Professional Documents
Culture Documents
Dr. Pickle:
Yes, so patients are certainly
our best educators, right? So
So one of the things I have I hear that a lot. "Nobody
it's kind of this balance of, we
certainly learned is that it is believed me. I've told this to so
need to know the medicine, but
okay to say, we don't know, we many people so many times
then our patients are really
don't have the answers to that and I was dismissed", and that
gonna teach us what they need.
right now, here is what the best is something that validation
So we always kind of say, you
science tells us. And then with and listening, doing less talking
know, in, in caring for
our patients, we can make and more listening, which is a
transgender folks, you don't
those decisions. So doses of constant struggle for me, cuz I
want your patient to have to
humility are definitely love to talk, but doing more
educate you on the knowledge,
something that I've learned listening is probably the other
skills, and attitude and needs to
from my patients. And then lesson that I've learned.
care for gender diverse
probably the next thing is to
populations. Right? You don't
just sometimes be the listener.
want them to have to tell you,
In medicine we wanna fix, we "Validation and
well, you know, since I've had
top surgery, I actually don't
wanna create solutions, like listening, doing
that's our job, right? People
need that mammogram. Right?
We don't want them to educate
come to us with issues, and less talking and
that's what they want. They
us on the stuff we need to know
want answers and solutions more listening"
as physicians, but we absolutely
and treatments. yet sometimes
are going to learn from them,
and they are going to teach us
the best thing we can do in the Maya:
examination room is listen and Yeah, that's awesome, so kind
what they need. So probably
validate an experience. of talking about that in the lens
the best first lesson of
Validation is probably the of the whole learning aspect, do
medicine always is to just stay
second lesson, just how you feel that the current
humble. I think COVID has been
important it is for all medical school curriculum and
a really humbling experience
individuals, but certainly those resources for practicing
for medicine in general. There's
who have otherwise been physicians are adequate to fully
a lot of things we don't know,
marginalized, who haven't been serve LGBTQ+ patients?
and in transgender medicine,
believed.
there's a lot that's still yet to
learn.
Dr. Pickle:
No. So the most recent study
that looked at adequacy of Only 13% of you have racism, sexism and
transphobia, all three of those
LGBTQ curriculum, it was called
the equity curriculum, and it
medical students things you might experience in
a day, and you can't necessarily
kind of pulled from two main across the US can turn off any of those identities.
resources. One is the Center for
American Progress and the pass a competency So it can be a cumulative effect
living in that chronic stress
other was Journal of the
American Medical Association
test for LGBTQ care where around the corner,
- Journal of the American Medical you're wondering, am I going to
or JAMA. And when the Equity
Association be fired? Am I going to be
Curriculum looked at these
physically or sexually assaulted
resources, what they found was
About 44% still show bias within my community? Am I
that 33% of medical schools
towards LGBTQ patients, and going to face stigma and
have zero LGBTQ health. So that
only 13% of students across US discrimination in my healthcare
means one in three physicians
medical schools can pass a field? Those chronic stress
will graduate medical school,
competency test for LGBTQ factors are something we call
never having any baseline
care. So no, we're not doing allostatic load, which is the
competencies to care for
enough. And I say, "we" buildup of stress and what it
LGBTQ patients. Patients don't
meaning the US medical does to the body on the cellular
know that, right? So when they
medical schools in general. So level. So we know that there
go to see a resident physician
how do we change this? We can be epigenerational stress
or a fellow or an attending, they
really have to develop that is inherited from being of a
wanna be able to trust that
competencies around LGBTQ minoritized, marginalized
medical school has prepared
care and hold medical schools identity and living in this stress
them well for the scope of care
accountable for those just like for decades. It can actually
that our trans patients deserve.
we would make sure that change one's genes. So that is
students knew about the renal what many of our patients
1/3 physicians will function and the cardiac and bring into the examination
pulmonary systems and knew room. So how that manifests is
graduate medical how to treat diabetes. We need often times very practical
things like housing instability,
school learning to make sure that this is a
insurance insecurity- it's really
competency that has been met.
zero LGBTQ+ hard for patients to afford
medications. If they don't have
health curriculum. Maya:
Absolutely. So then kind of in
insurance, it's hard for them to
- Journal of the American get a colonoscopy for cancer
that lens of disparities, what
Medical Association screening if they don't have
are some of the biggest
insurance. So really what we
We also know that for those disparities that you see in your
see are the kind of illness and
schools that do have a field and how do you see these
disease processes, people are
curriculum, the average disparities sort of working hand
coming in with much more
amount of time is about five in hand with the privileges held
advanced things like liver,
hours, and that's five hours out by non-LGBTQ patients?
