Dr. Victor Chedid is featured on this season of the RISE for Equity radio. Victor Chedid joins host Nicole Nfonoyim-Hara to explore the important issue of Health Equity within the LGBTQ+ community. The discussion explores the many different ways that LGBTQ+ people can benefit from presenting practical resources to patients and healthcare providers. It also provides insight into the significant impact of access to healthcare and access for LGBTQ+ people. Visit us for an engaging speech poised to resonate with both experts and patients alike, as we explore the landscape of care equity.
“The goal of the IBD Pride Clinic is to show the world that we have a safe space for you, and that we’re available, accommodating, and want you to find your care with us in a secure affirming space. We strive to keep your needs at the center of all our endeavors, just like the Mayo Clinic often says—the clinic’s value is the patient’s needs come first.”
– Dr. Victor Chedid
Guest: Victor Chedid, M.D., is a gastroenterologist and hepatologist with subspecialty certification in both digestive and hepatology, as well as internal medicine. Dr. Chedid has a subspecialty in Inflammatory Bowel Diseases.
“Creating affirming locations for doctors is very important. Creating affirming places for health kids is very important. When you see someone who is older than you, who belongs to the group, who is advocating, who is out and happy and is conducting research in these areas or LGBT health equity, you might think, “I can be that individual.””
– Dr. Victor Chedid
Read the Transcript:
Nicole Nfonoyim-Hara: Welcome to the Rise for Equity radio. In this series, we’ll be talking to leading doctors, scientists, and inventors about what it’s going to take to transform care for a more simple, more equitable coming. Your podcast host is Nicole Nfonoyim-Hara, and today I get to be joined by Dr. Victor Chedid. Dr. and Dr. discuss the health disparities facing the LGBTQI community. Chedid’s work as an advocate for LGBTQIA patients, trainees, and staff in his specialty and beyond. Welcome to the podcast, Dr. Chedid.
Dr. Victor Chedid: Nicole, thank you so much for having me. I’m really excited to be here.
Nicole Nfonoyim-Hara: So, the LGBTQI community, as you know, is really diverse. It is actually intersectional, and it includes gender identity and expression as well as identities that are related to sexuality. As I said earlier, this is intersectional. So, you’ve got faith and race, class, ability, all these things. Could you please help us just define the acronym LGBTQIA+ before we start defining it as something simple?
Dr. Victor Chedid: Absolutely, and I love how you acknowledged, first and foremost, the intersectionality and the diversity of that community, while it is labeled as LGBTQ+ as one bucket, but it is very diverse, and everybody’s experiences are so different, and it is used as a term that can describe people’s sexual orientation and gender identity.
It is an acronym for various identities, including lesbian, gay, bisexual, transgender, queer, and questioning, and is frequently used interchangeably with the terms sexual and gender minorities. The plus is a recognition of the diversity and that it’s not limited to just these identities.
We frequently discuss how health disparities and inequality have historical roots on this podcast, Nicole Nfonoyim-Hara. In terms of the LGBTQI community in the United States, what has some of that history looked like in terms of health equity?
Dr. Victor Chedid: I always remind everyone that health is a fundamental human right. Health equity is only achieved when we all have the ability to attain the full potential for our health and our well-being.
We are aware that there are so many variables that prevent people from achieving that equity, whether it is historical injustices or contemporary injustices, economic or social obstacles that people face, or other preventable causes of health disparities.
It all has to do with history of a lot of stigma, discrimination, not being accepted by whether their personal community, whether in their family, or on a bigger scale in their society, to prevent the LGBT community from achieving the health equity that they deserve.
Nicole Nfonoyim-Hara: It seems like a lot of layers in terms of the equity issues that are facing the community and I love how you sort of mapped us through the individual and communal, and then all the institutional and systemic things as well. You briefly discussed the effects. How does not being able to even see someone impact health outcomes and well-being in mental health?
Dr. Victor Chedid: Let’s say somebody needs to seek care for a medical condition they’re facing, they have some symptoms. I go to a GI—because I’m a gastroenterologist. You belong to the LGBT community and you have symptoms of bloody diarrhea or abdominal pain. You might sit at home and suffer and not seek that care because you’re afraid of the discrimination you’re going to face at the doctor’s office. Or you worry that the doctors will blame you for your symptoms, or for putting such a diagnosis, on you if you come out and describe them.
