Medical Schools Teaching Little About Gay Health

Future doctors aren't learning much about the unique health needs of gays and lesbians, a survey of medical school deans suggests.

On average, the schools devoted five hours in the entire curriculum to teaching content related to lesbian, gay, bisexual and transgender patients, according to the survey results appearing in Wednesday's Journal of the American Medical Association. A third of the schools had none during the years students work with patients.

More than a quarter of the medical school deans said their school's coverage of 16 related topics was "poor" or "very poor." The topics included sex change surgery, mental health issues and HIV-AIDS.

While nearly all medical schools taught students to ask patients if they "have sex with men, women or both" while obtaining a sexual history, the overall curriculum lacked deeper instruction to help "students carry that conversation as far as it needs to go," said lead author Dr. Juno Obedin-Maliver of the University of California, San Francisco.

Without such education, doctors are left guessing and can make faulty assumptions, Obedin-Maliver said. For instance, lesbians need Pap tests, which screens for the sexually spread virus that causes most cervical cancer, as often as heterosexual women do. But some doctors assume they don't need them.

"I'm an ob-gyn and I have had lesbian patients come to me and say I haven't had a Pap test in 20 years because my doctors said I didn't need one," Obedin-Maliver said.

Earlier this year, the Institute of Medicine reported that there's little research to guide doctors in the treatment of lesbians and gays. But some things are known: There are increased risks of depression, suicide attempts, homelessness and being victims of violence for lesbians, gay men and bisexuals. Lesbians and bisexual women may get less preventive care to stay healthy, and have higher rates of obesity and breast cancer.

The Association of American Medical Colleges recommends that medical schools ensure students master "the knowledge, skills and attitudes necessary to provide excellent comprehensive care" for gay, lesbian, bisexual and transgender patients.

The new findings are based on a Web-based survey that drew responses from 85 percent of U.S. and Canadian medical schools.

That's a remarkably high response rate, which shows the deans believe it's an important issue, said Dr. Raymond Curry, vice dean for education at Northwestern University Feinberg School of Medicine in Chicago.

In an accompanying editorial, Curry wrote that the researchers missed the opportunity to find out how many medical schools have gay and lesbian faculty and how many have student groups for gays and lesbians.

"Trying to assess the adequacy of a curriculum in addressing these issues is perhaps not best approached in counting hours of instruction," Curry said.