Showing posts with label Medical Doctor. Show all posts
Showing posts with label Medical Doctor. Show all posts

July 16, 2019

Looking for a New Doctor or Might in the Future Look for One? Read On

Finding a good primary care doctor can feel a little bit like dating. It's awkward. Your expectations are high. You know it's rough out there, but you're still secretly hoping to find the one.

So where do you begin? Just like dating, finding a doctor you click with is all about trusting your intuition. 

How To Get The Best From Your Doctor

"What you get in a snapshot isn't that far from the truth," says Dr. Kimberly Manning, a primary care doctor and associate professor at Emory University. "In terms of interactions, in how someone talks to you — I think those things can be really powerful markers to help you decide if this is a good fit."

It's worth it to get this relationship right. Your primary care doctor is your first point of contact in the health care system, someone who knows the full you — not just your kidneys or your heart. The doctor is there to help prevent you from getting sick and guide you through a complicated network of hospitals and specialists if you do become ill.

And research shows that having a primary care doctor you feel comfortable with can be critical to your well-being. A 2005 paper by Johns Hopkins pediatrician Barbara Starfield found that robust relationships with primary care providers help prevent illness and death and can help reduce racial and socioeconomic health disparities.

Shop around

A good place to start your search for a primary care provider is the directory of in-network doctors that your health insurance provides. By the way, your primary care provider doesn't have to be a doctor — you can also work with a nurse practitioner or physician assistant; both of these types of clinicians are fully qualified to handle your care.

You can call around to different offices and make preliminary appointments with different providers, so you can get a sense of which ones you like. This kind of doctor shopping is common when expectant parents interview different pediatricians — totally OK for grown-ups, too!

If you don't have insurance, don't give up. Many community health centers see uninsured patients free or for a sliding-scale fee. To find one, search online for "federally qualified health centers" near you.

Know your needs: convenience vs. complexity

As you start to narrow your search, Manning recommends asking yourself some questions about what kind of patient you are.

If you're young and pretty healthy, it's totally fine to prioritize convenience. Look for a doctor who is close to your home or work. Many offices offer evening or weekend hours, and some will do virtual visits for simple problems like a urinary tract infection or a cold. You can and should call and ask about amenities like these when you make your first appointment.

But for those of you who have some medical problems or have been hospitalized in the past year, it's important that you see a primary care doctor who shares electronic medical records with any specialists you see. This allows your doctor or nurse to communicate with your specialists about your treatment plan — which can be crucial for your health.

Rethinking Weight Loss
Rethinking Weight Loss
Sleep Better With Help From Science
Sleep Better With Help From Science
Eat Your Way To A Healthier Life
Eat Your Way To A Healthier Life

"As a practicing physician, I know how much better it is for us to take care of patients when we can all see the electronic medical record of what's been going on," Manning says. "It just allows for continuity."

All of this means you should probably look for a doctor who works for the same hospital system or physician's group as do a variety of specialists and hospitals. You can find this out on your doctor's website or by asking when you call the office. Be aware, this isn't the same thing as checking whether the doctor is in your insurance network.

Look for a personal connection

The most important factor is that you feel comfortable with your provider. Be on the lookout for someone who makes eye contact and who listens without interrupting.

It's about more than just pleasantries. Going to a doctor or nurse who is empathetic can actually help you stay on top of taking your medications and getting the preventive tests you need.

"Find somebody who is curious, who asks questions that let you know that you're being heard," says Sana Goldberg, a nurse and the author of How To Be A Patient.

If you're a person of color, there's research that shows that having a minority physician may be good for your health. One recent study showed that when black patients have black doctors, for example, they're more likely to get recommended preventive services.

And if English isn't your first language, it may be a good idea to call different doctors and see whether you can find one who speaks your native language.

Breaking up

So what if you have a doctor but things haven't been going so well? How do you tell your doctor, "I think we need to talk?"

First of all, you shouldn't hesitate to give your provider feedback. We promise: Your doctor really does want to hear from you about what she could be doing better.

Start with personal language about how your doctor makes you feel, and try to keep your feedback specific. You can try something like: "It makes me feel dismissed when you look at the computer more than me." Or, "I am having a hard time understanding the plan. Can you use less medical terminology?" 

And if you've given all this a shot, and still feel you aren't connecting with your doctor? It may be time to break up, Goldberg says.