Many people might delay the care they need, and they end up pushing it out until they have more severe conditions and ending up requiring more severe or drastic measures to treat their condition or ending up in the emergency room rather than seeking outpatient care.
Nicole Nfonoyim-Hara: The story that you sort of outlined in terms of someone really suffering on their own and having to delay care and the long-term impacts of that supersede just the physical symptoms. What are some barriers and biases that patients are encountering while speaking with a doctor who is still preventing them from receiving the care they need?
Dr. Victor Chedid: There are many implicit biases that people have that affect how they treat people who belong to the LGBT community. Let’s say you’re at the doctor’s office and the people don’t know how to talk to somebody from the transgender community or somebody who is nonbinary. So, they end up misgendering them. When they address a person, or deadname them, they are referring to them in the absence of their gender identity, using the incorrect pronoun, or using the incorrect pronoun. Deadnaming means when somebody is being referred to by their birth name rather than by their actual name.
Because they believe they are forgotten, these things have significant effects on an individual. They’re not being honored by who they truly are. Imagine that that’s happening every time you go to a physician’s office or a healthcare system. You are most likely going to be irritated. You’re probably going to be disappointed. You are probably going to think, “Hey, they don’t care about me as a person, and maybe I should seek my care in a different healthcare system where they might honor me.” But I also might not even seek care altogether because everywhere I go, I might experience stigma or misgendering.”
Another aspect of this is that many of us in the healthcare industry may not be culturally competent to comprehend differences between cultures, from other LGBTQ plus-related health issues, or pertinent, cultural nuances that are from the LGBT community. Also going back to your initial point of intersectionality, cultural differences with ethnicities and race, or gender cultural competence.
Having said that, when we lack cultural competence and don’t educate the healthcare staff and providers about cultural sensitivity and competence, it can perpetuate the stigma and reinforce implicit biases in the offices, and again, patients see it. People who belong to minoritized and marginalized communities feel it, see it, recognize it, and that furthers the wound that they carry.
Nicole Nfonoyim-Hara: These sorts of cycles of not being recognized, not being honored, and seen, and you mentioned, particularly with trans and non-binary patients, there have been national surveys that have found that these patients in particular have to be in a position to educate and teach their providers often, as you said, and you mentioned on the provider side, some of that cultural competence. What kind of training, if any, do providers receive in relation to LGBTQI health? What do you recall from your own training around this?
Dr. Victor Chedid: Training on specifically LGBT cultural sensitivity and cultural competence can vary from university to university, from med school to med school and from institution to institution. There’s no curriculum that is set and provided at institutional levels that is quite mandated. Technically speaking, that is unreal. In my med school in Lebanon, we had a lot of training on societal impact and social determinants of health in medicine and recognizing how different social determinants of health can impact healthcare outcomes, but we never had a specific curriculum on LGBTQ health.
I spoke with many of my American colleagues who attended medical school in the country. They also did not get that training in medical school. Now I’m talking 10, 15 years ago. These trainings are being implemented in medical schools by more and more medical schools, but they come more from those who work with the LGBT community and who are promoting LGBTQ health equity. They are acting as spokespersons or as organizers for the curricula to put them into practice.
Now I also know that, again, we get a lot of training, as physicians at different institutions on difficult communication skills, or things like how to prevent infections, or how to wear your mask properly, or how to dispose of needles, but we don’t have a specific curriculum that trains us on how to speak to LGBTQ+ individuals, what disparities that they face, and things like that.
Nicole Nfonoyim-Hara: It seems like things are changing, but there is still a need for that. There’s also this sense that for so long the mainstream health conversation around LGBTQ community has been around HIV/AIDS, which disproportionately and devastatingly impacted the LGBTQ community historically and many are still living with that reality. Why is it important for all specialties to be thinking about LGBTQI health and for LGBTQI health not to be reduced to a single story or narrative or legacy today?
Dr. Victor Chedid: Historically, in medical school, in our textbooks, whenever they wanted to teach us about something related to HIV or AIDS, it always had to be linked to an LGBT person. That leads to even more stigma. Whenever you see an LGBT person in a clinic, because of how our historical training has been linking those two together. Whenever you see an LGBT person, the first thing you think of: “Oh, do they have HIV? I will conduct an HIV test on them because it is very, very flawed and highly stigmatized.
