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How can LGBTQ health outcomes improve? Why is LGBTQ health care important? What is inclusive LGBTQ patient care? Why is LGBTQ education important?
Discussing how to provide culturally competent care to LGBTQ+ patients with recent AMA Foundation Excellence in LGBTQ Health Award Winner Alex Keuroghlian, MD, MPH, chief of MaineHealth Behavioral Health and chair of the Department of Psychiatry at MaineHealth Maine Medical Center. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Alex Keuroghlian, MD, MPH, chief, MaineHealth Behavioral Health; chair, Department of Psychiatry, MaineHealth Maine Medical Center
Dr. Keuroghlian: Knowledge about how to provide high-quality care for LGBTQIA+ patients is important for all physicians, not just people specialized in work with this population. All physicians are going to see LGBTQIA+ patients many times over in their practice.
Unger: Hello, and welcome to the AMA Update video and podcast. To close out Pride Month, today, we’re talking with Dr. Alex Keuroghlian, one of the winners of the Excellence in LGBTQ Health Awards from the AM Foundation. Dr. Keuroghlian is the chief of MaineHealth Behavioral Health and chair of the Department of Psychiatry at MaineHealth Maine Medical Center in Portland, Maine. I’m Todd Unger, AMA’s chief experience officer in Chicago. Dr. Keuroghlian, welcome, and congratulations on your award.
Dr. Keuroghlian: Thank you so much, I appreciate it. Great to be here.
Unger: The Excellence in LGBTQ Health Award is a big honor, and it recognizes those who have demonstrated outstanding work, innovation, and leadership in key areas of LGBTQ health. Before we get started, tell us a little bit about your journey and how you first became interested in this work.
Dr. Keuroghlian: Sure. I am a member of the community, which was starting point number one. And when I was in medical school, I did an HIV psychiatry elective where I realized that I could build a career working with queer and trans people and did research in that area, moved to psychiatry residency in Boston, where I had the opportunity, toward the end, to establish a fellowship where I’d be both at Mass General Hospital and at Fenway Health, which is an LGBTQIA+ focused health center in Boston. And that launched me on a path of providing patient care, doing research and education and training focused on LGBTQIA+ people.
I then had the opportunity to quickly move into leadership, directing our Division of Education and Training at the Fenway Institute and directing the National LGBTQIA+ Health Education Center to do this work in all 50 U.S. states, Washington, DC, Puerto Rico, and increasingly around the world, a number of countries.
Unger: Well, you’re having increasing and global impact. And that makes sense because you’re recognized with this award because you’ve made significant contributions to LGBTQ health education. Tell us a little bit more about the education part of this and why this type of education is so important.
Dr. Keuroghlian: Sure. Knowledge about how to provide high-quality care for LGBTQIA+ patients is important for all physicians, not just people specialized in work with this population. All physicians are going to see LGBTQIA+ patients many times over in their practice. And some of the things that we emphasize are universal design, having health systems and practices that are inclusive of everybody, rather than defaulting to doing something separate, necessarily, for LGBTQIA+ patients than what physicians would do for the general population.
We also emphasize foundational concepts and terminology, how stigma is related to health inequities in a minority stress and resilience framework. We focus on sensitive and effective communication, sexual orientation, gender identity data collection with patients, and how to build safe, welcoming, inclusive and affirming care environments for LGBTQIA+ people. There’s also a lot of specific, technical medical knowledge and practice that we emphasize, whether it’s gender-affirming hormone therapy, gender-affirming surgery, or in my specialty, for example, culturally responsive psychiatric care for LGBTQIA+ patients.
Unger: Now, you’ve created quite a bit of education in terms of webinars and additional resources. Where could people find those if they were looking for them?
Dr. Keuroghlian: Sure. We have a fabulous website for the National LGBTQIA+ Health Education Center, lgbtqiahealtheducation.org. We’ve been funded since 2011 by the Bureau of Primary Health Care at HRSA and the federal government to provide this kind of education, training, technical assistance, capacity building. We have on the website webinars by national experts that are offered live and then archived interactive learning modules, best practice guidelines, for example, on how to create a transgender health program. We offer continuing education credits, health care quality index credits. You can search all of this by population, by learning modality, by health topic to find exactly what you need, and it’s all available at no cost with a free login.