"If you feel like you've made an effort and you're not heard, you're not listened to, it's always OK to find somebody else," she says.

When you meet new potential doctors, feel free to tell them what wasn't working with your old one — it will help make sure you start off on the right foot.

It may be frustrating to start your search again, but it's worth it to find a doctor who really gets you. Your health depends on it.

Mara Gordon is a physician and the 2018-2019 health and media fellow at NPR and Georgetown University. In August, she joins the faculty at Cooper Medical School in Camden, NJ.

December 3, 2018

This Angel Doctor is Responsible For Lowering HIV Rates/Deaths in NYC, Young and Gay He Was in The Middle of It

 On a brisk November afternoon at Mount Sinai Comprehensive Care Clinic in Manhattan, Dr. Demetre Daskalakis sat in a brightly lit exam room, clicking away on a keyboard as his next patient walked in. The patient was in his 50s, and his first question was about his mental health. He felt depressed, but he didn’t know why. The patient recently stopped smoking and drinking, and an abdominal pain had him worried. He said his libido was nonexistent, even though he had a regular partner.

“How much of it do you think is because of your brain, and how much of it is because of your penis?” Daskalakis asked. He peppered his patient with questions about the nature of his erectile dysfunction. 

Eventually, Daskalakis discussed the patient’s HIV viral load and CD4 count, markers of the progress of his HIV infection. The patient’s blood tests indicated his viral load remains undetectable — meaning the amount of HIV in his blood is so low, thanks to HIV medications, that he can’t transmit the virus sexually.

                                                                        Demetre Daskalakis speaks at the formal dedication ceremony of New York City AIDS Memorial Park at St. Vincent's Triangle on Dec. 1, 2016.

Daskalakis, 45, updated his patient’s cholesterol medication and wrote him prescriptions for six Viagra tablets and a flu shot. He gave the man a hug goodbye and, before he walked out, said “Text me.”

Daskalakis still sees patients, as he has since the late 1990s, but today he’s just moonlighting as a clinician. The infectious disease specialist squeezes his patients in around the busy schedule of his main job: deputy commissioner for the Division of Disease Control at the New York City Department of Health and Mental Hygiene, one of the world’s largest public health agencies.


Demetre Daskalakis speaks at the formal dedication ceremony of New York City AIDS Memorial Park at St. Vincent's Triangle on Dec. 1, 2016.Erik McGregor / Sipa USA via AP 

Since joining the city’s health department in 2013, Daskalakis has promoted a framework for treatment and prevention strategy that he calls “status-neutral care,” which uses the same approach to initial patient care regardless of one’s HIV status. This type of care is intended to reduce HIV stigma and encourage frank discussions about sexual health, HIV risk and prevention options.

Today, the results of “status-neutral care” are beginning to be seen in public health data. On Thursday, the city released its annual raw data on diagnoses, which showed a record low 2,157 new HIV diagnoses in 2017, a 5.4 percent drop from 2016. The decline is most dramatic among men who have sex with men, whose rate of new infections is estimated to be 35 percent lower than 2013.


Before entering the municipal public health world, Daskalakis earned a reputation as “a progressive, radical gay doctor,” according to Mark Harrington, the executive director of Treatment Action Group, an HIV/AIDS organization.

During a 2012-2013 meningitis outbreak in New York City, Daskalakis went straight to those most at risk — including men who have sex with men, patrons of commercial sex venues and weekenders in Fire Island — and set up a popup vaccine clinic, occasionally dressed in drag as a nurse to take the edge off the injection. The effort was so successful that by August 2013, the outbreak was contained, and officials credited this aggressive vaccination campaign with halting it, according to The New York Times. Shortly after the meningitis campaign, a position opened at the NYC Department of Health for assistant commissioner of the Bureau of HIV/AIDS Prevention and Control. Daskalakis said his “email sort of exploded with people saying, ‘Hey, you should apply for this.’” He threw his hat in the ring and was offered the job, and as he was deciding whether to accept the offer, he said his mind was made up after he received an email from Mark Harrington, saying, “History’s calling. Are you going to answer?”

Harrington recalled telling Daskalakis, “This kind of opportunity won’t come around again, and you’ve got a new [mayoral] administration, you’ve got a governor committed to ending the AIDS epidemic.”