Yes, the HIV epidemic impacted the LGBT community disproportionately. I think there were many delays in achieving milestones to stop the epidemic and get the treatments to the right people because it had a disproportionately negative impact on the LGBT community. But that’s changing and thankfully the people now live with HIV without having AIDS or there are many other treatments that we could use that prevent HIV. The LGBT community is very vocal about preventing the spread of HIV and has been very active with that, but recognizing that HIV impacts everybody, not just the LGBT community.
That brings me to the next point, which is that I must acknowledge that an LGBT person may have any of our practice’s other chronic illnesses. Certainly, it is very important to study and understand how the intersectionality of having an LGBTQ identity with other chronic illnesses can be impacted. I see individuals who have inflammatory bowel disease. That’s a chronic condition that lives with somebody for the rest of their life. It has many implications on needing medical treatments, procedures, surgeries. You might develop more severe forms of IBD if you are afraid to see your doctor because you belong to the LGBT community. That’s why it’s so important for us to study the intersectionality of an LGBT identity. All of these chronic illnesses aid in promoting health equity for people with various chronic illnesses.
Nicole Nfonoyim-Hara: An LGBTQ person can get any illness. The importance of being able to hold space for that patient no matter what your specialty is, and as you said, you mentioned your own work within gastroenterology. I’d love to make a little bit of a transition to that in order to learn about your own path to becoming a doctor and how your advocacy and interest for the LGBTQ community in that field started. How did that start for you?
Dr. Victor Chedid: I started medical school back in the early two thousand and I, as I said, went to medical school at the American University of Beirut in Lebanon, and throughout my years in medical school, part of why I went to medical school is because I wanted to do better for people. I saw a lot of injustices in my life growing up. Through wars, seeing people experience discrimination, and poverty, I’ve witnessed a lot of inhumanity growing up.
Going to med school to me was not only just to be able to sit in an office and treat patients, but it was to advocate for people and advocate for people whose voices cannot be heard, or their voices are being silenced.
As I’ve always said, we doctors have a big influence on how people are treated and how the future of healthcare looks, including removing several chronic illnesses that can be treated better or many that can be treated more effectively, and providing it in an equitable, fair, and just way so that everyone can receive the care they deserve.
As I went on, I moved to Pittsburgh and during my time in Pittsburgh, I was at the University of Pittsburgh there for my residency. I was working in inflammatory bowel disease research, working in the intersectionality of mental health and having IBD. I was very interested in the impact of having such a severe illness on depression, anxiety, and suicidality, which is a very important subject to address and recognize because we gastroenterologists do not routinely screen our patients for mental health issues, especially suicidality.
While we recognize this more and more, research is showing that individuals who are impacted by chronic gastrointestinal conditions and specifically IBD can have worse depression and anxiety. We as gastroenterologists have a new role to play in identifying these symptoms and directing people to the appropriate medical care they need.
I did research on that when I was in residency. Then, moving on to a fellowship at Mayo Clinic, it was a life-changing experience. I’m so privileged and blessed to be at an institution like Mayo Clinic because I recognize that as I’m training as a gastroenterologist, I’m learning all the ropes that you need to become a gastroenterologist, including the pathophysiology of diseases and the procedures that you need to do different clinical trials. But also, what Mayo provided me with was a simple space where I have a stage where I can continue to advocate and you could be very creative with how you take your career.
I now feel like I can use my voice and choose to use my voice for all people and everyone who belongs to underrepresented or marginalized communities because I firmly believe that this is how we can achieve health equity by working hard for it every single day. This is done through proper mentoring and collaboration with so many people around me.
Nicole Nfonoyim-Hara: Thank you for sharing that powerful journey, Dr. Chedid. I love the ways in which you’ve articulated how this call to medicine was also a call to advocacy for you and how you saw those two things going hand in hand, in terms of this platform and the creativity that you had, to create a space and to think about how you could do that advocacy within your work at Mayo Clinic and beyond.
One of the ways I think that that has manifested itself is in this inflammatory bowel disease clinic. I want to know a little bit more about the purpose of that clinic and how it has made the LGBTQI community safer and more accessible.
Dr. Victor Chedid: It is crucial that we as physicians, as providers, and at healthcare institutions, make it clear that we are welcoming spaces and that people of all races, ethnicities, and all marginalized groups are being affirming in our spaces.
