up and down or staff in health care provider offices. For example, in particular, transgender folks tend to say that they’re called by the wrong name. A lot of folks who are transgender are in the process of changing their name legally, changing their gender identity legally, and that takes a lot longer but they still want to be called by their preferred name, the name that they’re changing to, the gender that they’re changing to, the pronouns that they want to use. And even after asking people to call them by that name, staff will deliberately call them by the wrong name or the wrong pronoun.

When they’re with a provider and trying to seek health care help, the provider is often either uncomfortable or outright discriminatory. There’s even reports in a lot of studies of assault and just inappropriate touching, and things like that. So a lot of it unfortunately comes from societal norms and the way that people are treated when they seek health care. I’ll let Dr. Kabani elaborate on some of the other ones. That’s the biggest one to me that’s most concerning.

Dr. Faizan Kabani:

I would echo what Dr. Pittman is saying, but I’d also add that a lot of the reasons why I believe health disparities exist among the LGBTQ+ communities is that it is actually externally imposed onto the community. So for example, we already know that access to quality health care and adequate health insurance coverage is a major limitation, so we know that. But now, if we pair restrictive health benefits and lack of education, training and research for health care workers with social discrimination as well as institutional bias, we end up having a major gap when trying to really provide a safe, supportive and equitable environment for the LGBTQ community.

Lindsey Hendrix:

What are some of the health benefits that the LGBTIQ+ community wouldn’t be a beneficiary of?

Dr. Alison Pittman:

A lot of it has to do with health insurance coverage. For example, a lot of health insurance companies will not cover beneficiaries unless they’re married. It wasn’t until very recently that we had same sex marriage, and there’s still a lot of barriers for same sex couples, for example, if one is employed to have coverage for the spouse if they’re in a same sex marriage. There’s still a lot of barriers to that.

Unfortunately, there are a lot of socioeconomic disparities for this population as well. There’s been some studies that have come out that say particularly among young people, youth and young adults, they have more difficulty getting employed, they often suffer from more mental health issues, there are increased rates of homelessness. So, those particular socioeconomic barriers mean that they may not have access or be able to afford health care. It can be something as simple as getting tested for COVID or having treatment for an infection or an illness. They oftentimes will have more barriers to getting health care.

Lindsey Hendrix:

Yeah. That’s something I hadn’t really thought about is how difficult it could be for a couple in a same sex marriage to benefit from their partner’s insurance. And then I guess all of these social biases are really playing into what is happening on the health care side.

Dr. Alison Pittman:

Yeah. If I try to seek health care and I feel discriminated against, I feel like someone mocked me or made fun of me or didn’t respect my freedoms and my identity, then the next time I get sick, am I going to want to go to the doctor again? It goes so far as to some preliminary studies saying that we see increased rates of heart disease, cancer. We don’t know for sure, but one of the associated factors is that people in this population may have those signs and symptoms of oncoming chronic disease just like anyone else, but they don’t seek the treatment because of the discrimination that they have experienced, and so those early signs of chronic illness are missed and it’s something that we really need to fix.

Lindsey Hendrix:

What can health profession schools do to help prepare students to better care for the LGBTIQ+ population?

Dr. Faizan Kabani:

That’s a really great question. Fortunately what we’ve been able to uncover with our group cohort of educators is that health entities, including the American Dental Education Association, American Medical Association, American Nurses Association, American Public Health Association and the American Pharmacists Association actually all agree that better LGBTIQ+ health research and education is needed. All of these particular organizations have position papers or actually statements that endorse this position.

However, these are all pretty much siloed recommendations within each particular profession and therefore, the bigger need and solution really, and this is where we’re working as a group, is to provide the solution at the interprofessional level, such as the Health Science Center level. It’s more ideally situated for improving culturally competent patient care, particularly for LGBTIQ+ communities. What’s alarming, too, is when you look at the literature on interprofessional studies, we find that the average health profession student actually gets between zero to five hours of LGBTIQ+ health education throughout their entire program of study.