Daskalakis said this made him realized the job offer came at an “opportune moment in the history of HIV in New York City.”

“There was an effort that was motivated by the community to look at New York City and New York State as a place where we could prove that we could end an epidemic of HIV,” he explained.


Around 2012, Harrington said it became clear that “we had the tools to bring down the rate of new HIV infections so drastically that it was possible — even without a cure or vaccine — that we could essentially end the epidemic in places where there was access to high-quality treatment and prevention.”

Part of the reason it was possible, he added, was the passage of the Affordable Care Act in 2010, which meant more young people and poor people were eligible for health insurance than ever before.

                                                                               Bottles of antiretroviral drug Truvada.

The way to end the HIV epidemic without a cure or a vaccine, according to Harrington, is by scaling up the use of two novel prevention tools: PrEP and TasP.

PrEP means “pre-exposure prophylaxis,” and it involves taking a daily Truvada pill to prevent HIV infection. Studies proving PrEP works were published in 2011. Since then, the government has recommended that more and more people consider the drug. This November, the U.S. Preventive Services Task Force recommended that doctors assess all Americans’ HIV risk, and counsel patients to take PrEP if they are at risk, including women who recently had any sexually transmitted infection, vastly increasing the number of people recommended to take the drug.

TasP means “treatment as prevention” and is a moniker given to the realization that HIV positive people can’t transmit the virus through sex if they are undetectable. Until 2015, treatment guidelines had HIV patients wait until their immune systems began to weaken before starting medication. Studies proving that starting treatment early helps HIV patients and also blocks transmission were published between 2008 and 2015.

“We were treating people late, and in many cases too late, to block transmission,” Harrington explained. When studies were published proving PrEP and TasP were both safe and beneficial, health bodies around the world overhauled their HIV guidelines and recommended that many millions more people begin taking antiretroviral drugs in order to control the HIV epidemic.

Harrington said this realization drove a “new wave of activism” at the 2012 International AIDS Conference in Washington, D.C. Activists began to talk about an idea that had been abandoned after the failure of HIV vaccine and cure trials: ending the epidemic.

In 2014, soon after Daskalakis joined the NYC Department of Health, New York Governor Andrew Cuomo announced the formation of “Ending the Epidemic,” a task force that would be responsible for devising a plan to use these new tools to draw down the state’s historically high HIV incidence. Daskalakis sat on the panel and was instrumental in developing the state’s robust PrEP program.


“The definition of ending HIV is a mathematical one,” Daskalakis explained. If New York City could get new infections down below 750 a year by 2020, he said new "transmission would no longer be fueling the epidemic."

When Daskalakis started work at the NYC Department of Health, he did so at a moment when it was suddenly possible, with proper inputs of political will and cold hard cash, to use antiretroviral drugs to engineer an end to HIV transmission in the city. The political will of Mayor Bill de Blasio and Governor Andrew Cuomo, he explained, helped secure the funding needed to scale up the distribution of expensive medications like Truvada.


Some of the language in this new HIV/AIDS prevention paradigm was coined by Daskalakis himself: “status-neutral care.” In an article in Open Forum Infectious Diseases, a medical publication, Daskalakis described status-neutral care as a “multidirectional continuum [that] begins with an HIV test and offers 2 divergent paths depending on the results; these paths end at a common final state,” which is the prevention of HIV transmission.

Daskalakis overhauled the city’s sexual health programs to make them status-neutral. STD clinics were renovated, streamlined and rebranded as “sexual health clinics.”

“All the services had to look alike, whether you're HIV-positive or negative, and the idea was that if you come in and you are newly diagnosed with HIV you get started on meds on the same day of your diagnosis,” he explained. “If you are at risk for HIV, and you test HIV-negative, we don't dilly dally and wait. We start you PrEP that same day.”

Ad campaigns that had attempted to shame people out of contracting HIV instead distilled prevention down to a simple formula: “New boo? Get tested!” That’s because in the status-neutral-care continuum, getting tested is the first step to getting a patient enrolled in PrEP or TasP.

An advertisement from the New York City Department of Health and Mental Hygiene.NYC Dept. of Health and Mental Hygiene / NYC DOHMH

Gone were the scare-tactic campaigns of the Bloomberg administration (one infamous YouTube ad showed a close up view of anal cancer). They were replaced by joyful, brightly colored ads that encouraged people to come in for STD testing. Joining those ads were public awareness campaigns aimed at underserved communities with higher-than-average HIV incidence, like Spanish speakers, transgender women and heterosexual women of color. For the past several years, New York City subways and buses have been plastered with health department PrEP ads.


