Both Dominic Moog and Chase T.M. Anderson are co-authors of this piece.
Yet another early morning spent meticulously examining my face in the mirror — I must look perfect. Of course, that means later I’m racing to meet my attending on time; thank goodness speed walking is a queer sport. I rehearse responses to comments on my appearance I always fear could come: unprofessional, extra, colorful, or some other thinly-veiled iteration of “too much.” I craft bulletproof responses down to the word.
I grew up with eyes on my femininity; I never passed. I was made to feel my Otherness before I understood it. I learned to survey my surroundings for signs of social danger, adjusting my presentation accordingly — these skills have served me well in medical education. I package myself into the most competent, reverent, and palatable medical student. I become the ultimate chameleon, transforming, performing someone “worthy” of safety; it’s an adaptation I’ve honed over a queer lifetime.
–Dom Moog, they/them, fourth-year medical student
This day isn’t like other days. Thankfully, it’s been years since I’ve felt this type of anxiety that I used to feel every day in medical school and residency, where I couldn’t breathe because of the discrimination I’d face as a Black, queer medical trainee. Even though I’m now at a university that’s vastly safer for me, that doesn’t stop the fear. After all, today is the first day I wear my silver glitter heels to work — I don’t know who might say what or if I’ll get in trouble.
I’ve checked the clothing policy with my career mentor. Though I’ve been out since age 12, that doesn’t mean I don’t get scared each time I show up, that I’m not constantly calculating how to navigate. Then I think of the colleagues, mentors, friends, family members, mentees, kids, adolescents, young adults, and families that I love and are striving to be authentically themselves in a world that continually harms people who are seen as “different” — I take a deep breath, do up the side zipper of my heels like I’m preparing for battle, and breeze out the door of my apartment for work.
–Chase T. M. Anderson, he/they, assistant professor
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Since the COVID-19 pandemic and 2020 protests against systemic racism, efforts toward eradicating the effects of bias and discrimination in medicine has reentered the national consciousness. While this is a good start, it may be better to try to overhaul — or at least make deeper efforts to heal– medicine’s social environment to foster safety and reduce disparately harmful effects of chronic social stress. For this, we can look to the queer community.
Reimagining Health Care with Authenticity
The Problem:
Queer people in medicine quickly learn how we are “allowed” to show up. Throughout training, unwanted guidance on attire, like “don’t paint your nails if you’re a man,” is ubiquitous. We are told to conform to a white, straight, cisgender standard of who and what health care is, one that’s alienated entire communities for centuries. As visibly queer people, we can feel like a rainbow elephant in the room, too visible yet invisible in the same breath.
Further, from drab, gray walls to harsh fluorescent lights, hospitals create environments that literally and symbolically erase or dim our vibrant identities upon entry. Even worse, countless community traumas have transpired in bleak, generically-decorated environments that look like this throughout history. The present, dominant aesthetic of medicine reifies the structures of power, oppression, and erasure under which Western health care developed.
Solutions through Queer Embodiment of Identity:
Queer prowess in self-articulation offers tools for medicine’s much-needed makeover. We excel in arts and aesthetics, adorning our bodies and environments to convey complex identities and lived experiences. One vivid example of this cultural infrastructure is Ballroom, a Black and Brown queer competitive tradition centered around performance and beauty that exemplifies queerness. Modern Ballroom emerged in the 1960s as a response to White dominance in the racially integrated, competitive drag balls of the century prior, providing alternative spaces and opportunities for Black queer people to express themselves and find success without having to “whiten up” their faces and mannerisms. Success in Ballroom is equal parts how you look and how you embody. Authenticity is essential — it was the point of Ballroom’s creation. If you lack presence, it’s a “chop,” meaning elimination from competition — conveying your fullness on the runway is incentivized and required by this queer institution, demanding an excellence in aesthetic communication that lends itself to the task of making over medicine, for everyone.
Now, we’re not saying anyone should get chopped on rounds — that would be rude. However, if cis/straight doctors can openly discuss their lives while wearing what they like and standing in their hetero-isms, why can’t queer people do the same? Why is so much of visible queerness deemed “unprofessional,” when respect for diversity is central to humanistic learning environments? The visible communication of identity and social safety is queer dogma, yet we stifle these beneficial practices under the guise of decorum.
Further, while clinical spaces must be approachable for all-comers, every time we choose to build another industrial-looking waiting room, we communicate that we don’t care to acknowledge the cultural conditions that dictate these environmental standards or improve patients’ experiences, even though consciously-built physical environments have been shown to reduce patient anxiety, pain, and stress. Responsiveness to community and patient needs is crucial to humanistic care, and queer artistry even includes a particular knack for interior design that could be leveraged toward this aim.
Mapping Aspects of Chosen Family onto Community in Health Care
The Problem:
Medical education’s culture restricts our ability to stand in community. Student mistreatment is exceedingly common, disproportionately affecting racial, gender and sexual minorities. Even worse, trainees who experience mistreatment are more likely to mistreat future students (the “cycle of abuse”) and students often enact biases towards minoritized patients after witnessing attendings do the same. We learn to perpetuate toxicity, and academic medicine’s “leaky pipeline” limits the potential for change, keeping minoritized physicians out of leadership. For queer trainees, mentoring relationships are especially important sources of support since they may face rejection by their families and society. Unfortunately, history has left distinct marks on the demographics and culture of the physician workforce, making these relationships sometimes feel distant or unsafe.
