Medicine is never just about the prevention and treatment of disease. Properly delivered, medical care sees beyond the diagnosis at hand and takes the whole person into account. Patients are more than their injuries and illnesses.
For LGBTQ people, the care we need and expect may differ from that our heterosexual and cisgender friends and neighbors receive, in some ways quite significantly. Medical issues largely irrelevant to the general population may have special importance to our community, and visa versa.
With that in mind, I am delighted to introduce myself to Outward’s readers. I’m a pediatrician in general practice in Massachusetts, specializing in the care of teenagers, and I live in Maine with my husband and our four kids. I’m thrilled to be joining the section as a columnist covering medical topics that intersect with LGBTQ interests.
I am also, as it happens, an unabashedly partisan Democrat, which a quick glance at the back of my car will confirm. This bit of personal trivia may not be as incidental to the way I practice medicine as one might initially suspect.
In a study published recently by the journal Proceedings of the National Academy of Sciences, researchers from Yale University examined the effect of political party affiliation on how physicians might approach several different patient care situations. After determining party registration through a voter database, they surveyed primary-care doctors about how they would manage a number of politically charged clinical issues, including marijuana use, a history of abortion, guns in a house that contains children, and sex with sex workers.
Controlling for various factors (among them where their practices were located and the socioeconomic status of their patient populations), the authors found that Republican doctors responded to those patient care questions differently than Democrats did. Doctors who were Democrats were more inclined to consider gun ownership a serious issue (though, disappointingly, less inclined than the Republicans to discuss proper storage), while Republicans attached more gravity to a patient’s history of having abortions or using marijuana. There was much less discrepancy along party lines in response to questions about less charged topics, including cigarette smoking or the management of depression or obesity.
I imagine LGBTQ readers turning a vivid shade of shocked on learning that Democrats and Republicans practice medicine differently.
Sarcasm aside, medical care for LGBTQ people has a lengthy, troublesome history of frank politicization. Homosexuality itself was deemed a psychiatric disorder until late in the last century, after all. The Reagan administration’s lethargic response to the AIDS crisis is among its greatest failures. Even now, absurdly, transgender people can’t attend to their basic physical needs without it becoming an issue of public debate. While this new study did not specifically address the medical care of LGBTQ patients, the authors note that we often specifically seek out providers who identify as friendly to our community and suggest that partisan differences in how doctors treat LGBTQ patients warrants further study.
I went to medical school in Missouri, and many of my classmates were drawn from very conservative parts of the state. Several of them remain good friends to this day, and I have little doubt they retain their proud Republican affiliation. I’m sure they treat their LGBTQ patients with respect and deliver compassionate, competent care. I balk at the notion that a doctor registering with the GOP automatically means that gay, lesbian, or trans patients should look elsewhere for medical care.
But when nearly half of the gay men surveyed for a study by the Kaiser Family Foundation report that their doctors have never even spoken with them about their sexuality, it underscores the importance of having medical providers who are sensitive to the unique needs of their LGBTQ patients. Ongoing allegiance to the Republican Party is an imprecise measure of this sensitivity, but it’s certainly enough to give pause. While at this point Republicans are falling all over themselves to disavow Donald Trump (whose first response to a massacre at a gay nightclub was to congratulate himself), they seem quite happy with Mike Pence, his running mate.
Pence’s record on LGBTQ issues is nothing short of abysmal and includes support for redirecting federal AIDS funding toward so-called “reparative therapy” aimed at changing the sexual orientation of gays and lesbians. Similarly, the Republican Party platform passed this year includes language that champions this kind of therapy (alongside the GOP’s shopworn opposition to marriage equality). Interventions designed to change a patient’s sexuality are widely recognized to be both harmful and ineffective, and enjoy no support within the legitimate medical community.
None of this is to say that any given Republican physician supports these positions. However, it does speak to the unique obligation these doctors have to advocate within their party on behalf of their LGBTQ patients—and in opposition to policies that will be specifically harmful to them.
Like our patients, medical providers are complex human beings. My experiences as a gay man inform both my political affiliation and the way I approach many aspects of patient care. As the Yale study notes, partisanship likely reflects other traits that influence how doctors practice medicine. It’s reductive to view physicians solely through the lens of political party registration or to use that piece of information alone in determining whether or not a particular provider would be a good fit for LGBTQ patients.
However, the Yale study suggests that the same factors that draw physicians toward one party or another also influence the way they interact with patients under certain circumstances. Whatever combination of personal history, ideology, or temperament draws a doctor toward the Republican or Democratic party likely weighs on how he or she addresses certain aspects of medical care, as well. But the medical needs of LGBTQ people have been treated as political issues far too often, to their grievous disservice. Whatever motivates doctors to support one party or another, the welfare of our patients should be our overriding concern. Any ideology that interferes with meeting that obligation should be abandoned.