Monday, October 25, 2010


Now that this round of exams is done, the "what I learned at the GLMA Conference" post, as promised.

I just talked to Dr. P about it earlier today and how to move forward with the info we (I) learned. I've basically grouped it into 3 categories: immediately useful/actionable info, good to know info, and personal.

1. Immediately useful/actionable info
Students. 29% of LGB students aren't out, mainly because it's: nobody's business (fair enough), fear of discrimination, and fears of not getting into a residency of choice. About 60% of transgender med students aren't out. Few med students feel that med school curriculum has adequately prepared them to serve LGBT patients. Students want more clinical exposure, more cases, lectures, and supportive faculty that they can turn to. On average, med schools in the US and Canada spend about 5 hours over 4 years on LGBT health issues (not including HIV).

Med schools. Deans of med schools have a different view on things. Most (68%) have LGBT content interspersed throughout the 4 years. It should be noted that 79% of med schools have no LGBT clerkship rotation sites. Transgender health issues are rarely taught. The good news is that 52% of deans are willing to improve curriculum; but, they aren't too keen on developing new stuff (because it's time-consuming and hard).

Allies. The barriers to being an effective ally must be addressed. This might be: a desire to avoid controversy, afraid to be called gay/associated, and not asked to speak up. Some strategies to help remedy this include: getting educated about the issues, talking about it, have some symbol of support (like, a small rainbow pin or something), learn the "language," ask the right questions, assume nothing, and discuss confidentiality upfront.

Some of things that can be done here right now include: working with the Office of Student Diversity, working with the Admissions Office, working with the new curriculum committee, safe spaces/ally training, and just continue general awareness. Incidentally, I somehow ended up on the student diversity committee. I just happened to attend the one meeting - a case of being at the right place at the right time I guess.

2. Good to know info
I didn't learn much about LGBT issues and health care reform, though I went to a couple sessions. I did attend a few transgender health sessions though, and they were actually really interesting.

Transgender kids. Toddlers start developing gender identity around age 3-4. This process evolves until the kid's about 7. This process appears intrinsic. That said, some kids are "just in a phase" or gender-fluid. Thus follow-up and just observation over the years are important. These kids tend to get distressed between age 2-5 and again at puberty. To treat these kids, one gives them hormone blockers to delay puberty until they're old enough to make a decision about transitioning or not. Apparently only about 10% of "gender variant" kids do end up transitioning. The point is, that up to 33% of transgender youths attempt suicide. But by showing acceptance, support, and delaying puberty until age 15 or so, it greatly reduces the rates of suicide and depression. Furthermore, the medical home concept is quite apropos for these kids.

Transgender care. Holy crap it's complicated! Someone's got to do it but I do NOT want to be among them. When to give hormones, how much to give, how to pay for them - it's all so overwhelming. Don't get me wrong, I like endocrinology and all that, but this is like endocrinology on steroids (lol, pardon that pun).

Also, HPV can apparently survive under the fingernails for a while (apparently that's how straight guys can get anal cancer, who knew?). I need to remember to buy Purell . . . Don't know if on that random off chance I'll get HPV from shaking someone's hand.

3. Personal
So Dr. P asked me if the Conference did anything for me personally. I suppose it did. It was nice to just be away from the Midwest and meet new people and not talk about classes and such. Yeah, still surrounded by medicine and such, but at least it's not worrying for this exam or complaining about that lecturer or something comparatively petty like that. He did concede that in hindsight it was perhaps a bit too overwhelming for me to experience that all at once, lol.

But then it was also incredibly cathartic. I disclosed more about my personal life/struggle to him than I had anticipated or expected. I suppose I wanted some kind of answer from him, but I didn't get what I was looking for (whatever that was). There were moments of long silences - of him staring at me and me staring back, of him staring at me and me staring off in the distance to avoid his gaze. Words just abandoned me and the silence doesn't force him to say anything to break it.

It felt like the more he subtly pressed against my walls, the more I wanted to crumble. He didn't tell me anything new or anything I didn't already know about myself. Other than perhaps suggesting that going to a therapist might be good (though how I'd pay is questionable). In a way I guess he forced me to realize just how uncomfortable I still am with all of this and how lost I still feel.

This catharsis was paralyzing and deafening. I've clearly still got some work to do. It never ends. :-/


Anonymous said...

If you have health insurance as a student then seeing a therapist should be very cheap. I also strongly recommend it.

As for delaying puberty until someone is 15...that sounds really...unhealthy.

Biki said...

The conference sounds as though you were challenged on many different fronts, both in the learning aspect and the personal.

I'm glad the conference so throughly covered the transgender issues, thats heartening to hear. Anything to slow suicide rates among our teens is wonderful. As long as the parents are open to what is really going on with their children, delaying puberty should really help.

Could it be that one reason you feel so lost and alone is that for the most part you go full tilt out day in and day out? I think in order to really work on you and truly process your emotions and feelings, is to have large blocks of nothing scheduled alone quiet time. It's hard to hear your heart in a vacuum of noise. You will find you, and wont feel lost any longer.

Aek said...

Biki: I just want someone to absolve me of all my responsibilities. All of them.

A Wandering Pom said...

Hi there, Aek

I've been intending to comment on this post since I saw it; I'm sorry I didn't get round to it sooner.

I don't think I have anything very useful to say about sections 1 and 2; in any case it's section 3 I'm interested in.

I'm glad you felt the conference was cathartic for you, because it seems to me that catharsis is something you need. Nevertheless, if it's paralysing and deafening, it may well be too much, too soon - overwhelming, as you say.

You mentioned going to a therapist. I'm not especially convinced of the merits of "therapy" as such (this may reflect a European point of view as opposed to an American one), but I am fairly sure of the benefits of talking to someone sympathetic who's willing to listen and let you find your own answers. As far as I can see, Dr P would seem to fit the bill very well: he's evidently sympathetic, your sexuality shouldn't be an issue for him, and you have already opened up to him to some extent.

I think it's very encouraging that you want your walls to crumble - I think I was in much the same state shortly before I came out (you might like to read my post on that subject), and I suspect many others have been too.

I'm happy to listen too, to anything you say, either here or (if you prefer) in e-mail. As a starting point, I'll turn your words back to you again, and ask another couple of "Wandering Pom" questions:
- What is "all this" that makes you uncomfortable? Why?
- Why do you feel lost?
There's no obligation to answer, of course, but I hope that you might at least find it beneficial to think about them. If you've already given the answers in older posts, please feel free to point me there.

Take care