In one of the broadest efforts in the nation to bring sexual minorities into the medical mainstream, the University of Pennsylvania is unrolling an LGBT health initiative that spans the medical, dental, and nursing schools as well as the region's largest health system.
With issues like gay marriage fast gaining in public acceptance, hospitals and universities have begun tackling LGBT health, but usually within a specific area. Drexel University, for example, started a certificate program two years ago in the School of Public Health.
"We really want to do more. We want to do research. We want to change the climate and culture," said Baligh Yehia, 31, an infectious-diseases doctor who spearheaded Penn's program. "To really prepare the next generation of clinicians to be sensitive to the needs of people."
Lesbian, gay, bisexual, and transgender patients can be an invisible minority. "It may not be apparent to me that a 19-year-old male I am seeing in my office is at risk for [human papillomavirus] and anal cancer, and should be offered the HPV vaccine," said Jesse Ehrenfeld, a physician at Vanderbilt University in Nashville.
Patients must feel comfortable enough to disclose their sexual orientation - and it's up to providers to create an environment where they will, said Ehrenfeld, codirector of a two-year-old program that is closest to Penn's in scope and size.
A simple example: "For the language on many intake forms, 'Married, single, widowed, or divorced,' we add, 'Do you have a partner?' " he said.
LGBT populations are known to be at greater risk for diseases ranging from some cancers to depression. Much of the disparity is due to stigma and discrimination that lead to lower rates of employment and insurance, and higher rates of violence and stress. Their tobacco use is two-thirds higher than the national average.
Still, there is little long-term research on how sexual orientation and gender identity affect medical conditions other than HIV. The National Health Interview Survey, a data source for thousands of research studies, included a sexual-identity question for the first time last year.
Penn plans to bolster its large research portfolio in the same way. A researcher who is studying smoking cessation, for example, would be encouraged to add LGBT to the demographic groupings, said Yehia, the program director and an assistant professor, who also chairs the American Medical Association's GLBT Advisory Committee.
Although Penn will not announce the Program for LGBT Health until Friday, details are posted at www.pennmedicine.org/lgbt and small changes began months ago. The Patient Bill of Rights and Responsibilities' nondiscrimination policy now includes "sexual orientation" and "gender identity."
Ted Kreider, a fourth-year M.D.-Ph.D. student, said he was invited onto the steering committee after designing a three-hour curriculum involving transgender health that is now mandatory for first-year medical students. It teaches with trans examples, such as using the body's physiological changes during hormone therapy "as a way of understanding the endocrine system," he said.
Penn medical students also must take six hours on LGB health. Nursing schools here and elsewhere have not taken the lead, said Madelyne Greene, a first-year doctoral student who has been pushing for changes at Penn's School of Nursing.
The new "institutionwide intent to raise awareness and make improvement on these issues has been crucial," she said.
P.J. Brennan, the health system's chief medical officer, said it was a natural fit with Penn Medicine's three-pronged mission: research, education, and patient care. There has been no opposition, he said, a sharp contrast with the 1980s. He was training in infectious diseases here when the division had to fight "a lot of fear and ignorance" to start an HIV program.
Now Penn is compiling a list of its LGBT experts - Brennan knows of about 30 so far - to include in a brochure that would help patients choose doctors. The idea came out of a daylong planning retreat that the program's organizers held in the fall.
Heshie Zinman, chair of the LGBT Elder Initiative, was one of several leaders in the city's gay community invited to play a role.
"It's a great business model," he said. "It is expanding your market, targeting, providing good customer service, . . . but in terms of moral and ethical imperative, it just makes sense as well."