Tag Archives: education

My Dream: Closing the Nation’s Achievement Gap Through Teaching Family Medicine

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Whitney LeFevre, MD

During most of my adult life, I’ve felt called to help close the achievement gap that exists in our country. So I deferred medical school to teach middle school math and science in inner city Baltimore with Teach For America. During my 2 years of teaching, I found that while I loved my students and I loved teaching them algebra and life sciences, I felt called back into the field of medicine. I saw that the best way for me to close the achievement gap was to return to medicine to find ways to address the many social determinants of health that kept my students from success.

In medical school, I was the education director for the MedZou Student-Run Free Clinic. The clinic both teaches medical students the joys of primary care and provides health care to the uninsured. My time at MedZou not only inspired me to become a family physician but also gave me the opportunity to create new programs to teach medical students while providing quality care to those in need. It’s at this intersection—the intersection of helping those in need while also stimulating medical students to be future family doctors for the underserved—where I truly feel I am able to fulfill my calling to close the achievement gap in our country.

In residency, I worked in an urban underserved environment with a predominantly Spanish-speaking population. Our patients had many social issues, including homelessness, addiction, food instability—the list goes on. In a place of great need like Lawrence, MA, I was motivated by how much family medicine was valued there. My patients deserved doctors who are full-spectrum trained and committed to quality, access, and patient-centeredness. And that’s what they got.

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Just Ask

Amber Cadick, PhD, HSPP

Amber Cadick, PhD, HSPP

A 24-year-old male presents to your office with complaints of fatigue and pain. When you go to listen to his heart you notice some red marks on his chest. When inquiring about this he breaks down crying and unbuttons his shirt to reveal claw marks across his torso. He quietly confesses through sobs that his girlfriend has been physically abusing him for some time, and he doesn’t know how to exit the relationship.

During didactics you notice that one of your star residents is sleeping. She has moved her typical seat with her peers to alone on the side of the room. The next 3 weeks you notice her dozing often during the lectures. What should you attribute this to—laziness, fatigue, apathy? Other faculty have noticed, and some are thinking about talking to her concerning professionalism. Thinking back, you realize that she has been lingering by your office but not saying much. One day she comes into your office, closes the door, and begins to cry. She shares that she hasn’t been able to sleep at night due to a fear for her safety. She thought this change in her partner’s behavior would be temporary, but now she doesn’t know how to stop it. She feels trapped, isolated, and lonely. She notes it is hard to perform her job as a resident with this stress at home.

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LGBT Health Is More Than HIV and STIs

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Adam Lake, MD

When it comes to LGBTQ+ health, the first topic that I often see is related to HIV and STIs.

While this is certainly one of many health disparities that emerge when comparing the LGBTQ+ population to the population as a whole, overdoing the focus on this topic can be divisive. The health disparities extend to mental health, cardiovascular risk, and use of preventative care.

As a family doctor and HIV care provider, I see this bias leading to an earlier diagnosis in a young gay man who had a sore throat that wouldn’t quit, but missed completely in the straight married woman with unexplained low cell counts despite extensive testing and multiple subspecialist referrals. This pattern is borne out in many, many, many studies.

True, sexual (and/or romantic) identity is what can be used to define the LGB population, though same-sex sexual activity is not always the defining factor for self-identification. As a juxtaposition, Trans*, queer, and gender non-conforming populations generally are defined by their non-cis gender identity and not sexual identity. The impact we have on Trans* patients seeking health care is especially striking with 28% putting off care due to discrimination and disrespect even when sick or injured.

The challenge here is deeper than where we may immediately recognize. The hard part is not seeing the nuance in the population prevalence: this is about being a safe space for all patients.

As teaching family doctors, we have a great opportunity to demonstrate empathy and to teach appropriate care for all. I encourage my learners to find a way to add sexual history inquiries into standard questions and to create a safe space to have candid dialog between provider and patient.

I will never forget a true conversation I had with a 60-year-old man in our more rural practice:

Me: Do you smoke cigarettes?

Patient: Nah, quit that years ago.

Me: Any alcohol?

Patient: Here and there, you know, nothing on a regular basis.

Me: Any other drugs?

Patient: Nope.

Me: Are you currently sexually active?

Patient: Yep.

Me: With men, women, or both?

Patient: Both, but I generally only have sex with guys when my wife and I are doing coke…

As you can imagine, more questions followed. While this patient identified as straight, I have found again and again that simply asking about sex will often lead to more accurate histories from patients in other domains of information. Questions about this have helped me break down my own preconceived notions of sexuality, especially when encountering unexpected answers in patients who challenge our assumptions.

To change the health care system as a whole is not within the power of a single one of us, but affecting that which is within our influence is possible. You may have the ability to affect curricular development or develop community educational activities. Or you may have the ability to personally open the eyes of your students, residents, or colleagues.  Whatever your power may be, go out and make the change.
We owe it to all our patients. For patients invisibly attracted to those on the same side of the gender spectrum who have never revealed that to a provider. For the transwoman who just wants to talk to you about her shoulder pain and not her genitals. For the straight woman with the sore throat that won’t go away. For the queer teen who just can’t take it anymore. I want our patients to know that we care.