disease, diabetes, sleep apnea,
of typically the 2,500 hours of
um, because they haven't had
medical school curriculum just
access. Then the other
in the first two years. So it's Dr. Pickle: disparity is that they can't find
pretty dismal, the amount of
So we know from studies like a doctor, right? So based on
material that's there. Additional
the minority stress theory and that, those medical school
studies have shown that even
the stigma sickness slope that outcomes, and they're not any
though student are exposed to
individuals that hold better really in residencies or
LGBTQ patients during their
minoritized and marginalized fellowship, people can't find a
clinical rotations and typically
identity and identities, right? doctor to provide them
the third and fourth year,
Cuz then the intersectionality competent gender affirming
medical schools in general are
component comes in where care.
not graduating students with
that layering effect of if you are
competencies.
a black transgender woman,
So as you layer those things Whereas gender is a process of So what that study
on, those are probably the self-identification. Gender has demonstrates, and there's
biggest factors that build up a social construct. So many other similar studies that also
to health disparities. So when cultures have multi genders demonstrate, that gender has a
we talk about trans beyond men and women. Really biologic basis. Even the most
populations and we say things it is kind of a historical coercive strategies- give your
like higher rates of colonization that has kind of child surgery, tell them they're
homelessness, higher rates of brought that binary construct a different gender- if gender is
unemployment, more likely to to most of the Western world. who you are, who you are, has a
experience severe mental So we know from some of our genetic component, and really
health experiences like indigenous cultures that there only an individual can really say
trauma, higher rates of are two spirits, that there is who they are. So we know that
suicide, more likely to live with room for gender expansiveness gender identity starts to be
HIV- four times that of the that has been historically part formed as early as three and
cisgender population- none of of tradition and culture, but four. And for kids who are
those facts are because gender also has a biologic basis. expressing gender
people are transgender. These So probably the best study of expansiveness, that's all very
disparities exist because of this comes from John's Hopkins common, right? Kids don't learn
the way society has treated, back in the 90's. gender except from social
views, and the non- cues, right? They don't know
acceptance of trans folks
within our communities. "Gender is a that the pink blocks are
supposed to be for girls or the
4. "Gender is what you're born with. You get what you get and
you don't throw a fit."
Gender is a societal construct, and for transgender people, their sex
assigned at birth does not determine their gender identity (McSweeney).
People can also be gender-fluid, nonbinary, or agender, all of which do
not fall under the constructs of a gender identity determined by your
genitals (McSweeney). We live in a society that constantly surrounds us
with cisnormative ideals, and while difficult to unlearn, this unlearning is
the only way to achieve a more gender-equitable world (McSweeney).
Gender expression allows people to present this identity to society, and
at the end of the day, it is crucial to note that gender boils down to what
people feel most connected with (McSweeney).
5. The wage gap is not a valid demonstration of sexism at work.
Women choose lower paying jobs that have more flexibility for
the family which is a personal choice, not a societal issue.
92% of single parents in the United Kingdom are mothers, and in the
United States, men earn $1 for every $0.77 women make (McCormack).
Women are far more likely to hold lower paying jobs like secretaries and
assistants, and many argue that this gap boils down to women "choosing"
lower paying jobs, not a societal issue (McCormack). However, we have to
ask ourselves why women are more likely to quit their jobs to be a full-
time parent or go for jobs that have more flexibility for their familes
(McCormack). While some of these inequities can be attributed to
remnants of blatant sexism from the past, the primary reason why it
perpetuates is the societal expectations that are placed on women
(McCormack). Women are expected to contribute more to family efforts
and suffer directly as a result by working lower-paying jobs (McCormack).
McCormack, Carla. “Why the Gender Pay Gap Is a Societal Problem, Not a
Women's Issue.” Elite Daily, Elite Daily, 26 Mar. 2015,
https://www.elitedaily.com/women/gender-pay-gap-societal-problem-
not-womens-issue/975964.
Milsom, Jessica. “Why We Still Need Feminism Even in 2021.” SPEAK Blog, 15
May 2021, https://blog.speak.social/why-we-still-need-feminism-even-in-
2021/.
Shaw, Julia. “Why Are We Not Outraged That Prisons Are Filled with Men .”
Psychology Today, 20 Feb. 2019, https://www.psychologytoday.com/
us/blog/making-evil/201902/why-are-we-not-outraged-prisons-are-
filled-men.