Harvey Makadon, MD Photo credit: Beth Israel Deaconess Medical Center
The Program for Diversity and Inclusion in the Office of Academic Programs hosted long-time health care leader Harvey Makadon, MD, for its inaugural John E. Fryer Lecture in Medicine held last week.
Dr. Makadon is director of the National LGBT Health Education Center at the Fenway Institute, part of Fenway Health in Boston. For many years he worked as a primary care physician at Beth Israel Deaconess Medical Center where he started the first primary care-based HIV program in the country, and is a clinical professor of Medicine at Harvard Medical School. He’s also a native of Philadelphia.
His talk, titled “Assuring Access to Quality Care for LGBT People: Knowing Yourself, Ending Invisibility and Overcoming Disparities,” continues his efforts as a leading voice for improving access to quality care for lesbian, gay, bisexual and transgender people in health care settings across the country.
Makadon thanked Penn for its amazing commitment to inclusion and diversity. (Dr. Fryer, for whom the lecture is named, was asked to leave Penn after coming out during his residency in the early 1970s. Fryer went on to have an illustrious career as a psychiatrist and was also key in getting the American Psychiatric Association to remove homosexuality as a psychiatric diagnosis from the DSM, the listing of approved diagnoses used by psychiatrists everywhere.) The contrast of Penn and the nation’s past with its emerging culture of acceptance is profound.
Makadon—who is the also lead editor of The Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health, the first textbook on LGBT health for clinicians—encouraged the packed house of mostly School of Medicine and School of Nursing students to know and understand themselves well, as this knowledge would be their guide for the many professional decisions they will face, will inform the path their careers take, and will help them in understanding their future patients and their unique needs.
Makadon then cited a few startling statistics about the health of the LGBT community: as a whole they earn less and have a higher rate of unemployment, 20-40 percent of homeless people are LGBT; LGBT youth are two to three times more likely to attempt suicide; and they have higher rates of tobacco use. Lesbians and bisexual women are four to 10 times less likely to receive preventative cervical cancer screenings for women. Young black men who have sex with men and transgender women are at particularly high risk for HIV.
Culturally competent care, he stressed, starts in the waiting room, asking the questions that can inform how a person is cared for. His practice separates sex, what a patient is assigned at birth, from gender-identity, one’s chosen identity/expression of self, on its intake form and asks patients to circle the pronoun by which they prefer to be called. He hit this point home with two stories: one of a transgender man who after affimation surgery to remove his breasts, developed breast cancer in his residual breast tissue after not being told about the need for continued screening, despite a strongly positive family history for breast cancer.
A second was about a transgender woman who developed an inflammation of the prostate gland with fever after surgery, but no one could easily disagnose this as the fact that she was transgender and had a prostate glad was unknown.
He encouraged the students and physicians in the room to talk to their patients, ask the questions to get the answers that will allow them to treat their patients as they should be treated. Fenway Health created “Do Ask, Do Tell” posters to be placed in physician offices encouraging patients and physicians alike to start the conversation.
With this, he stressed the need for data collection about the LGBT population, as little is currently known that can be used for study, because physicians have been remiss in asking the questions that would give researchers the necessary data.
He shared his hope that this will change over the next five, 10, to 20 years, but that current and future clinicians had an important role in decreasing disparities in care for LGBT and other marginalized populations.
He ended his talk with the following quote from the Tony Kusher’s play “Angels in America”:
“This disease will be the end of many of us, but not nearly all, and the dead will be commemorated and will struggle on with the living, and we are not going away. We won't die secret deaths anymore. The world only spins forward. We will be citizens. The time has come.”
Penn’s Commitment to Diversity
Over the last year, Penn Medicine has solidified its commitment to inclusion and diversity.
Eve Higginbotham, SM, MD, Penn Medicine’s first Vice Dean for Inclusion and Diversity was brought on to spearhead the School’s efforts and lead Penn Medicine’s Office of Inclusion and Diversity. An ophthalmologist and experienced leader in academic medicine, Dr. Higginbotham is helping to shape a new School of Medicine and Health System.
One of the department’s cornerstone programs is the Penn Medicine Program for LGBT Health, Baligh Yehia, MD, MPP, Director, which is a unique interdisciplinary program focused on improving LGBT patient care, education, research, and advocacy, involving the Perelman School of Medicine, School of Nursing, School of Dental Medicine, and affiliated health systems, along with the Alliance for Minority Physicians and FOCUS on Health and Leadership for Women.
Penn offers a variety of programs and support for LGBT students, including Lesbian Gay Bisexual Transgender People in Medicine Plus (LGBTPM +), a program for medical students and "allies", non-LGBT individuals who are supportive of their mission. LGBTPM Plus was also instrumental in bringing Makadon to campus.
The School of Nursing’s Nurses at Penn Understanding Sexuality in Healthcare (PUSH) Program promotes quality care for LGBTQ patients and serves as a forum for LGBTQ students and those interested in Interested in LGBTQ issues. The University offers the Lesbian Gay Bisexual Transgender Center, a home away from home for sexual and gender minorities and their allies at the University of Pennsylvania, offering peer mentorship, space to study and socialize, and a calendar full of events, and is the social and political hub for the LGBT community on campus.