In order to do that, you have to declare it. Because when you don’t declare that you are an LGBTQ affirming space, people wouldn’t know. Because of the stigma they might have previously experienced in healthcare, I said that if someone is suffering in silence, they are looking for a doctor or center that is LGBTQ affirming. They are probably afraid to go to any place that doesn’t actively declare that we are LGBTQ affirming. I’ve had the opportunity to hear from several LGBT patients in the IBD clinic.
I recall somebody who was denied care, and when they came to us at Mayo Clinic, their Crohn’s disease was quite severe by the time they came to us because they were denied care locally. That person was like: “I wish there was a clinic that looked at patients who have IBD and belong to the LGBT community in a way that is affirming to them and that provides them with that safe space. “
I was like, let’s look and research. Is there anything else that compares? I know there are several LBTQ plus centers across the country. For example, in Stanford or UCSF they have a center which provides more primary care, but I have not seen subspecialty clinics that specifically focus on LGBTQ health.
We don’t know what we don’t study, but I am aware that someone who has inflammatory bowel disease and belongs to the LGBTQ+ community might have specific questions or needs that we can address.
This has not been researched before. I came up with the idea of trying to create a space that is an affirming space called the IBD Pride Clinic because there are no prior subspecialty clinics that focus on LGBTQ health and IBD and there isn’t much research that we understand the impact of the identity on this chronic illness. I brought it up to my administrator, Stephen Fisher at the time, and the chair of gastroenterology and vice-chair, Daryl Pardee and Laura Raffles, and I got direct support. They thought this is such an amazing idea and wanted to see how we could make it happen. So, it took a little while. It took around two years of research. What steps can we take to bring about it? How can we implement it in our scheduling system so folks belonging to the LGBT community can opt in to be seen in the IBD Pride Clinic?
But not everybody who belongs to the LGBT community who has IBD will be scheduled in that clinic. Instead of making everyone who belongs to the LGBT community attend the IBD Pride Clinic, they can simply choose what I thought was a great idea.
We do have the IBD clinic where all my colleagues are very capable and well-versed in taking care of all patients, including all the LGBTQ+ patients. Therefore, the IBD Pride Clinic’s main goal was to promote awareness and assure the LGBT community that we have a safe place for you.
If you are in the IBD clinic at Mayo, or in the IBD Pride Clinic at Mayo, and you belong to the LGBT community, you are going to be treated the same, and you are going to be honored. The point of the IBD Pride Clinic is to declare to the world that we have that safe space for you, and that we’re ready and welcoming and wanting you to come seek your care with us in a safe affirming space and we strive to keep your needs at the center of all our endeavors, just like the Mayo Clinic always says—the clinic’s value is the patient’s needs come first.
Nicole Nfonoyim-Hara: That is the first thing you posed as you posed the question about being intentional, declaring, and being declarative, and how that is significant. I think sometimes when we’re trying to make space or we’re thinking about how we tackle these big issues, we’re like, “Oh, you know, I don’t want to exclude, or I don’t know how to be inclusive or affirming in the right way.”
As you’ve shared, for the growth of the Pride Clinic, the IBD Pride Clinic, this outward-facing part was such an important part of that process of conducting that outreach and engaging the community to think about it and that there’s a choice too. Your care will be held, and you will be honored in both spaces, but this one in particular is for you. That is the declaration. I appreciate it. That really made a difference in how I thought about other areas where advocacy work is being done and how crucial it is to be very intentional about the space you’re making for the community.
I think sometimes also in conversations around health disparities and inequities, it can feel very disempowering, right? It could feel like the issues are so insurmountable. All of your work, and the time we’re giving up here in this podcast, is about reflecting on how we can all feel empowered, as patients, as doctors, and as supporters of everyone around us.
In terms of patients, how can patients feel more empowered? What tools are available to LGBTQ patients to help them fight discrimination against themselves or their loved ones who are facing discrimination because of their sexuality, gender identity, and expression?
Dr. Victor Chedid: There’s so much that we feel like we want to change. We try our best to stop injustice at once because there is so much injustice in our environment.
For somebody who belongs to the LGBT community, they have that gut feeling, that instinct. They are aware of how discriminating against them is carried out, they are aware of that microaggression, and they are aware of what it feels like when someone intentionally misdiagnoses or disrespects their identity.
I always tell people, trust your instinct, trust that gut feeling. If you are feeling uncomfortable or feeling that you are discriminated against during a healthcare encounter, then you probably are, and it’s probably better for you to try to seek care elsewhere. Or it might be worthwhile for you to research the options available at the Mayo Clinic for the patient experience office, which is one of the options.