The success of New York City’s revolutionary HIV prevention program is seen in the city’s declining rate of new HIV infections, but its success stark when compared to jurisdictions that haven’t implemented status-neutral care, or scaled up access to health care. The hotspots of HIV transmission today are in some of the poorest states that have refused to expand Medicaid, like Mississippi.

Daskalakis said his efforts prove the concept works, but he points to the challenges inherent in a model based on the distribution of expensive medications. “A lot of people doing this work are going from, ‘So now we can do it, we know we can,’ to 'How do you create sustainability?'”

Daskalakis describes the city’s new status-neutral-care regime as “the steam engine that's rolling through HIV in New York City and mowing it down in a pretty aggressive way.”

“We're reaping the benefits by consistently seeing HIV incidence decrease,” he said. Last week, in an announcement of the record low HIV incidence, the City of New York said the new data shows it is on target to meet its Ending the Epidemic goals by 2020.

June 24, 2018

A Canadian Dr. Shot By Israelis is Asking For Brand New Hospitals in Gaza

The doctor says $11m investment from Canada could bring stable electricity to about nine hospitals and 50 clinics in Gaza
Palestinian demonstrator hit in the face with tear gas canister fired by Israeli troops lies at a hospital in Gaza earlier this month (Reuters)
Jillian D'Amoursn  

 MONTREAL, Canada - A Canadian doctor who was shot by Israeli forces last month during protests in the Gaza Strip has taken his fight for health-care access for Palestinians to Ottawa, the Canadian capital.

Injured in Gaza Hospital

 Loubani is asking the Canadian government for $15m Canadian ($11m) to help expand a longstanding project that aims to bring 24-hour electricity to medical facilities in the besieged coastal enclave.
The renewable energy project, known as EmpowerGAZA, involves installing solar panels on the rooftops of hospitals and medical clinics.
So far, three hospitals in Gaza have been equipped with solar panels.  

The $11m investment would pay for the installation of solar panels on about nine other hospitals, as well as 50 medical clinics, explained Loubani, an emergency physician based in London, Ontario.
Loubani met with Prime Minister Justin Trudeau earlier this week in Ottawa, as well as several parliament members from all the major political parties, all of whom welcomed the idea, he said.
“I was very happy to see the general Canadian mood - that the health concerns of Palestinians in Gaza have to be taken seriously – reflected in their representatives from all parties,” he told Middle East Eye in a telephone interview.
“I think all the parties agree that we have to do something about the desperate health conditions that currently exist in Gaza,” he said. 
The image, tweeted by the prime minister's office, shows Trudeau sitting directly across from Loubani, at a meeting earlier this week.
The prime minister’s office redirected MEE to the ministry of international development.
Louis Belanger, director of communications in that ministry, said the department was "not currently in a position to comment specifically on Dr. Loubani's proposed project".
"We salute the humanitarian work that Dr. Loubani has done in Africa and the Middle East, especially today as we mark World Refugee Day," Belanger told MEE in an email.
He said Canada "remains deeply concerned" about the humanitarian needs of Palestinians, and acknowledges that "the limited supply of electricity exacerbates the situation".
Helene Laverdiere, an MP for the New Democrats and the party’s foreign affairs critic, said on Twitter the NDP supports Loubani’s request.
She urged “the Canadian government to fund this initiative, which will save lives in #Gaza”.
Gaza’s health-care network has been on the brink of collapse for several years, with frequent electricity cuts limiting available services and a shortage of medical supplies resulting from a strict blockade on the territory imposed by Israel and supported by Egypt.
In that context, providing reliable electricity to medical facilities is critical.
So far, solar panels have been installed at Beit Hanoun Hospital and the Indonesia Hospital, both in Beit Hanoun and at al-Aqsa Hospital in Deir al-Balah, after an online fundraising campaign garnered more than $215,000 in 2015.
The steady flow of electricity has allowed patients at each facility to benefit from “the most essential, life-saving” care, Loubani said.
“In these three hospitals, Palestinian patients never have to worry about whether or not there’s going to be a cut in power in the intensive care unit, in the operating rooms or for the dialysis units,” he said.
If there’s electricity left over after these essential services are met, it goes to power the hospitals’ emergency rooms.
The project’s effects go beyond direct medical care, however. 
Knowing their local hospitals will be able to respond to their needs – and importantly, that they won’t be sent away amid a lack of power – also provides Palestinian patients in Gaza with a sense of relief.
“They know that whenever they come to this hospital, it’s always working. They know that they can always receive care and doctors [w]on’t send them away,” Loubani said.
Loubani acknowledged that the Israeli blockade makes it challenging to get the necessary equipment into Gaza to install the solar panel systems.
Still, the difficulties don’t “make [the project] any less worthwhile”, he said. 
There is no timeframe yet for Canada’s possible investment, but Loubani said he’s hopeful Ottawa will come through.
“There is currently an unfolding health disaster in Gaza and as a doctor that is my primary interest,” he said.
“This is so clearly a humanitarian project, that I can’t imagine anybody objecting.”