Lindsey Hendrix:

Wow.

Dr. Faizan Kabani:

That’s very alarming when you look at the particular statistic. So unfortunately, there’s really no institution within the state of Texas that provides this form of interprofessional LGBTIQ inclusive curriculum, which unfortunately then ultimately leaves health care providers and students lacking the training, the knowledge and the experience to really be able to provide culturally and clinically competent care to LGBTQ patients. So perhaps health profession schools can collaborate at a broader, perhaps national, level to really organize and to teach health curricula focused on caring for such patients. I know that there are several organizations that we in the academy can reach out to for help and guidance, such as the National LGBT Health Education Center, among others who can perhaps light the way for us in being more inclusive in our education.

Lindsey Hendrix:

What percentage of their patients can a health professional expect to see in their career, in their practice?

Dr. Alison Pittman:

That are LGBTQ?

Lindsey Hendrix:

Yes. Yes.

Dr. Alison Pittman:

Yeah. Studies vary. When we look at our general population, the population that we serve. Statistics, surveys, this is always based on survey data, anywhere from 3.5 to eight to 10 percent, depending on the community where you live. A lot of times LGBTQ folks will often want to be in a community where it’s more welcoming for them, so some cities might have larger percentages than others. But the general population typically, reports vary anywhere from three to about eight percent.

Lindsey Hendrix:

That’s very significant, so it’s really important to prepare health professionals to care for this population. What is Texas A&M doing specifically to address this issue?

Dr. Alison Pittman:

Well, Dr. Kabani and I are both part of a team that was really sort of a grass roots effort among faculty within all the different colleges to get together and talk about the problem. I think, gosh, it’s been a little over two years now that I sort of put out a call. I was seeing this as being a big issue. I’m a pediatric nurse by trade, and it’s always been a big concern for me particularly because youth and young adults tend to be particularly underserved within this population. I was seeing a lot of disparities and a lot of struggle, especially among teenagers.

A lot of times we just see a problem and start reaching out. I reached out to faculty and leadership in all the different colleges within the Health Science Center, and Dr. Kabani was truly one of the first ones to say, “Yes, I see this, too. I want to be a part of helping this out.” We started looking within the state of Texas. We have several health science centers, but no one’s really doing this sort of innovative idea of first of all, increasing the amount of curriculum we have in all of our students within the Health Science Center, but also doing something interprofessionally.

Dr. Alison Pittman:

I know you’ve covered in other podcasts how important and meaningful interprofessional education is to students within our colleges. So we decided we were going to start researching, start looking at how to make it happen for Texas A&M to really hopefully be the first health science center within the state to provide this. Eventually we want to allow health care providers within the community of the state of Texas to be able to get additional training, because as Dr. Kabani mentioned, a lot of the nurses, physicians, pharmacists graduate and don’t really get that education, but we can always provide it if they want to come back and get it.

Dr. Faizan Kabani:

I would simply add that in our endeavor, our deans and many of our leaders have been providing a lot of support resources towards this important cause, so we have support from top down to be able to help make this not just theory but a practical application. So we are working progressively towards that and we are very fortunate to have made strides in it, and we’re looking forward to making even more strides as we continue.

Dr. Alison Pittman:

You can tell, we’re super passionate about this. In our Zoom sessions when we get together, I know Dr. Kabani feels this way because we’ve talked about it, it’s the highlight of our week because it’s something that we’re really passionate about making a difference about. We’re basically volunteer time devoting to this. It’s funny, we just smile a lot because it’s really meaningful work for us.

Lindsey Hendrix:

It is. It’s exciting.

Dr. Alison Pittman:

Yeah.

Lindsey Hendrix:

Dr. Pittman, you mentioned why this is an important issue for you, you witnessed it in your practice as a pediatric nurse. Dr. Kabani, how about you? What got you interested in addressing this issue?