Unger: And I believe, if I’m correct, that that content—some of it, at least—is available on the AMA Ed Hub. Is that right?
Dr. Keuroghlian: Absolutely. We’ve had a wonderful multi-year partnership with the AMA Ed Hub, where we curate a subset of those resources to live on and be accessible through the AMA Ed Hub, which has been a wonderful partner and expands the reach of these resources so that we can ensure that these are in the hands of all clinicians who would benefit from them.
Unger: Now, in addition to all of your contributions to LGBTQ health education, you’ve also been a mentor to numerous medical students over the years. What do you see as the biggest challenges as they move into practice, and what do you hope that they took away from their time with you?
Dr. Keuroghlian: Great question. Well, in many ways, this has become a more acceptable specialization for medical students these days than it was when I was starting out, which is great. There’s more openness and more of an understanding that this is a legitimate area to focus on in terms of your clinical practice, in terms of your research, scholarship, education, training. So it’s being taken more seriously by the medical field at large, which is to the advantage of our mentees these days.
That being said, we’re in the midst of somewhat of a societal backlash against LGBTQIA+ people and the idea that there would be culturally specific and technically skilled approaches that need to be applied in a way that is responsive to the needs of this population. So I think it’s the best of times and the worst of times. We’ve never had more understanding of the need for this work, and we’re also in the midst, at least in the short term, of a bit of a backlash. That being said, I encourage my mentees to take a long view of things, that LGBTQIA+ people are always going to be there. These are going to be patients we’re always going to need to serve. And we need them now more than ever to incorporate this thoughtfully into their careers as physicians.
Unger: And I assume that makes your practice even more important in these times. You’ve got 2,000 patients. How do you do everything that we’ve talked about and take care of so many patients? What keeps you motivated to do that?
Dr. Keuroghlian: Well, I have a passion for the work, which is always important in any area where you’re going to encounter challenges. And the clinical care, patient care synergizes really nicely with research, education, policy work, advocacy. My best ideas for research scholarship policy come from seeing patients. And I encourage mentees, to your last question, no matter how much additional responsibility accumulates over time as far as administration, research, teaching go, to maintain some component of clinical practice in their work, because that keeps you grounded based on the realities that our patients and communities are experiencing. And you bear witness to a lot of suffering. You also hear what is really changing and coming up for patients and have your finger on the pulse in that regard to make the best decisions in other areas of your medical career.
Unger: Now, Dr. Keuroghlian, you mentioned this is a difficult time right now. When you look to the future, what do you think is most important to address in terms of opportunities to advance LGBTQ health?
Dr. Keuroghlian: Well, we’ve been very focused on transgender health, gender-affirming medical care access for all. And that partially is done through training and preparing the clinical medical workforce to be fully prepared to provide that outstanding care for transgender and gender-diverse people. There’s a policy element in terms of ensuring that this is care that’s reimbursed by insurance companies. There’s a research component in terms of innovating in this area of gender-affirming medical care.
And that doesn’t mean doing more and more studies forever to show that gender-affirming medical care works. We know it works. It’s highly effective and clearly voiced as a top priority and need by our communities. It’s more about innovating to optimize the ways in which we deliver gender-affirming medical interventions—doing comparative effectiveness studies for one mode of administration compared to another or different surgical techniques to make this less invasive and to optimize the experience of receiving care that our patients have, for example. So there’s a lot of opportunity in that regard.
And then to think about LGBTQIA+ subpopulations that historically have had less access to care, whether that’s racially and ethnically minoritized groups, rural populations, immigrant populations, so that we can innovate in terms of delivery of our care systems and have more equitable access.
Unger: Well, Dr. Keuroghlian, thank you so much for joining us today. And again, congratulations on your award.
Dr. Keuroghlian: Thank you. It’s such a pleasure and honor. I appreciate it.
Unger: Well, if you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/joinnow. That wraps up today’s episode. We’ll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today and please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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