January 25, 2018

US Drs.Are Still Doing Life Harmful Surgeries in Intersex Kids } Let us Show U

Medical professional associations should enact standards of care for intersex children that rule out medically unnecessary surgery before patients are old enough to consent, Human Rights Watch and interACT said in a report released today. After decades of controversy in the medical community over the procedures, the lack of centralized care standards allows doctors to continue operating on children’s gonads, internal sex organs, and genitals when they are too young to participate in the decision, even though such surgery is dangerous and could be safely deferred.

June 21, 2017

The Dr. is Out and How They Are Failing the LGBTQ Community

You can’t deliver proper care to a patient you don’t truly see. Too often, medical providers aren’t even taught how to look at sexual and gender minority patients.

“A physician is obligated to consider more than a diseased organ, more than even the whole man—he must view the man in his world, ” said Harvey Cushing, a pioneer of American neurosurgery. Leaving aside the gendered language, the sentiment remains true. In medical school, you’re cautioned to see your patients as entire human beings and not to reduce them to a mere collection of symptoms or diagnoses. Viewing them through the narrow gauge of their illnesses alone limits a provider’s ability to care for them comprehensively.

But learning to view LGBTQ people within our own particular world has been largely absent from medical education. By failing to incorporate material about the specific needs of gender and sexual minority patients into their curricula, medical schools have produced graduates who are less aware of those patients’ needs. This lack of awareness can have measurable ill effects. 

Earlier this month, a study in JAMA Internal Medicine documented a wide discrepancy between how doctors perceived asking patients about being LGBTQ, and how patients themselves responded to such questions. Noting that both the Joint Commission and the National Academy of Medicine recommend asking patients about their gender and sexual identities, the authors conducted a survey of emergency department (ED) physicians and nurses, as well as potential ED patients, including gay, lesbian, bisexual, and straight respondents. (Technically, everyone is a potential ED patient, after all.)

About 80 percent of ED health care providers believed that patients would refuse to answer questions about their sexual identity. Just 10 percent of patients said they would actually do so. Only bisexual respondents were less likely than their straight counterparts to respond to such questions (which I interpret as a reflection of biphobia within both straight and gay communities).

In its report on the study, the New York Times quotes Dr. Adil H. Haider, the lead author, reflecting that the providers’ attitude “was mostly paternalistic: ‘We don’t want to make anyone feel different.’ But it turns out to be that, ‘Doctors, you may have the best of intentions, but your patients want to be asked.’ ”

“Patients are saying that you’ll make us feel more comfortable if you ask—and ask everyone, so that normalizes the questions,” Haider continued.

This new study isn’t the first report of physicians failing to ask their patients about sexual identity. A survey of gay and bisexual men conducted in 2014 by the Kaiser Family Foundation found that 47 percent of respondents had never discussed their sexuality with their physicians. As I wrote at the time, “By treating questions about being gay or bisexual as too embarrassing to ask, we merely reinforce the idea that they are shameful and allow the stigma to remain.”

If medical schools never teach students how and why to ask patients about sexual and gender identity, those questions will always seem foreign and foreboding. The consequences of failing to ask, and not knowing what to do with that information once gathered, have the potential to be catastrophic.