Dr. Faizan Kabani:

Well, I know since I’ve joined the college and being a part of clinical faculty at the College of Dentistry, I have had firsthand experiences where students under my care have been providing care to patients that belong LGBTIQ communities, and I was able to observe the students having a sense of gap in understanding and knowledge and perhaps, not necessarily compassion but just not sure how to perhaps provide this care in the best possible manner.

You’re often taught the science, the intellectual, but one needs to be able to foster the heart and to build that in clinical care. When I was able to observe this gap in my local contacts, I knew that this was not an isolated incident, nor is it a very rare experience amongst health profession schools. So it became something that needed to be addressed not at the local level, but really at the broader in a professional level. It almost was like I thought of it and then I was reached out about it, so one of those things where you know there has been an intervention or reason. Paths have crossed for a reason to make a difference for a reason.

Lindsey Hendrix:

Yeah, absolutely. Where is the group now in developing this curriculum? I know you all have had meetings. Where are we?

Dr. Alison Pittman:

Well, we kind of started by sort of figuring out the issue, the gap, and doing a lot of literature review. We’re currently in the process of doing a survey of what our Health Science Center needs, so we’re currently in a process of preparing some surveys that are going to go out to faculty and to students amongst all the colleges in the Health Science Center to ask them what their knowledge level, their comfort level is caring for this population and also what they feel like the gaps are in terms of their education.

Dr. Alison Pittman:

Once we get that data, we really want to create a curriculum that’s specific to the needs of our college, because there’s a lot out there—well, not a lot. I think we need a lot more data, but there is some evidence out there about what the gaps are in education within each profession. There’s some developing evidence, but we want to really meet the needs of providers within our state and students within our state. So once we get that survey data back, that’s really going to guide us in developing the curriculum that’s specific to our students.

Lindsey Hendrix:

I think it’ll be really interesting to see what that data reveals and hopefully shed some light for other institutions in other areas on the need for this kind of curriculum and education across the health professions. We touched on it briefly, you’re hoping that you’ll eventually be able to engage current practicing health professionals so that they can benefit from this education and so that their patients can benefit from them getting this education. Right now though, what can practicing health professionals do to get that insight, to get the education so that they can better care for the LGBTIQ+ patient population?

Dr. Faizan Kabani:

I would say that the Dalai Lama said it best where he said that love and compassion are necessities, not luxuries and without them humanity cannot survive. So the need for LGBTQ friendly health care is quite clear, and it’s actually a critical issue at hand. Really the desire for nonjudgmental care, compassionate care is not something that is specific to the LGBTQ community, rather it’s a basic human need and really a right for every patient out there.

So really, to answer your question about what can health professionals do to better serve LGBTQ patients, I think one of the first steps that we can do is to really spend quality time learning and being sensitive to the unique personal and health circumstances really that are crucial to properly caring for patients in this context. Many we’ve talked about earlier already. I would say a second step and equally important really is cultivating a sense of empathy when caring for LGBTQ patients. When caring for these patients, health care providers should really not be afraid to respectfully ask questions, request and engage in feedback, communicate clearly, honestly and really make a concerted effort to learn from their patients’ experiences. We know that studies have long linked health care provider empathy to greater patient satisfaction as well as better health outcomes. So in sum, really take the time to learn and build the heart.

Lindsey Hendrix:

Yeah. To me, you really nailed it on the head with you’ve got to have empathy and you’ve got to come at this with a caring heart. After all, isn’t that what health professionals should be in this business to do, is to care for patients? So, why develop a curriculum specifically for the LGBTIQ+ population? I think if you’re engaging in that compassionate care and you’re asking those questions, you should be able to do that across your entire patient population, so what kinds of information is going to be in the curriculum? What are the health professionals going to learn specifically for the LGBTIQ+ patients?

Dr. Alison Pittman:

I think we start with essentially the concepts that Dr. Kabani was just talking about where each individual human that is in a caregiving role needs to sort of self-examine and think about and explore their own values, their own thoughts, their own possible implicit, explicit biases. You want to talk about implicit biases, biases that I have towards people that I don’t even realize I have and just our views.

