When Erin Krebs goes to the doctor for her annual exam, the line of questioning usually goes something like this:
The doctor asks, “Are you sexually active?” and when Krebs answers, “Yes,” the doctor — assuming Krebs is straight — immediately asks her what type of birth control she is using.
When Krebs answers, “I don’t use birth control,” the doctor thinks she either wants to be pregnant or is crazy. They do not assume Krebs’ partner might be a woman.
Conducting a sexual history is just one of the many areas in which physicians must learn to be sensitive to the lifestyles of their patients. But critics say the nation’s medical schools are not devoting enough attention to gay, lesbian, bisexual and transgender health issues.
Krebs said this awkward exchange has happened to her several times and creates an uneasiness between doctor and patient about whether the patient is “out” or not. The reason most straight women get annual exams is to get birth control, Krebs said.
The Gay and Lesbian Medical Association produced a report saying that although 5 to 10 percent of the population is gay or lesbian, physicians are not being trained to deal with GLBT health issues.
The report stated that throughout a medical student’s four-year education, only about three hours in lectures are devoted to gay or lesbian health issues.
“I think that’s pretty accurate of the University,” said Krebs, a third-year medical student and former co-leader of the GLBT Medical Students Group. “The University, like most other medical schools, focuses on biochemistry rather than social issues.”
Originally, gay health issues were regarded only as sexual issues in the context of HIV and AIDS, furthering a stigma linking HIV specifically to gay men. But now the health issues include providing better access for gay and lesbian patients, combating homophobia among physicians, and showing that sexuality is not a taboo issue between patients and practitioners.
For instance, because a lesbian might be uncomfortable discussing her sexuality with her physician, she might not feel comfortable getting an annual exam. As a consequence, she could go unchecked for diseases like cervical cancer.
Despite the minimal attention paid to gay and lesbian health issues, the Medical School is working to diversify its curriculum for the future.
“Currently there are not a lot of lectures,” said Dr. Douglas Wangensteen, the director of curriculum affairs at the Medical School. In their first year, medical students take a course in human sexuality that includes gay, lesbian and transgender issues, Wangensteen said.
After their first year, medical students deal with gay and lesbian health issues in their clinical work to a small extent.
“There’s definitely a lot more that needs to be integrated throughout the curriculum,” said Dr. Sara Axtell, chairwoman of community and cultural diversity of curriculum.
Beginning in March, a team of physicians and community activists will start a six-month evaluation of the Medical School’s curriculum, focusing on immigration, disability, religious and spiritual and GLBT issues.
But Axtell said their recommendations will ultimately take a couple of years to implement.
And for the past 18 months, Krebs and her peers have combed through more than 2,000 case histories the Medical School uses in its clinical curriculum. They then divided them into variables such as race, gender, class, age and sexuality.
“We’re looking to see who is being represented in the Medical School,” Krebs said. “It will allow us to look at the school’s broader curriculum.”