In a devastating article about the ongoing HIV epidemic among black gay and bisexual men, the Times notes that only about 10 percent of prescriptions for PrEP (a medical regimen that can prevent infection with the virus) are written for black men. In addition to lacking basic access to care, many of these men do not feel safe discussing their sexuality with providers, and many providers are unfamiliar with PrEP. Without doctors who know how to create a safe environment for disclosure of vitally important information about their patients and are up-to-date on the medical care of LGBTQ people, an underserved population of gay and bisexual men will continue to go without potentially life-saving medication.

Thankfully, medical schools are increasingly recognizing how important it is to include LGBTQ health in the education they provide.

“Over the past decade, schools have absolutely become more receptive to the need for improved LGBTQ health education,” Dr. Kristen L. Eckstrand, a psychiatry resident at the University of Pittsburgh, told me. As a medical student at Vanderbilt University, Eckstrand was co-director of the medical school’s Program for LGBTI Health, and chair of the Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development for the Association of American Medical Colleges (AAMC).

“This [increased interest] is due do many factors,” Eckstrand continued, “including students’ desire to take on scholarly projects towards understanding [other] students’ knowledge and attitudes regarding LGBTQ health, recognition of the importance of this topic by curriculum faculty and administrators, and release of recommendations by national regulatory bodies supporting improvement in medical training on LGBTQ health.”

In 2014, the AAMC released a comprehensive resource for medical educators to help improve the care of patients who are gender or sexual minorities. It offers a detailed description of how medical schools can recognize institutional barriers to creating an LGBTQ-friendly environment for learning, and how to implement curricular changes to better serve not only LGBT people but also those born with different sexual development (DSD), something about which my own education is seriously out of date. (DSDs have often been described as “disorders of sexual development,” which is the language the AAMC avoids.) Clinical topics range from HIV risk factors in gay men, to a DSD man suffering from “corrective” surgical trauma from after birth, to a child with same-sex parents, among several others.

“Our goal is to ensure that this topic is not siloed, but instead is embedded throughout the curriculum, similar to any other important topic,” said Laura Castillo-Page, AAMC senior director for diversity policy and programs. “We want to ensure that there is not solely an optional course which everything gets dumped into. We believe a more holistic approach works best for all diversity-related topics.”

In addition to the 2014 publication, the AAMC has an extensive range of online resources for medical education. These resources include videos and webinars devoted to all aspects of LGBTQ health care, from faculty development to clinical vignettes to enhanced focus on LGBTQ and DSD issues in research, and range from introductory t an advanced degree of familiarity with the various topics.

“We have developed various types of webinars on this topic, for a range of audiences and experience levels. Some are more introductory and include topics such as what does it mean to be transgender” said Castillo-Page, “what’s the appropriate terminology, how to take a medical history of a patient, and how to best collect data.”

As more new physicians learn these skills as a basic part of their education, the health needs of LGBTQ people will be better recognized and met. Simply learning how to ask patients about their sexual and gender identity as a matter of routine would be a good first step.

Top Comment:

"In a devastating article about the ongoing HIV epidemic among black gay and bisexual men, the Times notes that only about 10 percent of prescriptions for PrEP (a medical regimen that can prevent infection with the virus) are written for black men. 
Despite the encouraging trend over the past several years, Eckstrand identifies several ongoing barriers to widespread change. Due to lack of national standards for teaching the topic, experiences vary widely from school to school. In regions where the LGBTQ population is less present or the climate is more hostile, opportunities for supervised patient care can be limited. Similarly, few schools directly assess students’ skills in delivering care to sexual and gender minority patients, relying more on methods like multiple-choice testing. Finally, she notes the “hidden curriculum” of lessons students learn if they are in an institutional culture that is discriminatory against LGBTQ people, which reinforces bias against sexual and gender minority patients.

The work that remains notwithstanding, it’s encouraging to see how much more attentive medical schools are to these aspects of patient care than when I was in school myself. The needs of gender and sexual minority patients can’t be met so long as those needs are invisible. Learning how to see us in the first place is a necessary step toward equitable health care for LGBTQ people.

Daniel Summers is a pediatrician in New England. He writes about medicine and LGBTQ issues.
This article was first published on

April 12, 2017

Tunisia Doctors Refuse to Do the Anal Test for Homosexuals

(Tunis) – The National Council of the Medical Order in Tunisia issued a statement on April 3, 2017, calling for doctors to cease conducting forced anal and genital examinations. The move is an important step toward ending degrading, discriminatory, and unscientific “testing” for evidence of homosexual conduct.