Each of us, each profession that we serve in the Health Science Center takes some sort of commitment or pledge. We have our standards of practice in each of these professions. In nursing, we take the Nightingale Pledge, from Florence Nightingale, where we vow to keep matters committed in confidence and to devote ourselves to the welfare of those in our care regardless of their background and where they come from, and we really have to do better. The reason that this important and that we are really focusing on this population as underserved is that we’re not doing a good job. The evidence shows us that we’re either really demonstrating discrimination or just not knowledgeable enough to treat folks with the respect and the knowledge and communication, the ability to communicate with them in a respectful way. Honestly, in my glass half full heart, don’t believe that people often are doing it intentionally. It’s just not really knowing how or being comfortable in communicating effectively.

Dr. Faizan Kabani:

Let me add as well, I concur with Dr. Pittman. I would just add the fact that in our health profession schools we learn of certain vulnerable populations, certain underserved populations that experience a disproportionate amount of burden in terms of health and health care. We spend the time to learn about them because they require that additional knowledge and that additional expertise to be able to provide the right care, quality care, and so the LGBTQ community is no exception to that. We know from evidence. We know even with the NIH being able to designate this group as a health disparity group that we’re not, like Dr. Pittman said, we’re not doing a good enough job. More progress, more effort needs to be done in this area, and that’s why there’s just cause for us being able to build and work towards building curriculum in the health profession schools that help us and help future professionals, caretakers of our society, actually be quality caretakers in an inclusive manner.

When we look at the research, when we look at evidence, we know that LGBTQ populations have unique health care needs and experience a disproportionate amount of health burden across the lifespan, children, adults and elderly. We’re talking about a disproportionate amount of mental health issues, social isolation. We know that the literature also suggests increased rates of cancer, particularly breast and cervical cancer, obesity, eating disorders, heart disease, suicide, suicidal thinking, sexually transmitted infections, and a whole host of other issues, and that it is very important that curriculum be made to help in better understanding these unique health care needs. But also, what can we do to help this population as well?

Lindsey Hendrix:

Yeah, absolutely.

Dr. Alison Pittman:

It can be a little overwhelming. I think we often as health care providers feel a calling to be an advocate or a voice for those who don’t have one. I think, folks in the LGBTQ community have been voiceless for a very long time. As a community member, but even more importantly as a health care provider, we can at least be a voice for their need for adequate health care, for health equity, which is kind of the opposite of health disparities. We want everyone to have equal access to competent health care, so I think that’s the underlying motivation for a lot of us is just to be a voice for people who have not had one in this arena.

Lindsey Hendrix:

We talk about the importance of interprofessional education. I know that’s a big initiative here at the Health Science Center. We know that health care is not provided in a silo. More and more we’re seeing the team-based approach to health care out when you’re in practice. Why is it important to develop an interprofessional curriculum rather than individual colleges creating their own curricula?

Dr. Alison Pittman:

I think the simplest answer is when we get out and start working, we’re not working in silos, so why are we learning in silos? We work in teams. Regardless of whether you’re in a hospital, a clinic, out in the community, you’re not working just with your profession. You’re working with physicians, nurses, pharmacists, dentists, public health, community members, family members. Everyone has to work together to improve health, and so I think the health professions are finally realizing we need to learn in that environment as well.

Dr. Faizan Kabani:

Absolutely. The success of interprofessional collaboration and practice is highly dependent on interprofessional education. So if you’re wanting it to be successful in practice, it must be fostered and cultivated in the classroom and the clinical experience [inaudible 00:31:22] their student, so it becomes part of their fabric as they become health care providers.

