“An environment welcoming all teens”

I would love to say that I have not blogged in nearly two weeks because there has simply been nothing so troubling as to warrant me taking to the keyboard to share my thoughts in the matter. As if! As the expression goes, “life happens,” and life for me the past couple of weeks has been extremely busy. But I am not going to talk about what’s going on in my life. I am not even (for now) going to talk about the government shut down. What I am going to talk about is the American Academy of Pediatrics.

This organization represents more than 60,000 pediatricians across the country. According to its own web site the AAP is “dedicated to the health and well-being of infants, children, adolescents and young adults.” In late July the AAP posted on its web site a technical report entitled “Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth,” written by Dr. David Levine of the Committee on Adolescence, and also published in the July issue of Pediatrics. The article provides recommendations for pediatricians on how to answer questions from youth with questions about their own sexuality or that of their parents, relatives and friends.

Specifically, the article states, “Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. This includes having supportive, engaging office staff members who ensure that there are no barriers to care.” Notice what this says if you read between the lines: not having an environment that is welcoming to “sexual minority youth” and not having staff members who are supportive of such behavior is a barrier to care. Furthermore, the article states, “For transgender youth, pediatricians should provide the opportunity to acknowledge and affirm their feelings of gender dysphoria and desires to transition to the opposite gender.” In other words, pediatricians and their staffs need to ” express agreement with or commitment to” and “support” the desire for a young person to transition to the other gender. That is the definition of affirm. And remember, failing to take this supportive approach is a barrier to care!

The article further states that LGBTQ youth are most damaged by the heterosexism that is the “societal expectation.” One has to wonder where Dr. Levine and his colleagues live, though, because he also writes, “Pervasive in our culture, homophobia is institutionalized in stereotypes promoted in the media and in casual conversation.” Oh really? I think what is promoted in our media aggressively and, unfortunately, successfully, is the notion that homosexuality and other “alternative lifestyles” are quite acceptable and normal.

Levine writes, “Pediatricians have a role in helping teenagers sort through their feelings and behaviors. Young people need information about healthy, positive expressions of sexuality, and pediatricians should assist adolescents as they develop their identities and to avoid the consequences of unwanted pregnancy and sexually transmitted infections (STIs), regardless of sexual orientation. Research suggests that LGBTQ youth really value these opportunities for discussions with their pediatricians or primary health care providers.” I would agree with the doctor if this statement could be taken at face value. However, we must remember what he writes elsewhere in the article. Remember, according to Levine and the AAP, pediatricians and their staff members cannot help adolescents through the difficult teen years and the sexual questions that may emerge unless they affirm and embrace every version of sexual relationship–Lesbian, Gay, Bisexual, Transgender and Questioning. They cannot help teens avoid sexually transmitted diseases unless they are willing to affirm that kind of behavior in any pairing. Forget encouraging abstinence or suggesting that sex should wait until marriage; after all, that might damage someone’s psyche and result in lifelong mental anguish.

Later on in the article Levine writes, “Pediatricians have the responsibility to provide culturally effective care to help reduce health disparities.” Seriously? I would think medically effective care would be the standard. It seems to me that the pediatrician’s foremost responsibility would be the health of the patient. Apparently not, or least not that exclusively. Now, the care provided must be “culturally effective.” Translation: do not even think about taking any attitude other than affirming the “alternative lifestyles.”

Levine writes, “Being gay, lesbian, bisexual, transgender, or questioning, is not a ‘problem’ or ‘risk behavior’ in itself.” That’s interesting. Let’s set aside the fact that homosexual behavior is a sin, which certainly qualifies it as a “problem.” Levine’s statement is interesting because prior to making this statement he spent a considerable chunk of his article addressing the mental health disparities, eating disorders, substance abuse, sexual and reproductive health disparities and general health disparities of LGBTQ young people. It would seem, then, to the uninformed (like me) that this is a risk behavior “in itself.” But as I said, I am evidently uniformed. The problem comes not from the behavior, but from the fact that parents, physicians and the culture as a whole fails to embrace and affirm LGBTQ youth, thus driving them to homelessness, despair, poor self esteem and, eventually, highly risky behaviors.

Levine says, “One of the challenges to health care is removing barriers to care and creating an environment welcoming all teens.” By that he means, of course, that LGBTQ teens must feel welcomed. One of the ways to do that is to use gender-neutral terms when questioning or discussing sexual topics with patients. Why? Well, because… After all, “A nurse asking a teenage girl who is in a relationship with another woman about her boyfriend may be interpreted as nonaccepting of her relationship.” Furthermore, the office needs to be decorated in such a way as to welcome LGBTQ youth. “The office environment can be made welcoming for all teens by placing in the waiting room items such as brochures on a variety of adolescent topics, including sexual orientation, posters showing both same- and opposite-gender couples, and notices about support groups, if available in the region. … Even a small ‘rainbow’ button (often a symbol of acceptance of sexual minority individuals) or decal on an office bulletin board or door symbolizes openness and acceptance of diverse sexual orientation and will be appreciated by sexual minority teens and their parents.” Of course what Levine overlooks, or ignores, is that this kind of behavior and this kind of decor will absolutely not make the office welcoming to “all teens.” Many teens and parents would be offended by the things Levine describes. But remember, that is our insidious heterosexism.

Levine concludes his article with these statements: “Pediatricians have an obligation to ensure that sexual minority youth have access to a full range of appropriate health care services. As with all adolescents and young adults, sexual minority youth need honest answers and compassion in dealing with issues and questions around sexual orientation, identity, and sexual behaviors.” Of course pediatricians must provide all necessary medical care for their patients, regardless of their gender identity or sexual orientation; no sane person would argue otherwise. Levine, however, completely misses the fact that his entire article goes about making sure that pediatricians their staff members do not provide honest answers about “sexual orientation, identity, and sexual behaviors.” We cannot both tell people what to think, what to say and how to act and encourage them to be honest. We cannot tell people that what is sin is simply an alternative and then ask them to be honest. But then neither can we tell doctors to do everything they can to welcome and affirm lesbian, gay, bisexual and transgender individuals and simultaneously tell them make sure all patients feel welcome and comfortable.

Every human being is entitled to be treated with dignity and should be cared for when their health is endangered, regardless of who or what they think they are or claim to be. Beyond that, though, Dr. Levine and the AAP are no better than the elixir salesmen of the Old West; they’re saying a bunch of stuff that sounds good but has no legitimacy and no substance, and they’re promising something that just ain’t gonna happen.

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