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Diminishing barriers for LGBTQ healthcare

Emily McKnight • 4/6/18

Diminishing barriers for LGBTQ healthcare

Individuals within the LGBTQ community often face societal and personal challenges related to their sexual orientation and/or gender identity, one of which being the opportunity to access proper healthcare. This comes as the result of various barriers, including a shortage in healthcare providers who are both knowledgeable and culturally competent to address the social stigma and unique health disparities LGBTQ patients are presented with. Sadly, there is stigma and discrimination within the healthcare system as well. A native Hoosier and graduate of Indiana University School of Medicine, Juan Carlos Venis, MD, MPH, is working to change just that – to educate current and future physicians on the social determinants that affect gender and sexual minority patients with the goal of alleviating health disparities that impact this community. Read more about Dr. Venis in this Q&A:

What do your responsibilities with IU School of Medicine entail?
I work with IU School of Medicine Department of Family Medicine Medical Student Education team on issues related to the family medicine clerkship, evaluating students and developing curriculum. I am new to teaching Foundations of Clinical Practice Year One, which I have enjoyed. Additionally, I have enjoyed taking part in the LGBTQ Healthcare Committee and collaborating with students who are involved in Alliance on projects related to improving LGBTQ health topics in the curriculum and other projects.

What made you want to become a family medicine physician?
I think it always comes back to my interest in the stories and experiences of my patients around health. Being on the front line in primary care, I witness many of the difficult challenges patients face as they try to pursue well-being. Many of these are psychosocial factors, and I think my training well equips me to help patients navigate such issues. It’s a humbling experience to be brought into someone’s life as a partner (be they young, old, pregnant, etc.), and I like the challenge of working with patients to meet them where they are at tocome up with ways to better find health with whatever conditions they face. It is fun to be able to offer many services including office procedures too as a family doc, and having considered a surgical specialty while in medical school, this was a huge appeal. Additionally, I have always found the role of the community primary care physician to be essential to the partnership of the medical system with public health. I just naturally saw family medicine as a way to mesh my interests in public health and the social ecological model of health with my passion for patient-centered clinical care. I also think family medicine physicians have an important role in advocacy and pushing for changes at a higher level to help make health more equitable for all.

Why did you choose LGBTQ health as a specialty?
I would not call LGBTQ health a specialty per se, but it is definitely an area of expertise I am continuing to cultivate. Our LGBTQ-identifying patients have many similar health concerns as other patients, but also may have some unique health concerns and as a population face unique disparities that I feel require some additional training for the clinician. This is in comparison to what has been traditionally taught in medical education.

I was always critical of content we were taught in school and trained on in residency. It’s common to experience stigma in its many forms when you fall into the LGBTQ+ community, and I have experienced heteronormative assumptions about my own sexuality and risk factors when I have accessed medical care. I have heard about friends not being able to access preventive care they need when visiting their own doctors. I have even heard of doctors seeing patients and explaining to them that they “don’t have to be that way” in reference to their identity or sexual orientation. Regardless of any provider or physician’s personal beliefs, if you are in medicine, you have to understand basic well-accepted scientific knowledge around these concepts. In public health school, I became aware of health disparities and social determinants of health that affected gender and sexual minority people. Most of what we are taught in medical school about is HIV/AIDS and it tends to add stigma instead of teaching a comprehensive way of looking at gender identity, sexual health and sexual orientation as a component of EVERY patient’s health/well-being.

Because of the health disparities that exist (increased rates of depression and suicidality, for example), I view my area of interest as one that requires attention and action urgently on the part of our medical school and greater professional community. We need to be aware of health disparities that affect sexual minority and gender minority patients in order to bring attention to them and alleviate them. It’s work I want to be part of.

During my time in residency, I undertook personal efforts to learn about pre-exposure prophylaxis for HIV and prescribe it. I then took on efforts to educate my peers and clinic staff about this and other issues that matter to our LGBTQ patients. This was empowering and gratifying as I was able to teach a lot to peers and was seen as a safe person to ask questions to that were sometimes difficult to ask. I got to help my clinic make changes to be more welcoming to LGBTQ-identifying patients. During my third year of residency, I had the opportunity to rotate in the clinic I now work (Eskenazi Health Transgender Health and Wellness Program), and I became even more interested in the care of transgender and gender non-conforming patients as a result.

