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Join pediatrician Uchenna Umeh as she shares her personal journey and professional insights on creating a more inclusive and affirming health care environment for LGBTQ+ patients. We delve into the challenges transgender individuals face in medical settings, the importance of understanding intersectionality, and practical strategies for health care providers to support their LGBTQ+ patients. Uchenna also discusses the critical role of allyship and how medical professionals can balance personal beliefs with their duty to provide compassionate care.

Uchenna Umeh is a pediatrician.

She discusses her KevinMD article, “Allyship in action: Supporting your LGBTQ+ patients.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Uchenna Umeh. She’s a pediatrician, and today’s KevinMD article is “Allyship in action: supporting your LGBTQ+ patients.” Uchenna, welcome back to the show.

Uchenna Umeh: Thank you so much, Kevin. Thank you so much for having me. And happy Pride Month for all those out there who are celebrating. And of course, happy Juneteenth, we just celebrated yesterday. So I’m ready to go. Let’s do it.

Kevin Pho: All right. So Uchenna’s been on in the past. Go to KevinMD.com/podcast to search for her story and prior episodes. But today let’s talk about your most recent KevinMD article, “Allyship in action: supporting your LGBTQ+ patients.” So what’s this article about?

Uchenna Umeh: So this article was actually inspired by my own child. She had a recent visit to her doctor for a physical, and even though she’s a young adult, I kind of made her younger because I’m a pediatrician and I want to stick in that realm.

But she felt unseen, she felt invisible. She said she felt that the doctor looked through her, past her, and was over somewhere else, not wanting to come close, not wanting to touch her. And actually, outside the door, the doctor had said something about it. Like, what name should I use? Oh, is it he, her, she? Is it “it”? And I’m just going to go in the room and I’m going to just use their last name.

So I just went to talk about how, I’m sure enough physicians out there do not have this behavior, but enough LGBTQ+ patients have this experience. And it’s so bad that many of them avoid going to the doctor, avoid having a primary care physician. And you and I know that this is the best way to have a patient-doctor relationship. Going to the ER and to urgent care when you’re already advanced, or when you’re really sick, or by your friends when you’re out, is not the way.

And we all took oaths to first do no harm. I like to say first do no further harm, because this is a community that’s really been traumatized over the years. So this particular article talks about allyship being a doing word, being an action word. You don’t stand by the sidelines and watch as an ally. You roll up your sleeves and get dirty, so to say.

And so as the last remaining frontier, extenders of parents rather, pediatricians and other physicians who see LGBTQ+ patients have to be a sanctuary for them, because many of them are being rejected and being kicked out and being ostracized and being, frankly, not supported at home. So coming to the doctor is a whole process. She has to psych herself up. She says, oh, I’ll have it in two weeks time. Oh, it’s next week. Oh, it’s in two days. It’s a whole process for her, because she’s so anxious that, what’s going to happen when I get there?

So what I did with this article is just give you some basic steps. Number one, just tell your front office, to teach them first of all that all your patients are not straight. All your patients are not cisgender. Enough patients are not cisgender to make a difference. Let them know that if a patient chooses to go by Dr. Lulu, like I do, call me Dr. Lulu. If we are friendly enough, I might tell you why I chose Dr. Lulu. But coming at me like, well, why did you choose this name? No, no, no, no, no, no. That’s only going to push me back. So your front office using the proper name and the proper pronouns is the first place to begin.

Your office should be welcoming. You don’t have to have a fancy balloon like I do. But you could have your pronoun pin. You could have a little flag somewhere. You could have gender neutral bathrooms. You could have single stall bathrooms. So let these people use the ones that they feel affirmed in. We all have gender neutral bathrooms at home. The airplanes have gender neutral bathrooms. So we’ve used gender neutral bathrooms before, but they feel like you thought about them.

