Issues faced by LGBTQ individuals in the operative setting [PODCAST]

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“Studies have repeatedly demonstrated a vast majority of pain physicians don’t feel like they have adequate training in meeting the unique needs of this patient population, though most agree that such efforts are very necessary. This disconnect between demand and supply is a problem, a big one.

With the current pandemic stretching many people thin financially, the last thing that needs to happen is people avoiding the hospital out of fear, not of the virus, but of the health care field itself, much like what my patient seemed ready to do. In some instances, this could be the difference between life and death.

There needs to be a much larger emphasis placed on training students and even residents on how to become more aware of micro-aggressions, biases, and the struggles of the LGBTQ community. I’m not saying the changes will be evident overnight, but they won’t ever happen if we aren’t willing to even try.”

Indraneel Prabhu is a medical student.

He shares his story and discusses his KevinMD article, “Issues faced by LGBTQ individuals in the operative setting.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Indy Prabhu. He’s a medical student, and he wrote the KevinMD article “Issues faced by LGBTQ individuals in the operative setting.” Indy, welcome to the show.

Indraneel Prabhu: Hey, Dr. Pho, thanks for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Indraneel Prabhu: Yeah, sure. So I was born in Bangalore, India, and I was there until I was about two and a half years old. Then my parents moved out here, and by here I mean the Bay Area in California, and that’s basically where I spent the first 22, 23 years of my life. I did my undergrad out there at UC Berkeley, and that’s kind of where I decided I wanted to do medical school. I found myself where I am right now, at Touro Nevada, out in Las Vegas, and my current interest is going into anesthesia next year.

Kevin Pho: I understand you’re in your fourth year and you’re interviewing for residency. So how’s that experience been in the midst of a pandemic?

Indraneel Prabhu: So it’s been interesting. Everything’s been done via Zoom, and the sad part about that is you don’t get to visit the program. You don’t get to get a feel for the campus, for how people are interacting. But at the same time, it’s made for some interesting experiences, where people have done virtual interview tours and virtual meet-and-greet sessions where they give you an Uber Eats gift card and you do the resident dinner virtually, with them paying for it. So it’s made for some interesting experiences as well.

Kevin Pho: Wonderful. And any tips that you can share with your fellow fourth-year medical students who also may be interviewing virtually during residency season?

Indraneel Prabhu: Definitely, definitely. The biggest thing is have a dedicated laptop that you know is going to continue working, and have a stable Wi-Fi connection, because I can’t tell you the number of times that things have gone wrong, and at the worst times. So just make sure that you can optimize everything on your end to make as seamless of an experience as possible.

Kevin Pho: Great. So let’s transition now into your KevinMD article, “Issues faced by LGBTQ individuals in the operative setting.” Now, for those who haven’t read your article, can you just summarize it, walk my audience through it, and share the story of why you decided to write it?

Indraneel Prabhu: Yeah, so actually, this happened on one of my anesthesia electives. It was supposed to be a simple cholecystectomy case, and as a medical student, they let me do the pre-operative clearance. When I was talking to, and I’ll use quotes here, quote-unquote “him,” a young 22-year-old male, he suddenly had an angry outburst when I asked him how he was doing. Then he quickly apologized and burst into some tears, and he told me sorry, he didn’t feel comfortable in the setting. When I pried a little bit more, just as a good historian and medical student should do, he told me he actually felt as a woman trapped in a man’s body.

That was eye-opening to me. First of all, I was having this experience in real life, because I’d never had that before. On top of that, he was apologizing to me even though he was probably going through so many struggles, albeit I wasn’t trying to come from any place of malice or anything like that. But he told me he felt quite uncomfortable in the operative setting because he’d had experiences in the past where people were discussing his case within earshot of other families and other individuals, and that made him uncomfortable. On top of that, he could tell when sometimes providers were doing their best not to walk on eggshells, and doing their best to not breach this subject, and he felt he really couldn’t be himself, on top of the struggle that he was already going through internally.

He told me that, for ease, I could just call him “he.” But we established a bit of rapport as we got more into our conversations, and I think this was a very telling experience for me, because I didn’t know that this sort of struggle existed in the anesthesia and surgery realm. To be honest, I thought it was more maybe primary care, or maybe not even too much in health care. So it was a very eye-opening experience for me, and I just did my best to try and validate his experience, let him know that it’s going to be OK, I’m here to listen, and let him know that other providers will hopefully be listening in the future as well.

Kevin Pho: As we’re listening to this story, did he describe some of the scenarios that he had encountered that made him feel so apprehensive in this particular setting?

Indraneel Prabhu: I think one of the biggest ones that stuck out to me was when he mentioned that in the past, when he was a little bit more comfortable sharing, before any of the bad experiences that happened to him, I think he mentioned that he had told another student or resident that he felt this way. That resident, or student, maybe they panicked a little bit, and they offered him a pregnancy test. That completely shattered some of his confidence, because he didn’t know whether they didn’t know what a struggle was, or whether they were, maybe, he felt they were poking fun at him. Either way, it was something that really negatively impacted his outlook on medicine.

He was telling me that if the pain wasn’t this bad for his gallstones, he was even considering not coming in to have the surgery done. That was shocking to me, because that is something, I don’t know how many other people are doing the same thing, and that could be the difference between life or death. So that was really a touching moment where I realized that there are a lot of people doing this.

Kevin Pho: So you had mentioned that you comforted him and validated what he was saying. What are some of the ways that you did that?

