As only one of five women in a medical school class of 100 in Salt Lake City, it was too risky to be out as a lesbian to most of my fellow students and professors. Here is a short excerpt from my book, Making the Rounds: Defying Norms in Love and Medicine:
My roommate Arlis and I were walking from our apartment to the anatomy lab when several of our Mormon classmates caught up and walked beside us. Looking over their lab coats, clean and pressed by their wives, I became uncomfortably aware of mine: greasy and wrinkled and reeking of formaldehyde.
Muttering to no one and half joking, I lamented, “I need a wife.”
Arlis heard me and said loudly, “What about that woman in San Francisco?”
…This was Utah in 1971. I hadn’t known until this moment Arlis was on to me. I questioned her motives. We were both competitive. If it became known to my professors I was a lesbian, they could make it even harder for me in medical school. My face burned, and I said nothing—just pulled my greasy lab coat tighter around me and walked on in silence. I detected a faint smirk on Arlis’s face.
That morning, I decided I’d better find a more compatible roommate and better cover. I’d begun getting to know David, one of the other ten non-Mormons who I suspected was gay.
I invited David to share an apartment with me and he agreed. People would assume we were in a romantic relationship; in Utah, we would be a scandalous couple living together in assumed sin. But at least we wouldn’t be in danger of being ostracized for being queer, compounding the discrimination I felt as a woman in a nearly all-male profession. There were few women, let alone visible lesbians, who could serve as role models for me.
Times have certainly changed since I started medical school in the early 1970s. Nevertheless, LGBTQ+ medical students, and doctors still weigh the benefits and risks of being openly visible. A survey of graduating medical students as late as 2010 showed that 30% kept their sexual orientation a secret due to fear of discrimination.
LGBTQ+ people, who I will refer to with the current umbrella term “queer,” comprise every race, ethnicity, religion, age, and socioeconomic group and are estimated at 5% of the population of the US. However, we are disproportionally affected by lack of access to health care and health insurance, and the impact of societal biases on physical and mental health and well-being.
Queer youth are at a higher risk for substance use, sexually transmitted diseases (STDs), cancers, cardiovascular diseases, respiratory diseases, obesity, bullying, isolation, rejection, anxiety, depression, and suicide as compared to the general population. Up to 40% of homeless youth are queer usually due to familial rejection. To cope with stress and discrimination these young people are more likely to engage in risky behaviors and self-medicate with smoking, alcohol, and drug use. Queer youth receive inferior quality of care due to stigma, lack of healthcare providers’ awareness, and insensitivity to their unique needs.
Queer adults also have poorer physical and mental health and a higher incidence of preventable illness and substance abuse. Significant shares of our community report negative experiences when seeking care, including disrespectful treatment from providers and staff.
A few years ago, a study showed positive role modeling by, and increased interaction with, queer physicians decreased both implicit and explicit bias among medical students toward the patients they serve. Doctors with such exposure are more likely to perform more comprehensive patient histories, hold more positive attitudes toward queer patients, and possess greater knowledge of our unique health care concerns.
Early in my career as a doctor, it outraged me that I was denied disability insurance with the explanation that women doctors were more likely to become depressed and alcoholic (due to discrimination). Later, after the passage of Title IX, prohibiting discrimination in education based on sex, many more women entered medicine. This correlated with improved outcomes.
For example, if you’re a woman needing surgery, you may be far better off in the hands of a female, rather than a male, surgeon. A study recently published in JAMA Surgery reviewed outcomes for more than 1.3 million patients and found that women were 32 percent less likely to die (and 16 percent less likely to experience complications) if treated by a female surgeon rather than a male one. We are more likely to follow guidelines, collaborate with specialists and ask patients about social circumstances that may affect their health; we also spend more time with patients.
I can’t help but believe the visible presence of queer doctors, especially in positions of power in more medical schools and residency training programs, would also improve health care outcomes for queer patients as the increased presence of women doctors did for women’s health care. In choosing my own primary care physician, I not only chose a woman, but also an out lesbian. The health intake form asked about my partner rather than my spouse (although we are now married). Inquiries about whether I was sexually active did not assume I had sex with men. Pre-examination chit-chat, inquiring about life and my relationship with my partner as well as my medical history flowed easily without having to change pronouns or omit relevant information (as I had with previous doctors who were also my peers).
I would wish for my queer sisters and brothers similarly comfortable experiences with their health care providers, so that trust and understanding can begin to improve health outcomes for all. I regret that for most of my medical career I was not able to be a totally-out lesbian until about a decade from retirement--for fear of the very real likelihood of career damage and discrimination. However, society has progressed to the point, that I hope all queer physicians now make the choice to be out and proud.
Patricia Grayhall is a medical doctor and author of Making the Rounds: Defying Norms in Love and Medicine as well as articles in Queer Forty and The Gay and Lesbian Review. After nearly forty years of medical practice, this is her debut, very personal, and frank memoir about coming out as a lesbian in the late 1960s and training to become a doctor when society disapproved of both for a woman. She chose to write using a pen name to protect the privacy of some of her characters as well as her own. Patricia lives with the love of her life on an island in the Pacific Northwest where she enjoys other people’s dogs and the occasional Orca and black bear.