Dr. Leigh Roberts is Howard Brown Health Center's medical director. The straight-talking family practice physician has a lot to keep her busy. Earlier this year, Roberts and three of her colleagues went to China to introduce doctors there to HIV/AIDS testing methods and treatments. Here at home, HBHC serves approximately 7,000 patients across two locations (on Sheridan Road and at Illinois Masonic Hospital), and that is not counting recipients of services such as counseling and psycho-therapy. Of that total number, 1,400 are HIV positive, 38% are women, and 60% are uninsured. With a serious yet welcoming demeanor, Roberts took the time to discuss some aspects of her work.
Marie-Jo Proulx: The obvious, first question is what was your main motivation in becoming a doctor?
Leigh Roberts: Bad healthcare. Bad medical services, I guess. ... First I should say that I dropped out of college twice. The third time was a keeper. But every time I went with the idea that I was going to be a doctor. So I started college at 17 and I was clearly not ready, so I quit. And then a couple of years later I did that again. When I did go back for the final time, I specifically chose Hampshire College in New England where I could write my own curriculum and use the five-college consortium that's there in North Hampton and Amherst. So I'd grown up some by then. I began in earnest my pre-med preparation. I did it in an unconventional way, I was at an unconventional school and I guess I'm an unconventional kind of person. ...
My focus over the three years was to look at healthcare in the context of our western United States world. So I examined what the health and research priorities in this country were at the time, and the role that homophobia, racism, ageism, and genderism played in how those agendas got set and how the funding then flowed. And in that process, I learned that the system was rife with preferential treatment and although I will not go so far as to say 'corrupt' ... it definitely had an agenda. Public health has an agenda that is often counter to people's good health and that is at the heart of medicine for me. So my goal has been to be honest, I think that that's particularly needed in LGBT healthcare. MJP: And why Howard Brown?
LR: Where else? I can't do this work really anywhere else. There are sister agencies in the U.S. and I work with them on projects, we partner on a variety of things. But it's pretty fabulous that [Chicago] is my home, this place is in my home and it matches exactly the work I want to do.
MJP: Can you describe briefly a typical patient profile?
LR: No. There is no typical patient. Every single person that walks in this door, walks in an individual with an individual set of risks, limitations, strengths, and concerns. I would be remiss as a provider if I evaluated them any differently than the individual that they are.
MJP: A few weeks ago, Howard Brown and the Lesbian Community Cancer Project announced they were joining forces. LCCP was supposed to move in on Sept. 1. Have you seen any changes so far?
LR: No, they haven't moved in yet.
MJP: So that would explain why the Web site hasn't been updated and the LCCP sign isn't up yet outside.
LR: Yes, probably (laughing). I was at an LGBT forum on aging [recently] and Jessica [Halem, executive director of LCCP] and I were there ... and we were asked this question. My response is that we are becoming roommates ... The strength of the partnership is in the strength of the services that we will be able to bring back to the community. ... We partnered on a smoking cessation grant for lesbians. LCCP has a lot of experience with the lesbian population and smoking. We have the research infrastructure to do the outcomes measure piece. So together we could do a grant. Singularly, neither of us could have. ... We've done about three of those projects so far, before they've even put their foot in the door. Our goal is going to be to do more and more ... .
We met with Rev. Ted from the deep South Side and we're talking about ways we can partner with the lesbian community down there and we're thinking outside of the box around ways that we can have a special health day where we can bring people in. ... A group of folks would come, they'd have the comprehensive medical appointment, their mammogram, they'd go out to lunch, go shopping and then go home. ... We're working on every kind of idea that we can do together that's going to help people in our community get messages about their health and get the care that they need.
MJP: What's the most difficult message to get across in terms of prevention?
LR: Changing human behavior, no matter what, is tremendously difficult and so changing human behaviors in marginalized communities is even harder because the motivation to change is not there. Because of all the messages that society has sent for all the years that they're no good or they don't belong. That homophobia is internalized and it manifests in self-destructive behaviors. It's really hard to undo that. We do it by repeatedly repeating ourselves and trying to change the spin, or the look, or the venue, or the words. It's about repeated messages of support. When they do take that moment to finally reach out [if] there's some system there to catch them that reinforces 'OK, I did the right thing' then you're on track. ... We always talk about how we've got to educate the providers and we absolutely have to ... and we absolutely have to educate our community that they're entitled to quality healthcare, that it's available to them, that they should expect it and demand a standard of care ... and when it doesn't go well that they know how to protest, and when it does go well that they can pass it on. So we have a lot of work to do.
MJP: Sept. 18 was declared Medical Ethics Day by the World Medical Association. What ethical challenges do you encounter in your daily practice?
LR: What works for me is honesty and that is integrity. ... I could go in so many directions here. ... I'm going to talk about just me being a doctor, not a medical director or anything else. ... I work very hard to leave whatever issues I have at the door as I enter an exam room. You never know what's on the other side of that door. It could be something disgusting, elating, boring, ... I see my role as a physician as being a service provider. ... I view it as my job to ensure that I know that the client knows what I'm talking about and that I have given them all the information they need to help them make decisions. I have to do that no matter the circumstances in that room. A lot of people don't view it that way ... and they will feel entitled not to deliver care. Well, that to me is unethical. It is not what being a physician is about.