Indraneel Prabhu: I think the biggest thing for me as a student, in any of these kinds of scenarios actually, is just letting the patient talk a little bit. A lot of times, there are some papers in front of you, there are charts, and you’ll be looking down and looking at the chart and nodding. I think in this case, I just maintained eye contact. I smiled when it was appropriate, and I moved close to him. I sat down, I didn’t stand; there were some chairs there that made it nice to do that. And just sometimes put a hand on the shoulder here and there, and just listen to him, and then ask him pertinent follow-up questions, or make pertinent remarks to show him that I am actually listening and I’m not thinking about the next patient, or I’m not thinking about what I’m going to say to the attending.

It just became a conversation at some point, and I think in that way it made him more comfortable sharing the story, and it made him realize that maybe this guy’s being genuine. So I think those were some big ways that he was validated.

Kevin Pho: And in general, what are some of the issues that LGBTQ individuals face within our medical institutions?

Indraneel Prabhu: Yeah, so I think some of the things that he experienced are probably the biggest ones. Coming from an anesthesia perspective, I can definitely say that sometimes, with the pre-operative discussions and talking to the surgeons and things like that, it’s definitely done in a pre-op area where there are a lot of people. The only things separating the rooms are curtains, and you don’t really know how comfortable certain people are sharing certain things. It might not even be in terms of LGBTQ, but some people may not want other people to know they have diabetes or a certain condition or things like that, or that they take blood thinners. So I can say this happens a lot, and I think that’s one big thing that he mentioned as well.

As well as, with the T in LGBTQ, transgender people, sometimes it is actually pertinent to offer a pregnancy test, because sometimes it’s not just a man feeling that he’s a woman trapped in a man’s body. It could be someone that had had an operation, and they may have formerly been a woman, and this might be in the period where they’re still on hormone therapy, and it might still be viable that they could have a pregnancy. So those are more instances where it could actually completely change the way care is delivered, not just how it’s felt that it’s delivered. I think that’s another big one that I saw when I was looking things up and trying to figure out more ways that we could change.

Kevin Pho: Entering your medical training, did you have any education on issues related to the LGBTQ population?

Indraneel Prabhu: Yeah, so actually, in the article that I submitted to you, I was discussing how there’s not really enough training. Fortunately, where I am, students voiced their opinions on this, and some of the faculty and administrators had some guest lectures come at lunch specifically just to talk about these sorts of issues, not necessarily in the operative setting, but just generally in the health care field. So I would say that we did get a decent bit, and maybe that made it a little bit easier for me to handle this.

But at the same time, I feel that some of the doctors that are already in the field may not have had that training. So it’s not really fair to say, “Hey, it’s their fault,” or anything like that, but more that maybe they didn’t have the training, and maybe they want to learn. So I think that one of the things that we can do is maybe implement some of these training sessions within residency, and maybe even require doctors to go to some. I think that’d be a great idea.

Kevin Pho: We’re talking to Indy Prabhu. He’s a medical student. He wrote the KevinMD article “Issues faced by LGBTQ individuals in the operative setting.” Indy, after hearing the story, and reflecting, and going through this experience, what are some recommendations you have for other medical students and, for that matter, other health care workers?

Indraneel Prabhu: One of the biggest things that I learned from this is that the humanistic aspect of medicine definitely matters. We stress it in school. It’s always part of the OSCE grade: You have to have the content, and you have to be a humanistic person. That’s part of the grade. But after that, the stresses of “Hey, you have to deliver care to this many patients, you have to do this many surgeries.” I think the pressure, volume, output definitely shows up. I think there is some merit to that. At the end of the day, you do need to provide care to many patients.

But at the same time, I think it’s worth the investment to take one to two minutes and just listen to people, just listen to what their story is, listen to what they have to say. There have been studies that have shown that someone with a positive attitude, a positive mindset, who is generally happy, does much better post-surgically than someone with depression, let’s say. So if you were to take the time to do one to two minutes of this, it would not only help with just being a good person and establishing some rapport, but it might actually help your post-surgical outcomes as well. So everyone’s happy at the end of the day.

And so I learned about the humanistic aspect, and I think that’s the biggest thing: We just need a little bit more training in this regard. There are studies out there that have shown a majority of physicians just don’t know how to approach the situation, not necessarily for any fault of their own. And I think just being willing to understand different perspectives that people have, and being able to understand that people go through different things, and just because Person A experiences it one way doesn’t mean Person B is going to experience it the same way, would do wonders for everyone involved and really improve the way that we can deliver care and shape the field for the better.

Kevin Pho: And for those of us who want to read more about LGBTQ health care-related issues, what kind of resources can you recommend?

Indraneel Prabhu: I found PubMed to be fantastic, especially for my personal article. In surgery and anesthesia, and LGBTQ issues in that realm, there have actually been a surprisingly large number of studies looking at what those issues might be, what percentage of physicians are comfortable with it, and what we can do. A lot of those studies and the conclusions provided what their thoughts were, why certain things might work, what certain things might not, and what the feasibility of a lot of that is. I think PubMed’s a fantastic resource. I would maybe stay a little bit more away from not-as-reputable sources, because we don’t know where they’re getting their information from. But I was surprised to find a lot of evidence-based research in this area.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Indraneel Prabhu: I would definitely say the take-home message is just listen to your patients. They have so much to tell you. I’ve always been told that for histories, your patient knows; listen to them. I think we can go beyond that and listen to their experiences outside of what they’re just coming in for.

This individual was coming in, young, 22 years old. I think that was the most touching part. He was younger than me, and I’m always told, “Oh, you’re so young,” by all the patients. But he was coming in for a cholecystectomy. I could have asked him a bunch of questions about his pain, fever, chills, things like that, but I just had to listen to him for about two to three minutes about what he was going through, and I think it made a huge difference in our overall, in what he took away from our encounter as well.

Kevin Pho: Indy, thank you so much for sharing your time and insight, and thanks again for being on the show.

Indraneel Prabhu: Thank you so much for having me.

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