They’re only 5 to 7 percent maybe of the population. That’s not a lot of people at all. So I think we can manage. Unfortunately, or fortunately, they are blooming in numbers. They are growing. They are booming, rather, in numbers. I think they said baby boomers was like less than 2 percent. Gen X, like me, were less than 5 percent. Millennials were about 10 percent. Gen Z, about 22 percent of Gen Zs are not identifying with the gender they were assigned at birth. That’s a lot of people. Gen Alphas, we don’t even know. It may be up to 60 percent.

So I’m preparing the pediatricians to start thinking about this, to start normalizing conversations about this, because the kids are coming, and their parents may or may not be affirming. If the parent is affirming, great. The question is, how do you handle other parents who are not necessarily agreeing with your prescription? Many parents want me to write an antibiotic for green mucus. I don’t write it. What do I do? I educate them. And I’m also prepared with the fact that they might not like that, and they might take their kids.

So if you do want to be affirming and an ally and an advocate for the patient who has maybe told you that they’re gender expansive, or told you that they’re transgender or LGBTQ+, you may want to watch that you’re not bringing it up when the parent is in the room, if the parent is not affirming. Most pediatricians, thankfully, have a one-on-one. After a while we can have a one-on-one with the patient. You can have your conversations with them.

Most patients want to have one affirming adult. And that’s all the patient is asking for. So if they feel seen by you, they will tell their friends. They will tell their coworkers. You will get more patients. Your bottom line will expand. So I think it’s a win-win, is what I’m trying to say.

Kevin Pho: And when you first heard this story from your child, what was your first reaction? Did you feel that this is commonplace among doctors’ offices? What was going through your mind when you first heard that story?

Uchenna Umeh: What was going through my mind was, I’m not surprised. I really have to come out and say, because I myself was not taught anything about the LGBTQ+ community when I was in medical school.

Even as a queer person myself, I never ever shared my sexuality in medical school. It was in the ’80s. I did not know what was going to happen. My father already told me it was a phase. We thought it was a mental illness. I mean, I was not trying to tell anybody. I had to go and learn everything that I learned about it by myself, about myself.

And even with that, I missed my child’s gender expansiveness. My kid was assigned male at birth. Like most people, you just go based on the genitalia. Now we know that gender identity is more of what’s happening up here than what’s happening down here. And so when I learned that, I was shocked myself. I was like, wait, are you sure you’re not just gay?

It is normal for parents to feel that way. So when you’re a parent and a physician, you get words like, Mom, I was never going to tell you. And I was like, why? He said, because you were my doctor.

So I want us to remember that we are not prepared for this. It’s expected. But when my child said that to me, I said, OK, it’s time to start talking to my colleagues, because my child is only one person out of millions of people out there who are going through this, and I can control myself and people like me. So I can talk to doctors. Doctors listen to doctors.

So I said, well, you know what? Thank you for that, because now I can write this whole article and use that as a need, or as a carrot, to get into the physician community. So actually that’s kind of what came out of that. Talking to you, writing the article.

Over the weekend I spoke to the Georgia State Medical Association, which is all Black, and it was surreal, because I was talking to people like me, and I had my anxiety going in there, but at the end of the talk I had 12 people gather around me wanting to know more. So I’m like, OK, it’s something that I could do more. So you don’t know how happy I am to be talking to you right now.

Kevin Pho: So other than not feeling welcome in the majority of health care practices, talk about some of the health care obstacles LGBTQ+ patients specifically face.

Uchenna Umeh: So specifically, health disparities would be the best way to go about it. The health disparities really have to do with the environment where you live, right? That affects who you are. That’s who you are. Your schools, your churches, your playgrounds, your doctors’ offices.

They’re systemic problems. I’m not going to sit here and say it’s just doctors. We’re all part of a system. One of the things I talk about specifically is the word intersectionality, which basically talks about how your various social identities either create discrimination, or maybe worse, right?

So my child’s specific intersectionality includes being Black, being a Black transgender woman, having immigrant parents, growing up in America where racism is kind of the norm. So really, truly, I am not going to pretend that that doesn’t exist.