Solutions through Queer Mentorship:
To find a better version of mentorship we can again refer to Ballroom’s culture of kinship. At a Ball, Mothers and Fathers of a Haus (a group of chosen family members who compete together) often call “shade” over decisions affecting their children’s success. Was a judge’s vote intentionally unjust (shade) or just “tea” (truth, therefore a valid teaching moment)? Raising this question ensures their child’s chance to shine, naming and confronting injustice while voicing belief in their ability and right to succeed. This passionate advocacy stands in stark contrast to the distance and mistreatment we allow to pervade mentoring relationships in medicine. Furthermore, Haus parents often share similar racial, ethnic, gender, and/or sexual identities with their children, contributing to a sense of acceptance and support that builds resilience. This frequently is exactly what individuals who are underrepresented in medicine (UIM) lack compared to their white and and non-queer peers.
Queer Guidance on Coping with Burnout
The Problem:
In health care, we often avoid identifying the true sources of our discontent — their scale overwhelms us. We admit people to our hospitals repeatedly, pejoratively calling them “frequent flyers.” This crude term abbreviates histories of socioeconomic disenfranchisement to the detriment of our therapeutic relationships. We witness community trauma while working inhumane hours amidst labor shortages and inadequate resources; burnout is inevitable. Instead of organizing against these socioeconomic conditions, we are often forced to submit to them, our capacity to imagine better crushed by the existing system’s weight and our inability to meaningfully process experiences with colleagues. It’s a ruthless business of living and dying, and we treat symptoms instead of causes. Worse still, critiquing this infrastructure can endanger our careers, our lives.
Solutions from Queer Survival, Linguistic Art:
Queer people have devised ingenious ways of coping with environments that harm us. Camp is an essential queer ideological adaptation that balances painful facts of reality with humorous acknowledgement of how absurd they are. Camp often lives in the expression, “it’s giving…” Queer people know this phrase precedes an interpretation of some image, conversation, or circumstance; when used dexterously, it does so tactfully yet searingly, entertaining with a lightning-fast “read” of the situation. A queer health care worker might repeatedly admit a patient and quip, “It’s giving Uncle Sam’s least favorite nephew” — which means they’re calling attention to America’s socio-structural failures to care for its most vulnerable. This shared language bonds us and creates conversations that can lead to activism.
In medicine, we exert extraordinary effort to master a language that includes words as ridiculous as “choledocholithiasis” that merely describe — stopping short of nuanced interpretive work to describe the patients we care for and the confines of circumstance. Queer people’s powerful leverage of language can teach us about bonding through adversity via gratifying exchanges of honesty and humor. By doing so within a health care system whose interests are often in conflict with those of our patients and ourselves, we may better cope with and organize against such dissonance.
A Better Future for Health Care
Queer life is imperfect, but it offers alternatives for relating to one another. In medicine, we could honor and celebrate our identities. Hospitals could provide space for deeper healing and community building. We could incentivize justice and reverence for humanity as we have technological advances — if we can speak freely and honestly. For now, our incentive is in resistance, finding joy in reflecting light that is warm, flattering, and illuminating.
As we crafted this essay one evening, queer medical student and queer mentor, both serving camp, discussing medical culture, and living, we were reminded of the words of Angela Davis: “Act as if it were possible to radically transform the world. And you have to do it all the time.”
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Dominic Moog (they/them) is a fourth-year medical student at Washington University School of Medicine in Saint Louis.
Chase T.M. Anderson, MD, MS (he/they) is an assistant professor of child and adolescent psychiatry at The University of California, San Francisco.
The authors would like to acknowledge and thank Dr. Jack Turban of The University of California, San Francisco for looking over this work.
Image credit: Mermaid Ball NYC (CC BY 2.0) by petercruise
Attending Physician Contributing Author
University of California, San Francisco
Dr. Chase T. M. Anderson (but just call him Chase!) is currently a child and adolescent psychiatrist at The University of California, San Francisco, the Director for The Muses Program for Minoritized Youth, and graduated from adult psychiatry residency at The Massachusetts General Hospital/McLean Hospital and child and adolescent psychiatry fellowship at UCSF. He completed his undergraduate education in Chemistry at The Massachusetts Institute of Technology and his master's in Biological Engineering at MIT as well, and is a graduate of The Northwestern Feinberg School of Medicine.
Their writing has appeared in The New England Journal of Medicine, Nature Mental Health, NPR, Scientific American, in-House Magazine, WonderMind, STAT News, and other news and journal outlets. In their free time, he enjoys going for long walks, doing queer things, listening to K-pop, reading fantasy books, playing soccer, writing, planning dinners with friends, and dreaming of how we can better the world together.
Medical Student Guest Writer
Washington University School of Medicine in St. Louis
Dom Moog is a fourth-year medical student at Washington University School of Medicine in St. Louis and a transfeminine individual of nonbinary experience. Dom hails from the Twin Cities of Minnesota and attended the University of Southern California, where they received a Bachelor of Arts in Gender and Sexuality Studies. This educational background and a lifetime of personal experiences inspire their interest in psychiatry with emphases on marginalized peoples, economic justice, substance use disorders, and community building as a pillar of psychiatric wellness work. Dom co-founded The Shades Project St. Louis in 2022, a grassroots non-profit organization focused on the intersections of health, community, and art, and serves as Director of Development at the School of Opulence in Chicago. Dom also sings with the St. Louis Chamber Chorus and is an avid participant and budding leader in the queer Ballroom community.