Tunisia is among several countries in which Human Rights Watch has documented the use of forced anal examinations in the last six years. These invasive and humiliating exams, based on discredited 19th century science, usually involve doctors or other medical personnel forcibly inserting their fingers, and sometimes other objects, into the anus of the accused. The law enforcement officials who order the exams claim that, based on the tone of the anal sphincter or the shape of the anus, one can draw conclusions as to whether the accused person has engaged in homosexual conduct. Forensic experts reject such a claim.

Tunisian doctors have taken a courageous step in opposing the use of these torturous exams. To ensure that forced anal testing in Tunisia ends once and for all, police should stop ordering the exams, and courts should refuse to admit the results into evidence.” 
Neela Ghoshal
Senior lesbian, gay, bisexual, and transgender (LGBT) rights researcher
“Tunisian doctors have taken a courageous step in opposing the use of these torturous exams,” said Neela Ghoshal, senior lesbian, gay, bisexual, and transgender (LGBT) rights researcher at Human Rights Watch. “To ensure that forced anal testing in Tunisia ends once and for all, police should stop ordering the exams, and courts should refuse to admit the results into evidence.”

Forced anal exams violate the Convention against Torture, the International Covenant on Civil and Political Rights, and the African Charter on Human and Peoples’ Rights. As the United Nations Committee Against Torture has emphasized, they “have no medical justification and cannot be performed with the free and informed consent of the persons subjected to them, who consequently will then be prosecuted.” For medical practitioners to conduct such exams is a violation of medical ethics, Human Rights Watch said.

The statement from Tunisia’s medical council said that doctors must henceforth inform peoples that they have the right to refuse the exam. Prohibiting doctors from carrying out anal exams without consent is a step in the right direction, but because of their unscientific nature, the use of anal exams to test for consensual homosexual conduct should cease altogether, regardless of consent, Human Rights Watch said. In that sense, the medical council’s statement does not go far enough: it leaves open the possibility that someone accused of same-sex conduct might “consent” to an anal exam under pressure from police, because they believe their refusal will be held against them, or because they believe it will prove their innocence.

Doctors in the Tunisian towns of Sousse and Kairouan subjected at least seven men accused of sodomy under article 230 of the penal code to forced anal exams in 2015, sparking a civil society movement against the practice. Human Rights Watch interviewed the men, some of whom described the forced anal exams as akin to rape. A 22-year-old student subjected to an anal exam in Kairouan told Human Rights Watch: “I felt like I was an animal, because I felt like I didn’t have any respect. I felt like they were violating me. I feel that up to now.”

The UN Committee Against Torture condemned the use of anal exams in Tunisia in May 2016, and the European External Action Service asked Tunisia to immediately stop conducting these examinations at an EU-Tunisia human rights dialogue in January 2017.

The statement by the medical council follows a more recent case in which two young men were arrested on sodomy charges in December 2016. They were subjected to forced anal exams, and though the results were “negative,” were sentenced in March 2017 to eight months in prison.

In a July 2016 report, Human Rights Watch documented and condemned the use of forced anal exams in Cameroon, Egypt, Kenya, Lebanon, Turkmenistan, Uganda, and Zambia. Tanzania also carried out forced anal exams on suspected gay men in Zanzibar in December, during an ongoing anti-LGBT crackdown. 

In Lebanon, the use of forced anal exams declined significantly in 2012 when, in response to a campaign by activists against the “tests of shame,” the Beirut Medical Syndicate issued a circular calling on doctors to cease carrying out the exams. But isolated cases occurred as recently as 2015, indicating that action by a medical council is unlikely to be enough to fully stem the practice.

Heads of states and heads of governments should take steps that are legally within their powers to end forced anal examinations in prosecutions for consensual same-sex conduct, such as issuing executive orders prohibiting their use; introducing and advancing legislation banning forced anal examinations; or instructing relevant ministries to take steps to ban the exams, Human Rights Watch said.

Judicial authorities should prohibit judges and magistrates from admitting the results of anal examinations into evidence in cases involving criminal charges of consensual same-sex conduct, and law enforcement officials should refrain from ordering the exams.