Dr. Alison Pittman:

And just from personal experience, our students all love it. They get so excited when an interprofessional opportunity comes up, particularly simulations. It takes a lot of time and effort and scheduling to make that happen, because our schedules and calendars don’t always jive. But when we have the opportunity to schedule an interprofessional simulation where we’re working alongside other team, other colleges, students from other colleges, the students get so excited and when we get the feedback from the students, it’s always, “We need more of this, we want more of this.” That’s most meaningful, is that the students find it to be a valuable experience.

Lindsey Hendrix:

That’s great. How do you see this interprofessional curricula playing out between all of the colleges, separated by discipline and in a lot of cases by geography? Because the Health Science Center has campuses all over the state of Texas, a large state, so we can be hours apart from each other. Have you all thought about how that’s going to be implemented?

Dr. Alison Pittman:

We have. We know that not every profession within the health sciences is going to provide the same type of care, so our vision based on what we see being innovated in other institutions and what the research says is to really start with an interprofessional group to talk about respectful and knowledgeable communication with all patients, just basic patient and client communication with folks in this population, the right terms to use, the right way to start a conversation to be comfortable in that conversation and also, as I mentioned, just exploring your own thoughts, beliefs within each individual person, our biases and our views of folks in society.

Then the way we think the curriculum might flow is that a lot of that general communication and patient care will happen in an interprofessional realm and then specific treatments. For example, in dentistry, dental hygiene versus what nurses do versus what physicians and pharmacists do, will happen in sort of breakout session type ways so that education or curriculum specific to that profession can be provided. Again, we’re a work in progress. I don’t know what Dr. Kabani envisioned. We’ve talked about it, but I’m interested to see what his thoughts are as well.

Dr. Faizan Kabani:

I would only add the fact that one of the things that COVID has taught us is that we can still move forward in a virtual platform. So when we’re talking about interprofessional education, we know that we’re able to connect. This podcast is a case in point of an example where individuals from various different parts, located in different cities, are able to come together for a shared cause. So if the cause is from an educational perspective, you can sure bet that there’s going to be a lot of educators that are willing to provide this care, provide this knowledge, share this knowledge with students in other areas through a perhaps virtual platform if a physical space is not available or practical in time being. We have seen the success across, not just health care, but across a variety of industries, and that’s what one of the main things, like I mentioned, COVID has taught us. So if anything, we know that we can build upon this platform as we go into the future.

Dr. Alison Pittman:

That’s a great point. I completely agree and as an example, when you talk about what existing providers can do to further their education of caring for LGBTQ folks, we have to seek out sort of our own continuing education. I went to nursing school in the ’90s and we got nothing in terms of this curriculum, and so I have to give a shout out to the University of Louisville in Louisville, Kentucky. They have a post-graduate certificate that is interprofessional on LGBTQ health care. There were some online modules that we could do, but there was a simulation that was live. Fortunately I was able to travel there to do this interprofessional simulation of LGBTQ health care, and it was outstanding.

Since COVID happened, the university has moved a lot of that online, and so one of the silver linings, I think, of COVID is that these things are so much more accessible. You don’t have to travel, get a plane, get a hotel room to get this continuing education across all health professions. A lot of it is available online, and that makes it more accessible. Dr. Kabani is right. We’re actually kind of rethinking, if we continue to live or even if we don’t live in a pandemic world any longer. If this is effective way of learning, why can’t we provide this in a virtual environment and still have the same learning outcome.

Lindsey Hendrix:

This makes me think, too, when we’re talking about interprofessional education is that this isn’t just about communication with the patients, this is also communication within the professions, right? We say that three, upwards to 10 percent of the general population in areas identify as LGBTQ+. How is that represented in the health professions? How many of your future colleagues or colleagues in your educational program identify as LGBTQ+?

Dr. Alison Pittman:

That’s where I see a big gap, and I’m sure Dr. Kabani can speak to his profession, but in nursing there’s not a lot of data. That’s one big research interest I have, is there’s just not a lot of evidence out there on what percentage of the nursing profession is LGBTIQ. We have an idea of what our population that we serve is, and we always strive, all at least within nursing and I know all other professions, we strive to reflect the population that we serve in terms of ethnicity, race, background. We want patients who we’re caring for to see us in them, see them in us. In looking at this question and looking at the literature, there’s really not any hard data for nursing. What about you, Dr. Kabani? Do you have any data on yours?

