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msJAMA
October 6, 1999

Uneasy Partners: The Lesbian and Gay Health Care Community and the AMA

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JAMA. 1999;282(13):1287-1288. doi:10.1001/jama.282.13.1287-JMS1006-3-1

Organized medicine's increased acceptance of lesbian and gay physicians and patients indicates greater recognition that sexual orientation influences health care delivery. The American Medical Association's (AMA's) 20-year history relating to these issues reflects the evolution of organized medicine's response to sexual orientation concerns.

In December 1973, the American Psychiatric Association deleted homosexuality from its list of mental disorders. Though no longer a diagnosis requiring correction or treatment, homosexuality remained controversial in the medical establishment. At the AMA's 1980 annual meeting, the House of Delegates, via a Medical Student Section (MSS) resolution, requested a "study of the health care needs of homosexuals."1 The resulting report by the Council on Scientific Affairs was adopted as policy in December 1981 and published in JAMA.1,2 The report "encourag[ed] the development of educational programs for homosexuals to acquaint them with . . . sex-preference reversal in selected cases," and acknowledged that "some physicians may be less than objective in dealing with a professed homosexual if they harbor traditional antihomosexual biases or disapprove of the politics of ‘gay liberation.'"2 The report also suggested that such physicians might miss disease manifestations common in gay and lesbian people and concluded that "an open, accepting, non-judgmental attitude . . . can be difficult for some physicians to achieve when treating a homosexual patient . . . but a sick individual—heterosexual or homosexual—deserves the best care that the psychiatric or other medical condition demands."2

At this time, a California-based doctors' group approached the AMA's national leadership seeking to form a lesbian and gay caucus. The request was denied. The group organized the American Association of Physicians for Human Rights (AAPHR) in 1982. That summer, AAPHR made the first public appearance of an organized gay and lesbian physician group in San Francisco's annual gay pride march (L. Siegel, MD, oral communication, August 1999).

Efforts to establish policy on issues of sexual orientation continued within the AMA. At the 1988 interim meeting, the MSS adopted Resolution 26 urging the Liaison Committee on Medical Education (LCME) and the Accreditation Council for Graduate Medical Education (ACGME) to amend standards to prohibit discrimination in admissions decisions because of sexual orientation. This was adopted as organization-wide policy in 1989.3 However, the LCME and ACGME have yet to modify medical schools' and residency programs' accreditation standards to protect lesbian and gay applicants.4,5

More contentious was the adoption of internal policy. Prior to 1993, AMA bylaws made no reference to sexual orientation in the nondiscrimination clause. In December 1989, the District of Columbia's delegation proposed amending clause B-1.50 so that membership could "not be denied or abridged on account of sex, color, creed, race, religion, ethnic origin, national origin or sexual orientation."6 Although the reference committee saw "no good reason not to prohibit discrimination on the basis of sexual orientation," floor debate was heated. Delegates presumed that the resolution intended "endorsement [of] an alternative lifestyle" and was "too prescriptive."7 The resolution failed.

The Resident Physicians Section offered similar language in December 1991, citing failure to revise the bylaws as de facto discrimination. Several delegations expressed support, but the majority opposed. One dissenter did not "want to make or give minority rights to this group of people."8

Finally, in June 1993, citing 7 failed resolutions on the subject, the AMA's Board of Trustees, led by chair Raymond Scalettar, issued Report A, recommending that the bylaws' nondiscrimination clause be amended to include sexual orientation (A. Novick, MD, personal communication, August 1999). Debate was no less contentious 5 years later. Delegates worried that the AMA would be seen as accepting a "deviant lifestyle" or succumbing to "outside pressure groups."9 Then AMA President John Clowe spoke strongly in favor: "All these individuals want . . . is some recognition without fear to appear at this House. . . . We are not condoning it. We are merely saying it is time for this House of Delegates to vote for the approval of including sexual orientation in their Bylaws." To the sounds of cheers and applause throughout the chamber, the House of Delegates approved the change in bylaws.9

The end of the tumultuous 5-year battle to amend the AMA bylaws prompted other organizations to make more expeditious changes.10 In October 1993, a statement from the American Academy of Pediatrics charged pediatricians to care for gay and lesbian adolescents' health concerns.11 The American College of Physicians–American Society of Internal Medicine linked effective patient care to the equal treatment of physician colleagues, regardless of "race, religion, ethnicity, nationality, sex, sexual orientation, age, or disability."12 In 1996, the American Academy of Family Physicians adopted policy supporting equal treatment of lesbian, gay, bisexual, and transgender (LGBT) physicians, patients, and their families: "By encouraging diversity in their physician workforces, physician groups and health care systems can help ensure their ability to deliver culturally competent care to all segments of their patient populations."13 Meanwhile, on National Coming Out Day in 1994, to obtain greater visibility as the premier national organization advocating for gay and lesbian health care, AAPHR renamed itself the Gay and Lesbian Medical Association (GLMA).14 In August 1996, GLMA broadened its focus by incorporating bisexual and transgendered patients' health concerns into its mission statement.

In successive years, the AMA amended civil and human rights policies to be inclusive of sexual orientation.15,16 In addition, the Council on Scientific Affairs commissioned another report, "Health Care Needs of Gay Men and Lesbians in the United States." The report, published in 1996, cited 126 sources and provided a substantial summary of pertinent literature on gay and lesbian health care.17

A new force for change emerged in 1998, when the MSS convened the first-ever meeting of a lesbian, gay, bisexual, and transgender caucus to serve as a resource for LGBT members and as a center of policy development. At the interim meeting in Honolulu, caucus members secured passage of a medical student resolution calling for organizational support of the Hate Crimes Prevention Act of 1999. Upon transmittal at that same meeting to the AMA's House of Delegates, the resolution won passage.18 Similarly, in June 1999, the caucus organized intersectional support for a resolution petitioning the LCME to adopt a standard requiring nondiscrimination clauses including sexual orientation at all medical schools. At its fall meeting this month, the LCME will consider such language and potential adoption of the new standard. Also in June 1999, the MSS and the caucus sponsored an educational program on primary care of the lesbian, gay, and bisexual patient, with similar plans for future meetings.

A recent issue of American Medical News profiled GLMA, noting its growth to 2000 members and its impact on promoting quality health care.19 Recently, as part of the cultural competence initiative, the AMA published a compendium including references to sexual orientation and citing GLMA as a contact.20

Internal policy commits the AMA to being a leader in lesbian and gay health concerns. Having articulated this commitment to diversity in medicine, the AMA could now provide standards of ethics, practice, and education that would break new ground in this field. Objectives could include acting as a clearing house on cultural competency and related lesbian and gay health care issues; collaborating with GLMA and other organizations in advocacy, initiatives, and legislative efforts; and improving the organization's internal environment by appointing gay and lesbian members to committees and task forces, welcoming GLMA representatives to the House of Delegates, and increasing membership recruitment efforts targeted at lesbian and gay physicians and medical students.

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Article Information
Acknowledgment: The authors wish to thank Lila Valinoti, AMA Medical Student Section policy analyst, and Robert Tenuta, AMA reference archivist, for their research assistance.
Proceedings of the American Medical Association are copyrighted by the AMA and reprinted courtesy of the AMA Archives.
References
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