One idea that has become clear to me as a medical student at the University of Wisconsin School of Medicine and Public Health is that the distinction between social problems and health problems is arbitrary. The famous physician Rudolf Virchow said, “Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution … The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.” A physician’s training allows him or her to be as much attorney as mechanic.
Health is a goal and an indicator of social justice, and the sexual minorities face unequal risks to their health. That is why my peers and I started the student organization PRIDE in Healthcare (Promoting Recognition of Identity, Dignity, and Equality in Healthcare). I have served as co-president since its founding. Our goals are to improve the conditions of healthcare for sexual minorities (LGBTQ and beyond), to increase integration of LGBTQ content in medical education, and to raise awareness of LGBTQ health disparities and their causes while cooperating with others to eliminate them. It’s a mission bigger than the hot topics like HIV or suicide. It is about what happens when medicine’s culture collides with a partially invisible, highly politicized, misunderstood minority.
The answer is not just to change laws and policies to remove insurance barriers or give visitation rights; it’s about ensuring conditions where all people can achieve health, empowering community members to take ownership of their own health, and helping every health professional bridge the gap between his or her own experience and the patient’s.
I did not start medical school thinking I was an advocate. But I looked around and saw there was a lot of work to do. LGBTQ health issues do not get addressed in the medical curriculum until quite a long time after students have learned how to perform medical interviews. Discussions that focus on health disparities include race/ethnicity and socioeconomic status but hardly ever sexual orientation and gender identity. Weird misperceptions, like that lesbians do not need Pap smears (they do) and do not contract STIs (they can), are never addressed in a frank way.
So, if there is any lesson about moving medicine forward for the sexual minorities, it is this: it will take everyone. Patients must articulate their desires and demand better recognition, care providers must reflect on their own knowledge and biases, and health professional trainees must get the right training from the start.
Health is nothing less than a social justice issue. For ourselves and for each other, we should strive for better health by every available means. When we figure out the best way to bridge these important divides, we will feel it in our bodies.