Dr. Faizan Kabani:

Unfortunately, I’m not aware of any particular official source that provides this particular information, but I would imagine, just thinking, that there’s probably a shortage of health care providers who identify as sexual minorities. In some instances, I’m sure that there are health care providers who perhaps do not publicly disclose their sexual identity. But a general principle, however, whenever we look at the literature for any kind of data that may be containing sensitive information, we know that the data is often under-reported. In other words, the reported shortage is probably underestimated in reality as well, which actually kind of touches upon another relevant and important point that Dr. Pittman also mentioned which is the need for role models. People need role models in every field, so be the patients to be able to see us them and them in us. They need someone to be able to look up to, to seek guidance from, comfort from and potentially to build a similar career like. So we need more advocates, allies, supporters in the health professions so we can really build for a more positive future.

Lindsey Hendrix:

Yeah. I think if a youth or adolescent who is struggling, being a teenager is hard anyway.

Dr. Alison Pittman:

Yes, indeed.

Lindsey Hendrix:

If you’re struggling with your sexual identity and you encounter a negative experience with a health care professional who is supposed to be caring for you, I would imagine to see a health care professional that you can identify with, who identifies in a similar viewpoints, background, orientation, all of those things that go into the individual person. I can imagine that would be inspiring for that youth to then pursue a career so that they can provide better care for future patients, so that their experience is not repeated in the future. So I think it is important for people to be open, right?

Dr. Alison Pittman:

Yes, absolutely.

Dr. Faizan Kabani:

Absolutely.

Dr. Alison Pittman:

Yeah. Med Pride is an organization here on our campus. The College of Medicine student body has really been a forerunner in terms of attention to the LGBTQ community. They did an event not too long ago and they repeat it every couple of years where students from all professions can come into our clinical learning center and they have a waiting room, a simulated waiting room that is LGBTQ friendly and a waiting room that is pretty much the standard, which is not very friendly. Everything from the form that you are handed to fill out, is it respectful of your identity? Are the gender boxes simply male and female, or is there another option? Does it ask about your sexual orientation? Are there welcoming signs that say that it’s an inclusive and welcoming office and organization? Anything from are there magazines that have depictions of LGBTQ folks on the cover?

I think that a lot of the effort that I’ve seen in my experience has come from the bottom up. We can’t wait for leadership in any entity, from government on down, to make these changes for us. We really have to push for them where we work in our everyday lives. So I think a lot of that is truly comes from wanting to make things better or make them change. That’s really what a lot of it comes from for me.

Lindsey Hendrix:

I think as a larger social issue, the media has been trying harder to represent minority populations in media and communications. How is that seen or witnessed in health communications specifically? If you’re on WebMD or you’re doing a Google search for a health care issue, are you being represented in that communication, or do we have work to do there?

Dr. Faizan Kabani:

In just my experience, I know that we have been able to make pretty significant strides, particularly in the electronic medium, I think, where the LGBTQ community friendly health communication is getting out there, and a lot of the credit really has to go with the grass roots efforts of a lot of the LGBTQ friendly organizations. However, we are nowhere near done. We have a lot of progress that still needs to be made in this area to really make it an integral part of mainstream communication.

Dr. Alison Pittman:

I would agree, and one thing that we are looking at is we have our prospective students that are trying to decide where they’re going to go to dental school, dental hygiene school, nursing school, med school. A lot of times we surf the web, and when people are shopping for where to go to school, when they go to our website, when they go to the website of the school, do they see themselves represented in the photographs that are there, in the representations of the student body? I would say that patients are going to be a same way. When they’re seeking health care and they’re shopping, and they are consumers, do they seem themselves as being represented in what they view as that patient population or within that entity, that health care provider’s organization? Because if they don’t, they’re going to keep shopping and go elsewhere. So I think we need to think about especially when we put out communication as providers, are we being inclusive and welcoming to all persons when we put ourselves out there as providers in the care that we provide?

