Teaching LGBT Health to Med Students

The Association of American Medical Colleges (AAMC) has released guidelines – two years in the making – for training physicians on caring for lesbian, gay, bisexual, transgender and gender nonconforming patients. “This document discusses how to integrate and assess 30 competencies for how students should be able to perform in a clinical setting,” says Kristen Eckstrand, a fourth-year medical student and editor of the guidelines. She adds:

Over the past 25, or 30 years, there’s been slowly increasing evidence about the health disparities that are faced by individuals who identify as LGBT, who are gender nonconforming, or who have been born with some kind of difference in sex development. There’s a fair amount of evidence saying that these individuals face discrimination and healthcare disparities when accessing and receiving care. There could be challenges with obtaining insurance, challenges being able to disclose their sexual orientation or gender identity, being able to name their spouse as next of kin, having providers being aware of the health concerns of the community. All of these things cumulatively add up.

LGBT individuals, we know, face disparities in mental health care. They are much more likely to attempt and succeed at committing suicide, they’re more likely to have eating disorders, more likely to have certain kinds of cancer, obesity, and cardiovascular disease. All of these things lead to increased morbidity and mortality in the LGBT community.

Medical education itself plays an incredibly important role in this, because if we can train our providers to meet the healthcare needs of the LGBT community, which makes up a good chunk of the American population, we can increase the health of 15 million Americans. That is a substantial number and not something that should be ignored.

For a quick sense of what issues the guidelines address, see health care reporter Martha Bebinger’s post on tips for treating transgender patients. It includes this brief interview with Dr. Joshua Safer of Boston University Medical School:

Dr. Safer says Boston University’s med school has the nation’s first transgender medicine curriculum focused on the biology of gender identity.

The post also links to Bebinger’s series on the challenges transgender teens face through the story of Nate, a 16-year-old transgender male.

No Joke: World Toilet Day

November 19th is World Toilet Day, an event that draws its share of casual humor. It is estimated that 2.5 billion people do not have access to toilets, a fact that leads to another: almost 2 billion people worldwide drink water contaminated by feces.

This real public health problem finds expression in various examples of media cleverness, including this World Toilet Day Quiz from The Guardian. But it’s a critical situation: meeting the world’s sanitation needs is among the least successful targets of the United Nations Millennium Development Goals, and 1000 children a day die preventable deaths because of disease caused by inadequate sanitation.

Rose George is a journalist and author of “The Big Necessity: The Unmentionable World of Human Waste and Why It Matters.” Watch her 2013 TED talk.

The Emperor of All Maladies Comes to Film

Siddhartha Mukherjee’s 2011 best-seller “The Emperor of All Maladies, a Pulitzer Prize winning “biography” of cancer, is the basis for a new PBS special by WETA and acclaimed documentarian Ken Burns premiering in March 2015.

The book offers an exhaustive history of cancer in America as well as the search for treatments and cures. The documentary series turns that sweeping story into three films presented as the past, present and future of the disease.

In the series trailer, executive producer Burns explains that his mother’s death from cancer during his childhood has had a lasting impact on him humanly and creatively.

Nature: A Global View of Depression’s Burden

According to the World Health Organization, depression “accounts for the biggest share of the world’s burden of disease, measured by years lost to disability.” This month’s issue of Nature features a series of articles and commentaries exploring the global picture of depression, the progress of science, and the issue of stigma. It includes an interview with Dan Chisolm, a WHO health economist whose work focuses on mental disorders, about the worldwide prevalence of depression and how “stigma effects everything.” The interview begins at 7:51 of this podcast:

Linda Eagle Speaker on Healing Historical Trauma

Victims of historical trauma include specific cultural groups that have been systematically traumatized by past events (e.g. slavery, genocide, colonialism, war, for example), and whose descendants experience health disparities attributed to those circumstances. The attempt to identify the effects of historical trauma is meant to help resolve the lifelong health issues that can accompany it.  (Wisdom of the Elders)

Source: Lake Roosevelt National Recreation Area

Source: Lake Roosevelt National Recreation Area

Among American Indians, historical trauma represents a history of forced removal from homelands and prohibitions against freedom of religious expression, language and other cultural traditions. American Indian ceremonies were outlawed in the United States until the early 1970s. Only recently has the forced attendance of American Indian children at boarding schools been acknowledged. Boarding schools upheld strict rules against native languages and traditions, and imposed harsh punishments for infractions.

According to the theory of historical trauma, unresolved anguish from these experiences is passed down through generations and can lead to despair, depression, drug abuse and disease. Historical trauma is considered by some a root cause of the tremendous health disparities among American Indian people. Some believe the trauma takes root in the DNA, others say it’s learned behavior and still others say there is a blood memory — we are metaphysically connected to the experiences of our ancestors.

The idea of historical trauma helps communities affected understand the roots of their own condition. In the struggle to restore health, people find something clicks into place when they understand their personal problems in the context of the history of their community.

At a recent conference in Minneapolis, Linda Eagle Speaker, a citizen of the Blackfoot Tribe and Program Director at the Minnesota Indian Women’s Resource Center, shared her story of being forcibly taken from her family and spending years in a boarding school. She says decades of hard work have helped her to heal, so she is not handing down to her children the pain of her boarding school experience.

Listen to her story here.

The Disillusionment of Doctors

Dr. Sandeep Jauhar is the author of a new book, “Doctored: The Disillusionment of an American Physician,” a memoir that relates his path from an idealistic young medical student to a harried, frustrated, and sometimes cynical practitioner in a broken health care system.

He spoke to MPR’s Kerri Miller on The Daily Circuit last week.

Growing frustration among physicians, especially primary care physicians, has led to high rates of burnout, with many doctors reporting their intention to give up the practice of medicine. A 2012 survey found 30% of American doctors between the ages of 35 and 49 reported they were planning to leave medicine.