I empower you to go speak up and say, I feel like I’m being discriminated against. That is very important to speak for yourself because it highlights gaps that some people might have and crucial things that a particular center might need to work on, such as adding more cultural sensitivity training to their staff or making system changes that make their environment more welcoming. Again, trust your instinct. Advocate for yourselves.
Try to look for LGBT-affirming organizations. You can look at websites: institution websites might state who is an LGBT affirming provider, or there are other online directories that folks can look at LGBT affirming healthcare providers. Find organizations that are affiliated with your chronic illness, such as the Crohn’s and Colitis Foundation and IBD support organizations.
There are so many support groups that you can find to join. People who are going through the same experiences as you are.
Nicole Nfonoyim-Hara: I appreciate you, Dr. Chedid. We’ve primarily been discussing out patients, but we also know that LGBTQI trainees and staff and faculty face unique challenges. What are some ways that trainees, faculty, staff can seek support and how can allies work to create an inclusive and affirming culture for their colleagues?
Dr. Victor Chedid: That is also very important because when you are a member of the LGBT community and going through your training to work as a doctor or healthcare provider, you may encounter many challenges that are similar to those that patients face: stigma, discrimination, or not being recognized by your identity.
Probably going back several years, there have not been many LGBT-friendly advocacy groups within medical societies. People who belong to the LGBT community and were previously in medical school were forced to repeatedly conceal their identities. That’s how they passed through all the medical training and then became physicians.
I know folks who are much older than I am, who have never come out in their life and have hidden their identity from their colleagues and their trainees and kept their personal life private from their professional life, thinking that’s how they could pass through. However, we also know that when you’re not at ease or out with your identity, that can increase your risk of depression, anxiety, and suicidality, which is a very serious issue for doctors. So, imagine if you were also unable to be your true self at work and show up as your authentic self. That worries me.
Creating affirming spaces for physicians is very important. Creating affirming spaces for medical students is very important. When you see someone who is older than you, who belongs to the community, who is advocating, who is out and proud and is conducting research in these areas of LGBT health equity, you might think, “I can be that person.” If you don’t see somebody like that, you’d probably feel, “I can’t, I should stay closeted or I should keep hiding, because this is how I could pass.”
There are different specialties that are more LGBT welcoming than others, but at the end of the day, the wave is changing, and I’m seeing a lot of advocacy groups that are growing. It’s very refreshing to see. I’m seeing ENT groups and LGBT orthopedic groups in surgical specialties. I’m seeing in pulmonary LGBT sections in the pulmonary societies, OBGYN societies, as well as the GI societies. Within our GI societies, Rainbows and Gastro is now a group dedicated to promoting equality. It is a group of LGBT gastroenterologists who got together and created that safe space for advocacy for trainees, for physicians, for patients, and by creating these spaces, it allows these medical trainees or undergrads to recognize that, “Hey, I could be that person.”
They can connect with these organizations to get advice on how to network, get research, and get involved in finding new jobs. And I think this is very exciting. It will have a greater impact on the environment and the field as a whole, and it will be more positive.
Nicole Nfonoyim-Hara: Thank you. Thank you for sharing that powerful and refreshing note around the change that’s happening and that you’re seeing. According to research, having providers who feel supported, feel included, and are represented also results in better patient outcomes.
It’s this beautiful ecosystem and culture that we’re trying to change here, so thank you so much for your work in this space, and thank you so much for joining us today. Dr. Chedid, you’ve shared such important perspectives on LGBTQI health and health equity.
The LGBTQI community encompasses so many identities, experiences, and lived realities, and you provided us with some real key ways to think about how to cultivate more inclusive, affirming and safe spaces and cultures. We once again appreciate your involvement in this crucial work, your advocacy, and of course, your story. Your work with the IBD Pride Clinic serves as a model for how that work can be done in medicine.
Dr. Victor Chedid: Well, Nicole, thank you so much. This has been so refreshing and exciting, and I’m really appreciative that you had me on this great podcast.
Nicole Nfonoyim-Hara: Well, thank you, Dr. Chedid. That’s all for today’s episode of the Rise for Equity podcast by Mayo Clinic. Nicole Nfonoyim-Hara, your host, and we hope you’ll join us for our upcoming episode. We’ll see you then.
The views expressed are the guest’s personal views and do not necessarily reflect the policy or position of Mayo Clinic.