I don’t have my badge with me but the caduceus… I can’t ever say the word right, that’s like the little symbol for health care and medicine with the two snakes around the pole. There are little pins that are that symbol but that they’re rainbow. So it can be something as subtle as having that on your name badge saying, “I am an ally. I am welcoming to any and all questions. You’re welcome to discuss your status with me and I can do my best to get the health care that you need.” Something as simple and nonverbal as that can be a powerful symbol and a message to LGBTQ folks who are seeking health care.

Dr. Faizan Kabani:

Health care providers or even academics, we have different ways in which we can demonstrate that we are allies, that we are a safe zone area. Some of the ways that we’re doing it at the College of Dentistry is as we do ally trainings, we can post the ally safe zone on our office doors. I know that there are an increasing number of faculty who are listing what their pronouns are as part of their digital signatures, and so as these correspondences are going out to different groups, it is a marker, a symbol of showing that we are an inclusive environment, I am an ally and I am a supporter of being an inclusive member of the society.

Lindsey Hendrix:

What are some ways that LGBTQ+ patients can find a health care provider who is well equipped to care for their individual and unique needs?

Dr. Alison Pittman:

I would start by saying, again, it’s grass roots in a lot of places where community organizations put together a list of LGBTQ friendly providers, businesses, service professions. As an example, here locally in Bryan-College Station, the Pride Community Center has just within the last couple of years put together a great list. We’re not a big community, and I think historically being completely transparent, a lot of LGBTQ folks in Bryan-College Station have felt the need to go elsewhere for health care, larger cities like Houston or Austin, and we’re finally seeing some providers who have sought out that extra training and the ability to provide specific health care to folks within our community. That’s just an example. I think a lot of times the GLMA and other organizations have lists that are sort of nationwide, but a lot of times those are limited to large cities. So within smaller communities, centers sort of had to create their own list, just by word of mouth is what a lot of it is.

Lindsey Hendrix:

Right.

Dr. Faizan Kabani:

I would also add that in addition to the directories that are out there, in addition to word of mouth, we also have the ability to explore the provider’s website. A lot of the times, health care providers now have websites and kind of to what Dr. Pittman was mentioning earlier, being able to look at their forms that they put online, the verbiage that they use online. Are they giving a lot of gender identity markers? Are they being more inclusive in their terminology? You can always go back to old school, which is picking up the phone and calling the office and being able to talk to them and asking, is the health care provider comfortable or regularly working with patients of LGBTQ affinity, or even questions such as if the facility has a gender-neutral bathroom. Some of these important aspects serve as major and key indicators to see if the environment is welcoming, the provider is welcoming, or not.

Lindsey Hendrix:

That’s great advice. That’s great advice. We talked a little bit about allies, so what can allies who are not necessarily health care professionals do to raise awareness or to fight the health disparities that their LGBTQ+ friends and family are facing?

Dr. Alison Pittman:

I think, honestly, we need to be brave. Allies need to be brave, and when we see clear disparities in terms of health or societal discrimination, we need to be brave enough to call it out in a respectful and a professional way, just saying we as a profession can do a better job. We as health care providers can be more welcoming and more inclusive and rather than be critics, just be contributors and say, “I noticed this. Let’s think of a way that we could be more welcoming and more inclusive.” That would be my idea of a first step that allies can take. Again, I keep coming back to this, but just being aware of your own views, your own perceptions of the profession and what being professional means, maintaining confidentiality and being respectful to every patient that walks in their door regardless of their background, I think is an important underlying foundation to being a good ally in the profession.