However, you can only plant roots where you are. You can truly only try to change the people around you by changing yourself. So I want to challenge physicians who are in racist states like Georgia, where I live, to become an ally to yourself. AKA, come out to yourself and say, I’m an ally. And it doesn’t matter what the legislature is saying, what the governor is saying, because truly, your patient, nine times out of 10, if they’re a child, they don’t know the legislators. They don’t know the governor. But they know you. Your child knows you. So being an affirming person is a deep personal journey.

And laws can change. We know that laws can change. And we also know that racism is still perpetuated because we don’t have enough anti-racists out there. So why don’t we, who took an oath to first do no harm, to be beneficial to our patients, to for justice, for veracity, all the things that we did, autonomy, why don’t we decide on our own to make a difference?

I know that one person can make a difference, even in a system that pushes back, because I am here making a difference, and I’m a Black woman. It doesn’t get any worse than that as far as intersectionality goes, but I’m here talking about it. And you’re here holding space for me and sharing your platform with me.

So I know that there are affirming physicians out there. I just have to get to them before their patient gets to the ledge, because a lot of times suicide is the option. And I don’t want to talk about that too loudly, but that is true, that there’s a very high suicide rate among transgender people, and it’s not because they’re transgender, it’s because of the way society treats them.

And it’s just really toxic all around us. So they prefer to unalive themselves, which, no doctor ever wants to have a doctor’s visit and then the next time you hear about your patient, you hear that this is what happened. And it happens to all of us.

Kevin Pho: Well, tell us a successful case study or story where a physician or physician office would be an ideal ally, or really be inclusive of LGBTQ+ individuals. So tell us what an ideal situation would look like.

Uchenna Umeh: I honestly believe that any physician’s office is the ideal place. I don’t have one individual I want to tell you like, this is Dr. XYZ, but I do know, I did a grand rounds at Atrium Health Navicent here in Macon, Georgia, a couple of months ago, to the pediatric faculty and students.

And after that grand rounds, the chief of pediatrics offered me a job as an adjunct professor, to come and teach LGBTQ+ basics. That is a success story, because he knew the need for this. His students understood the assignment. They knew the need for this. So I’m going to be starting there in July. And I’m going to start planting seeds.

So it can be done. Their offices are going to become affirming. They’re going to normalize conversations about queerness. Doctors are queer. Your employees are queer. Your coworkers are queer. Your patients are queer. So let’s normalize conversations about queerness, so we don’t feel like you’re different. Nobody likes to be different. So that to me is one success story.

You are one success story. You allowed me to post about LGBTQ+ content on your website, which has, I don’t know, how many millions of visitors. So that also is a success story. You may not be seeing patients and giving medication, but this is allyship. KevinMD is allyship in action. The Georgia State Medical Association, more than 200 physicians, welcomed me over the weekend. That is allyship in action. So I don’t know if that helps, but that’s my story and I’m sticking to it.

Kevin Pho: Do you ever meet physicians who have to balance their personal beliefs with providing unbiased and compassionate care to LGBTQ+ patients? And tell us about some of those stories that you may have encountered, and some of the tension that some of these physicians face.

Uchenna Umeh: I love that question. A couple of years ago I gave a talk about suicide prevention in youth to, it’s called ANPA, Association of Nigerian Physicians in the Americas. Let me tell you, if you want a group of people who are diverse in their thinking, go there.

After the talk, I had about half of the people who were positively affirming, and the other half were hell-bent on saying, but what about my morals? So one of them actually walked up to me and asked me, they said, what about my morals? And I had a four-letter word to use that I cannot use here about that, because you cannot and should not, as a physician, make it personal.

Otherwise, you probably won’t take care of your patient who’s still smoking even after you’ve told them that smoking doesn’t work. Or your patient who became HIV positive because you tried to counsel them about it. We cannot take it personal, because you’re supposed to take care of the patient in front of you. So I told her, I said, what about your morals? What about them? I mean, you have a patient in front of you who needs your help. You may have to rethink wanting to become a physician, because at the end of the day, you’re not supposed to put that forward in front of your patients.