What are your research interests?
I have very limited research experience but am looking forward to projects in my new role at IU School of Medicine. My partner in the transgender health program, our medical director Dr. Janine Fogel and I have already began collaborating with folks in social sciences and health technology research to look at issues that are unique to the care of transgender patients. I am interested in patient-provider communication and best ways to collaborate with patients who often have faced stigma and discrimination in their efforts to access medical services. We continually notice things about our patients that interest us that spark interest and question asking. The field of transgender health is really expanding and there is a shortage of research on many issues of importance. A cool thing that we are doing in the program is starting a patient advisory board which we hope to use to frame some of our question asking and searching for answers to questions that matter to the community we serve. Our program is dedicated to partnering with the community, as we feel this is essential to repairing a difficult history of discrimination that transgender people have all too often faced in accessing the healthcare system. Outside of this, I am hopeful to collaborate with peers on questions around other disparities faced by sexual minority patients in our local community and state. I also intend to do some research on education around these topics as we get some new curriculum initiatives up and going within the school of medicine. I hope that work I do can help contribute to greater health equity in our own state that traditionally has been behind in advancing equality for LGBTQ population.

Why did you choose to become a part of the faculty here at IU School of Medicine?
My sincere desire is to have an influence on population health in my home state of Indiana. I really enjoyed my experience in medical school and the home I had in the Department of Family Medicine. So many important mentors like Dr. Gaylen Kelton, Dr. Scott Renshaw, Dr. Deanna Willis and Dr. Javier Sevilla were crucial to my experiences as a medical student. Many more people, especially within the IU Health Methodist Family Medicine residency program played an important role too. I was so excited to have the opportunity to be welcomed back as a part of the team. While I am not too far out from my own experience in medical school, I wanted to have an opportunity for variety in my job that this offered. Having a heavy clinical responsibility but also, a significant percent of my time to have academic effort is a great balance for me as someone with a wide range of interests and commitment to population/community health in addition to my clinical interests.

What are your goals for education and research at the School of Medicine?
As far as education, I am working with colleagues in the Department of Family Medicine, in the school of public health, in the residency program, and in Interprofessional Practice & Education (IPE) on a few projects. I want to bring elective opportunities to students focused on the health of gender and sexual minority patients. We hope to soon unveil a new elective where students can have the opportunity to rotate within the transgender program at Eskenazi Health as well as other community primary care clinics serving a high proportion of LGBTQ-identifying patients. Also, with IPE we are working on an interprofessional learning opportunity within the transgender health program given that a multidisciplinary team based approach is our default (in addition to two family medicine physicians, we have a nurse, a psychiatric nurse practitioner, licensed clinical social worker who offers continuing therapy, a patient care coordinator, program coordinator, medical legal partnership, speech therapy, chaplain, yoga). We feel like our team has a lot to offer to learners about the value of collaboration in meeting the needs of patients like ours. In partnership with our residency, we are hoping to soon have our first residents enter a LGBTQ Health Track where they will get clinical focus during their second and third years of residency in the care of gender and sexual minority patients. As a part of this, they will get continuity experience in the clinical care of transitioning patients. With the school of public health, we are collaborating on an effort to expand training opportunities to become available to clinics throughout the region and state. This is in early phases of planning, but we are quite excited to be collaborating with the IU Fairbanks School of Public Health on an LGBTQ Health ECHO project

Outside of work, what are your hobbies and interests?
I enjoy spending time with family and friends, as well as traveling and trying new foods with my partner. My dog, Oscar, keeps me busy and I also try to stay physically active. I enjoy riding my bike, music and dancing. I had participated in the medical school’s orchestra in the past and hope to again start playing the violin. I enjoy learning about other cultures, and am trying to dabble in some American Sign Language and Portuguese. I’d love to learn more.

Author

Emily McKnight

Content Marketing Manager

As the content marketing manger, Emily is responsible for the planning, organization and execution of effective digital marketing campaigns that align closely with the school's strategic priorities. A self-proclaimed "news nerd," Emily's background is in broadcast journalism and healthcare communications. She has a passion for storytelling and is excited to be able to share the stories of IU School of Medicine. Emily is also the proud and slightly obsessive mom of two furry felines, Fred and Oscar.