Dr. Faizan Kabani:

I would add that really allies should really try to remain informed on current issues that are being faced by the LGBTQ community and really to take a stand with them. This includes really being aware of changes in legislation or policies and being able to advocate for health care reform that is really LGBTQ friendly. I would also add that allies can help by standing against institutional as well as systemic discrimination, and really one can fight ignorance with knowledge, phobia with love and despair with activism.

Lindsey Hendrix:

I’ll say as a marketing and communications professional, I think I’ll be reaching out to you all to see how we can do a better job of representing the LGBTQ+ community in our communications at the Health Science Center for prospective students and the general public that we serve through our health communications, so I would appreciate your feedback on that.

Dr. Alison Pittman:

Absolutely. We’re happy to help.

Dr. Faizan Kabani:

We’d love to.

Lindsey Hendrix:

Awesome. It sounds like there’s hope. It sounds like the issue is being addressed. I think we’re raising awareness here with this podcast. You all have raised awareness across the Health Science Center with faculty and students, so are we seeing this start to improve?

Dr. Faizan Kabani:

Yes.

There is always hope. In fact, there is more than hope, there’s progress and I would argue that more than ever before in our history, we have stronger networks, resources and allies that move our agenda forward towards building a more inclusive environment. Unfortunately, we have also observed recent unsuccessful attempts by certain senior political leaders in this country to reverse nondiscrimination protections for LGBTQ+ people when it comes to health care and health insurance. Undoubtedly, we live in a delicate context where we must continue to be united in our efforts to progress the status quo as well as make our country and the world a more inclusive place that we can call home.

Dr. Alison Pittman:

I completely agree. The main thing that I would also add is that a lot of times when we talk about health disparities, we’re talking about all of the negative things, all of the problems that a particular percentage or a little group of the population has, and that is only one side of the coin. I also want to focus on the fact that there is so much resilience in all humans, the ability to overcome challenges and discrimination and disparities and obstacles, and it’s no different for the LGBTQ+ population. That’s where I think we all as a team have talked about that we find that hope.

Dr. Alison Pittman:

We can’t focus on the disparities without also focusing on the resilience and the hope that each individual person who is a member of this population brings when we interact with them, when we try to help them. Being kicked out of your home from your parents because you identify as gay and not having a place to live and couch surfing and still creating a meaningful, happy, healthy life with all of those obstacles being in your way, that’s a hero to me. That’s someone that is a role model for me, and I can’t help but draw inspiration from the people that we care for on an individual, everyday basis. They are truly hope for us, and it’s our goal as we develop this curriculum to not just focus on the negative but focus on the positive and the resilience that each human, regardless of whether they’re in the LGBTQ+ population or not, if they’re part of that community or not, the resilience that they bring and the hope that they bring to us as a community.

Lindsey Hendrix:

I love it. Those are amazing messages, and I always like ending a show on a positive note. I’m so happy to see progress and like you said, we’ve got so many heroes in this story and I think we should do a better job of celebrating that and celebrating the successes, and the two of you and the group at the Health Science Center who are working on this curriculum are no exception. I think you all are heroes in this story as well, so thank you for all the work that you’re doing.

Dr. Alison Pittman:

Thank you so much, and thanks for having the conversation. It’s meaningful to us.

Dr. Faizan Kabani:

Absolutely. Thank you for inviting us and letting us be a part of this process.

Lindsey Hendrix:

Absolutely. I look forward to getting updates along the way as you’re building out this curriculum, so we’ll be in touch. I’m sure this won’t be the last time we talk about this.

Dr. Alison Pittman:

Great. We look forward to it.

Lindsey Hendrix:

Awesome.

Dr. Faizan Kabani:

Til next time.

Lindsey Hendrix:

Til next time. Thank you both.

Tim Schnettler:

Thank you for joining us on Texas A&M Health Talk, a production of the Texas A&M University Health Science Center. Visit us on the web at vitalrecord.tamhsc.edu, where you’ll find answers to all of your health questions. Until next time, stay healthy.