Dr. Daniel L. Roberts, chief resident of internal medicine at the Mayo Clinic in Arizona, gives an overview of the data on doctor burnout in this 2013 video, produced by the Mayo Clinic.

ICYMI: Dessa’s Interviews at “A Celebration of Women & Recovery”

The gender gap in substance abuse has been shrinking for several years, and it’s estimated that women are nearly twice as likely to suffer from major depression than men. But while millions of women know what it’s like to struggle with addiction or some form of mental illness, the good news is many recover to lead purposeful and meaningful lives of health and wellness.

To acknowledge this major public health issue and to break down the stigma associated with addiction and mental illness, Healthy States and Hazelden Betty Ford Foundation recently presented an evening of conversation and music that celebrated women’s experiences of recovery.

The audience partakes in a body stretch exercise led by Jennifer Matesa / Caroline Yang for Healthy States

The audience partakes in a body stretch exercise led by Jennifer Matesa / Caroline Yang for Healthy States

Over 600 people gathered at the Fitzgerald Theater in St. Paul to hear writer and musician Dessa speak with two authors, Jennifer Matesa and Gayathri Ramprasad, about their own stories of recovery.


Dessa! A talented host. / Caroline Yang for Healthy States

Matesa is author of the new book “The Recovering Body: Physical and Spiritual Fitness for Living Clean and Sober.”


Jennifer Matesa and Dessa / Caroline Yang for Healthy States

Ramprasad is the founder and president of ASHA International and author of “Shadows in the Sun: Healing from Depression and Finding the Light Within.”


Gayathri Ramprasad / Caroline Yang for Healthy States

You can listen to both interviews here.

The Mother of Holistic Medicine

Gladys McGarey, now in her 90s, has been a family practice physician for over 60 years, and is widely known as the “mother of holistic medicine,” a title she earned as one of the original founders of the American Holistic Medical Association in the late 1970’s. She is often credited with being among the first physicians to have fathers in delivery rooms during birth, and to use acupuncture as a complimentary therapy.

Holistic medicine is often conflated with wholistic medicine, but the two are not identical. While wholistic medicine includes some of the same complimentary  practices it does so within traditions of integrative western medicine.

As Dr. McGarey explains in this interview with Healthy States’ Kate Moos, the root of holistic is the word “holy,” and the original founders of the movement had little interest in seeking acceptance by conventional western medical practitioners. McGarey’s early work includes practices inspired by the 20th century clairvoyant Edgar Cayce, a champion of practices like homeopathy and  trance states.

The interview took place in September 2014 at The Marsh, a wellness and fitness center in Minnetonka, Minnesota, where Dr. McGarey made a public appearance.

Upcoming Event: Community Responses to Toxic Stress

Join Healthy States on Wednesday, November 19 at  7:00 pm in MPR’s UBS Forum in St. Paul for an evening exploring toxic stress and the community response.

New scientific research is discovering that children who experience high levels of environmental stress in infancy and early childhood may suffer enduring problems in learning, physical well-being, and social development. The research into “toxic stress” is helping us understand when stressors like poverty, abuse, and unstable home environments seriously undermine children’s long-term health. It’s also helping communities develop tools for addressing toxic stress and creating interventions that put children on a better path to well-being.

This video from the Center for the Developing Child at Harvard University gives context to this new knowledge about toxic stresses such as neglect on early development and lifelong health.

We’ll take a closer look at the science of toxic stress and strategies to address it. Dr. Megan Gunnar of the University of Minnesota’s Institute of Child Development, a national leader in this field of study, will share insights from her research. We’ll also hear from community leaders about what’s happening, and what’s working, to mitigate toxic stress and foster young children’s healthy development. Guests include MayKao Y. Hang, president and CEO of the Wilder Foundation, Sondra Samuels, president and CEO of Northside Achievement Zone, and Dr. Michael Troy, medical director of Behavioral Health Services at Children’s Hospitals and Clinics of Minnesota.

MPR News reporter Sasha Aslanian will host this evening of discovery as we explore expanding knowledge about toxic stress and real world solutions. This event is sponsored in part by the Carlson Family Foundation.

The event is free, but requires registration here.

Hacking Health Care: Tackling Disparities

“Hackers” discuss ideas for building lifelong health

In Healthy States’ third “Hacking Health Care” event a group of talented young people came together to propose creative ideas to improve health among culturally diverse young adults in the U.S.

They proposed using more sophisticated – and fun – technology. They described how you could integrate dental and medical care and insurance coverage to improve health. Lastly, they discussed how health care providers can be better resources for them, their patients. Our hackers summed it up in two words: cultural competence.

“Competence” implies having the capacity to function effectively as an individual or an organization within the context of the cultural beliefs, practices, and needs presented by patients and their communities. – Association of American Medical Colleges

No cookie cutter care, no one size fits all. As one hacker said “My provider should avoid assumptions. She/he should understand cultural context and health values in my community.”

Illustration by Uncle Louis for Healthy States

Illustration by Uncle Louis for Healthy States

We know, thanks to the Centers for Disease Control and Prevention, that young people of color are much less likely to have a regular health care provider than white people. Doctors concerned about these racial disparities in health care say developing cultural competence is an important strategy in reducing them. There are a number of efforts underway to make this a reality.

Even so, developing cultural competence is a big challenge. Schools need to recruit medical students so the field of physicians mirrors the growing cultural diversity of the nation.  Providers need to write care instructions in a number of languages. And they need to take care that translated materials use words and terminology that are appropriate to many different languages and contexts.

Meeting that challenge seems a worthy goal given the racial disparities in health care and the increasing diversity of the American population.

Healthy States’ third Hacking Health Care event was made possible in part by Delta Dental of Minnesota.