Health ministries and national medical councils or similar regulatory bodies should prohibit medical personnel from conducting anal examinations on people accused of consensual same-sex conduct. National human rights institutions should investigate the use of forced anal examinations and call on relevant authorities to put a stop to the practice.

The World Health Organization should issue a clear statement condemning the use of forced anal exams in homosexuality prosecutions, Human Rights Watch said.

Human Rights Watch calls on all countries to revoke laws that criminalize consensual same-sex conduct, which violate international recognized rights to privacy and nondiscrimination.

“It is time for the world to say a resounding no to the use of forced anal exams everywhere,” Ghoshal said. “It is encouraging to see Tunisia’s doctors leading the way. Medical councils around the world, as well as law enforcement agencies and other government bodies, should take their cue from this example.”

February 12, 2017

Foreign Born Doctors in Underserved Areas at Risk for Deportation

Patients in Alexandria, La., were the friendliest people Dr. Muhammad Tauseef ever worked with. They'd drive long distances to see him, and often bring gifts.

"It's a small town, so they will sometimes bring you chickens, bring you eggs, bring you homemade cakes," he says.

One woman even brought him a puppy.

"That was really nice," he says.

Tauseef was born and raised in Pakistan. After going to medical school there, he applied to come to the U.S. to train as a pediatrician.

It's a path thousands of foreign-born medical students follow every year — a path that's been around for more than half a century. And, like most foreign-born physicians, Tauseef came on a J1 visa. That meant after training he had two options: return to Pakistan or work for three years in an area the U.S. government has identified as having a provider shortage.

He chose to work with mostly uninsured kids at a pediatric practice in Alexandria. "That was a challenge," he says. "But it was rewarding as well because you are taking care of people who there aren't many to take care for."

And the U.S. medical system depends on doctors like Tauseef, says Dr. Andrew Gurman, president of the American Medical Association. He worries that if President Trump's executive order on immigration takes effect, it will mean parts of the country that desperately need medical care may not have a doctor.

"International medical graduates have been a resource to provide medical care to areas that don't otherwise have access to physicians," he says. "With the current uncertainty about those physicians' immigration status, we don't know whether or not these areas are going to receive care."

According to the AMA, today there are about 280,000 international medical graduates in the U.S. That's about 1 in 4 doctors practicing here. Some are U.S. citizens who've gone abroad for medical school, but most aren't.

"They don't all have permanent visas, and so a lot of them are concerned about what their status is going to be, whether they can stay, whether they can go home to visit family and still come back, and the communities they serve have similar questions," he says.

And the care provided by the graduates of foreign medical schools is, by and large, top notch. A study published Feb. 3 in the journal The BMJ, formerly The British Medical Journal, shows Medicare patients treated by doctors with degrees from non-U.S. medical schools get just as good care — and sometimes better — than those treated by graduates of American medical schools.

The immigration uncertainty is hitting medical schools at a tough time. Dr. Salahuddin Kazi is in charge of recruiting top students from across the world for the University of Texas Southwestern residency program.

"Typically we have 3,000 people applying for our 61 positions — of those 3,000, at least half of them are international medical graduates," he says.

Applicants find out their program match in March and usually start working in June. That gives them about 90 days to get a visa. Kazi worries this year that won't be long enough and that students from countries included in the travel ban won't be admitted.

"That would create hardship for the hospital, for us and for our remaining residents," he says. "They'll have to pick up more shifts or give up vacation."

Pediatrician Tauseef left Louisiana two years ago but continues to care for low-income patients at Los Barrios Unidos Community Clinic in Dallas. Six of the 30 physicians who work at this clinic are from other countries.

Tauseef says they're all educated to do the same thing. "As a physician, being a foreign medical graduate, U.S. medical graduate, a Muslim doctor, a non-Muslim, we are trained to look for signs and symptoms," he says. "We do not look at anybody's color; we are not trained to look at anybody's religion or ethnicity."

Tauseef, who has been in America for 13 years, says he will apply for U.S. citizenship in March.


This story is part of a reporting partnership with NPR, KERA and Kaiser Health News.

Featured Posts

Angry Residents (Puerto Rico) Took To The Streets on Monday About The Government Warehouse Locked Up With Hurricane Supplies

  Gov. Wanda Vázquez fired the island's emergency director Saturday after the incident set off a social media firestorm...