Pathology is the Truth

As a post sophomore fellow when he a medical student at the University of Vermont College of Medicine, Ron Balassanian, MD, quickly realized pathology is where the final diagnosis is rendered, and how exciting it is to find an answer for the patient.  He picked cytology as a specialty so he can perform FNA biopsies. Being able to see a patient, perform an FNA, and immediately render a diagnosis, was empowering. 

As a member of the LGBTQ+ community, Dr. Balassanian has seen how far healthcare has come in terms of acceptance of LGBTQ+ people, but notes that there is still much work to be done. Recognizing LGBTQ+ specific healthcare needs is important, because LGBTQ+ people are people. It is imperative that healthcare professionals listen, and meet their patients where they are, without judgment and an open mind. Here, Dr. Balassanian shares his insight and more.  

In your experience, what obstacles does the LGBTQ+ community face in healthcare?  

The obstacles the LGBTQ+ community faces are as varied and diverse as the community. Historically, the LGBTQ+ community has been ignored, dismissed or completely invalidated. Today, we still confront bias that is rooted in that unfortunate history. For example, HIV was once wrongly assumed to be a gay disease and victims were blamed for contracting an infection. Today, gay men still confront bias from healthcare workers who resist or shame patients when prescribing PREP for HIV prevention. Similarly, bias rooted in this history results in lesbians being told they should have a husband or can’t have children, bisexuals being told that they aren’t, transgender people being mis-gendered or denied gender appropriate care, and queer people being told they are confused. Anti LGBTQ+ bias, rooted in history, continues to create obstacles for all members of the LGBTQ+ community. 

However, with LGBTQ+ visibility, changes in public policy, and awareness and education of healthcare workers, obstacles faced by the LGBTQ+ community are receding in some areas. Though there is still work to do.   

Tell us about your own personal experiences as an LGBTQ+ person or ally in health care.  

Having been in academic medicine for the last 20 years, I have been witness to, and part of, a transformation. When I started, being gay was acceptable, but not really accepted, certainly not among my peers. As a result, many faculty, residents, and students were closeted, and this created an atmosphere of tension, which was destructive on many levels. The year I started residency at UCSF, there were six of us who were openly LGBTQ+ residents and like it or not, the closet doors had to swing open. I wish I could say this went smoothly. It did not. However, over time, and through visibility, and by living out our authentic lives, LGBTQ+ people have created a new culture in academia. Being a member of the LGBTQ+ community is no longer just tolerated, it is now accepted, and in most academic places, fully supported. But I am working towards the next step—the LGBTQ+ community should also be celebrated, both for who we are, and also for everything we do to enrich the healthcare profession.  

What challenges have you encountered around LGBTQ+ diversity and inclusion?  

There are always challenges LGBTQ+ people encounter in many different settings. I am fortunate to live in San Francisco and work at UCSF, where these challenges tend to be minor and few. Today, a big challenge is recognizing and celebrating the expansive diversity that the LGBTQ+ community represents. What was once gay, then lesbian and gay, then lesbian gay and bisexual has now been expanded to recognize transgender and queer people and others who were there in our community all along. Recognizing, and understanding the complexities and needs of all the different members of the LGBTQ+ community is a challenge as we expand diversity and inclusion in healthcare. Diversity allows for diversity in perspective, which is essential in healthcare and treating patients, allowing us to look at a problem in different ways and find new solutions.  

What important changes can healthcare systems make to improve LGBTQ+ medical care? 

In 2001 Shane Snowdon, who ran the national Center for LGBT Health & Equity at UCSF, put together a list of out people at UCSF. It was posted online as the “Out List.” This simple act of visibility was transformative. By connecting us with each other and making our colleagues aware of who we are, the culture at UCSF changed. For example, for the first time, partner benefits were offered to LGBTQ+ faculty and staff. Now in 2022, healthcare systems can follow this example and improve LGBTQ+ medical care by creating open lists of LGBTQ+ healthcare providers and their allies. This will allow patients to identify providers who can address their specific and unique healthcare needs. Moreover, healthcare systems can establish centers for LGBTQ+ health as well as centers focused on specific members of the community such as transgender patients. We have recognition. The next step is meeting the healthcare needs of the community.  

What can healthcare systems do to be a better ally for the LGBTQ+ community?  

Start by listening. Healthcare systems should listen to the needs of the LGBTQ+ community in their own community and respond to those issues. Beyond that, healthcare systems can be an ally for the LGBTQ+ community by celebrating with the LGBTQ+ community: recognize Pride Month, participate in Pride parades, and support LGBTQ+ public policy including same sex marriage and transgender rights for starters. Be vocal and sincere about the support and committed to making changes when needed.   

How have attitudes/perceptions of the LGBTQ+ community changed over the past decade, both for patients as well as those of the community working within healthcare?  

Attitudes and perceptions of the LGBTQ+ community have changed over the past decade. In many ways there has been great improvement with the acceptance of same sex marriage and an increased understanding of the unique needs of different members of the LGBTQ+ community, especially transgender people. However, it is important to recognize that there also have been setbacks. Currently anti LGBTQ+ legislation is being considered, or has been passed in numerous states, setting us back in the struggle for full equality. For patients, this can be very difficult and in fact may be quite damaging. For those in the community working within healthcare, it should be a call to action. We must speak up and join with our allies in protecting the rights of LGBTQ+ individuals threatened by regressive political policy.