That said, on Saturday I had another African physician, she’s Kenyan, walk up to me to ask me a question. She was very distressed. She said, what is being done about parents? I have one child, an only son. Are you trying to tell me that tomorrow he’s going to go from his name being Mark to, I don’t know, I’m just going to make up a name, Markisha? I’m just making up names here. You know, what should I do?

I said, well, this is great. This is what I do. I’m actually a parent coach. I help you analyze your thoughts about the queer community. Where did that thought come from? Who is giving you information about queerness? Because if you’re not queer or LGBTQ+, you truly cannot advise someone about being LGBTQ+. And if someone gives you information and they are not, you need to challenge them back, softly. Because truly, if your child were to come back and say, Mom, indeed I’m transgender, there’s nothing you or I can do about it.

So I told her, in my softest, nicest, most compassionate way, to lean in to the newness, and what to learn about this community, who truly just want to be left alone to just be who they are, like anyone else. And I don’t know that she was fully in on it. She took my information and said she was going to reach back out to me.

And to me, I choose to believe that that was a win, in the sense that she didn’t keep going and going, and I think I got her to say, hmm. And I think that’s what I want everybody to do. Just things that make you go, hmm, well, what if it’s me? It’s OK when it’s your neighbor’s child, when it’s your coworker’s child, but what about when it comes down to your house?

And I used to be that person. I used to ask God all the time, why me? Why me? Why, of all the things you can make my child, why this? And you know what God said? God said, why not you? And I was like, wait, what? Yeah, why not you? Who am I going to tell? You’re a physician, you’re a pediatrician, you’re Black, you’re a woman, you’re a mother, you’re an immigrant, you’re queer yourself. Who else should I send?

And so I take very seriously this load that has been given to me, to educate people and just get them to lean in to the possibility that if you are not queer yourself, someone you know is queer. Someone you know, in fact, is transgender. Here’s why. Gender identity is purely a personal revelation. So if I don’t tell you now, Kevin, that I’m actually non-binary, you will never know. The only way I’m going to tell you that I’m non-binary is if I find you a safe space.

And so I want us to realize that coming out, the process of coming out, is purely based on safety. Unfortunately, many children are not able to tell their parents who they are, because they are afraid of what’s going to happen. They’re going to get kicked out, they’re going to get into conversion therapy, they’re going to get all the things. And so many children resort to self-harm, or running away, or multi-substance abuse, all the things that we know that end up bringing down their health, inequities kind of aggravating that, if that makes sense.

So it’s all connected to getting educated, wisening up about what you don’t know. And if you truly cannot see the patient because you feel that strongly, I want you to advise them that you can’t. Because we also are allowed to tell patients, for whatever reason, ma’am, I don’t think I can see you anymore. That is a bona fide option for doctors. So you can always practice that, as opposed to trying to antagonize your patient, because you can always tell when you walk in the room and people kind of feel somehow about you. My kid felt that she was being judged the entire time. So I don’t even know if this answers your question, Kevin, but that’s my answer to that question.

Kevin Pho: We’re talking to Uchenna Umeh. She’s a pediatrician. Today’s KevinMD article is “Allyship in action: supporting your LGBTQ+ patients.” Uchenna, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Uchenna Umeh: I think my most important take-home message is asking yourself, what if this were you? What if you were the LGBTQ+ patient that the entire world, as we know it today, is against you? How would you feel? And go from there. But really sit down and ask yourself that question.

And if you were 5 years old and you just discovered this about yourself, or you were 15 years old, or 55 like me, and you discovered, just a couple of weeks ago I realized that I’m actually pansexual. Who knew? But I’m 55, though. And the freedom that comes from that, from the knowing, rather than focusing on understanding, because sometimes your patient doesn’t fully understand. Your child truly doesn’t fully understand, but they know.

And so I’m asking you to lean in with just the energy of, what if this was me? Or what if it’s my child? How do I move forward? Thank you so much, Kevin. I appreciate the time.

Kevin Pho: Uchenna, thank you so much for sharing your story, time, and perspective, and thanks again for coming back on the show.

Uchenna Umeh: Thank you.