Aliya Feroe remembers the doctor who sent her to another doctor after learning she identified as queer.

The doctor who would not treat her was a woman who specializes in women's health.

For Rhi Ledgerwood, it was a doctor advising about things like pregnancy prevention. Ledgerwood was designated female at birth but now identifies as transgender and does not have sex with men. Transgender people have a gender identity different from that designated at birth.

For Tim Keyes, it is when doctors thought he was sexually active with women. But he had no interest in having sex with women. When he was 17 years old, Keyes announced that he was gay.

Ask any LGBTQ patient about their experiences with doctor visits and chances are they will have an unpleasant story to tell. The term LGBTQ is short for lesbian, gay, bisexual, transgender and queer.

When doctors think all of their patients are heterosexual, those who identify in other ways can feel ignored. They also are less likely to seek medical care. This can lead to health problems including high rates of depression, suicidal behavior, alcohol and drug use and ineffective health screenings. That information comes from LGBTQ advocates in the United States.

But changes are coming to the medical field, these advocates say.

Feroe displays a button resembling a Harvard School of Medicine coat of arms lion, in rainbow colors that symbolize LGBTQ pride, left, and a button featuring pronouns, center, on the lapel of her lab coat.

Reaching out to LGBTQ individuals

For example, the American Medical Association, or AMA, promised in November to push for a federal ban on conversion therapy. The treatment attempts to turn members of the LGBTQ community into heterosexuals.

In addition, U.S. medical schools are expanding education on LBGTQ health issues. And some schools are pushing to have more LGBTQ medical students.

Research shows that patients often get better care when treated by doctors who are more like them.

Feroe, Keyes and Ledgerwood are part of that movement. They are all studying for careers in medicine.

Feroe is a third-year medical student at Harvard University in Massachusetts. She told The Associated Press that LGBTQ doctors should be treated like other members of the medical community. She also thinks LGBTQ patients should get the same quality of care other patients get.

Increasing LGBTQ student enrollment in medical schools and training in LGBTQ health issues can help reach those goals, advocates say.

Exact numbers of these medical students and doctors are unknown. In 2018, the AMA added sexual and gender identity to the information members could choose to include on their profiles. Of the 15,000 doctors and students who have volunteered that information so far, about four percent identify as LGBTQ.

Changes at Harvard

In autumn of 2019, Harvard's entering class of medical students was 15 percent LGBTQ, a high rate that is no accident.

Harvard asks students if they want to be identified as lesbian, gay, bisexual, transgender or queer. An answer is not required, but the choice "sends a message that you're wanted," said Jessica Halem. She works with LGBTQ students at the medical school.

"We know that doctors need to look like and be a part of the communities they serve," Halem said.

"We have gay Muslim students, lesbians from China; students who are survivors of conversion therapy," she said. "They are now out and very proud gay people and they are healing those wounds."

In the beginning, Aliya Feroe planned to present herself as heterosexual in medical school. She feared that making the truth known would cause patients to dislike her and make her feel different from the other students.

But Harvard has an active LGBTQ student group and teachers who ask students what their chosen pronoun is. It also has classes dealing with LGBTQ medical care.

During a recent visit to one of Harvard's sister hospitals, Feroe was happy to see some patients there with their same-sex partners. She said doctors who were training her "smoothly asked about people's lives" and were at-ease "when learning patients were queer." All are important steps, Feroe says, toward offering non-judgmental "patient-centered" care.

The Association of American Medical Colleges reports that while most schools offer LGBTQ courses, half reported three or fewer classes, group discussions or other learning activities.

And a study of medical students published in March 2019 found a serious lack of knowledge on LGBTQ health issues. Carl Streed was the lead writer of a report on the study. He is a doctor and an associate professor at Boston University's medical school.

Streed said that a bad experience with a doctor 15 years ago when he was sick made him want to join the medical field.

When he told the doctor he was gay, the doctor became very unfriendly and then "suggested HIV testing, left the room and never came back." Streed was a young student at the time.

Testing elsewhere showed he did not have the virus, but no one suggested tests for infections more common among college students. And he never found out what his sickness was.

Streed said doctors' personal beliefs should not affect their quality of care and kindness toward patients.

Tim Keyes started attending Stanford University's medical school in 2015. Back then, LGBTQ health issues were only discussed in one unrequired class that had low enrollment. But now expanded coursework is part of the required study program.

Two years ago, Keyes was among six students at four universities who created the Medical Student Pride Alliance. The group now operates at 31 universities across the United States. Its aim is to get more LGBTQ students into medical schools, push for more informed coursework and improve LGBTQ medical care.

Lindsey Tanner reported this story for the Associated Press. Alice Bryant adapted it for Learning English. George Grow was the editor.

_______________________________________________________________