PPMW: Can you tell us a little bit about yourself?
Dr. Aaron Shapiro (AS): My name is Aaron Shapiro. I am a third-year medical resident at Montefiore Medical Center in the Bronx. I'm doing a residency in Primary Care Social Internal Medicine. My clinical focus is mostly in substance use disorders, transitions between settings of incarceration, and trans healthcare. I came to Planned Parenthood of the D.C. area for a two-week clinical rotation, mostly focusing on family planning.
PPMW: What has your journey in the healthcare field been like?
AS: I am a gay man with three brothers. Women's health and uterus care weren't really on my radar until I had this amazing mentor who had a gender clinic in my medical system. And as someone who wanted to go into queer health, I had this kind of epiphany moment: not only do so many of the trans men that I hope to care for have vaginas but that anatomy often causes them dysphoria. So, not only do I need to learn to conduct an expert pelvic exam but I need to do it sensitively and in a trauma-informed way.
PPMW: What misconceptions did you have about the practice of medicine?
AS: Unfortunately, Internal Medicine training has this stereotype of forgetting that half the world's population has vaginas. It's very common for internal medicine docs, especially male internal medicine docs like me, to kind of say, "Oh, I don't do gyn care. I don't do pap smears. I just don't do pelvic exams. It's not part of my 'practice.'" And that just never made sense to me. And to be quite honest, it embarrassed me.
PPMW: At PPMW, we often talk about the social determinants of health - that the conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes. Can you talk about this methodology of care?
AS: What we focus more on are the structural determinants of health: the systemic barriers, like racism, that are enforced by the governments that impose and actively push people out of accessing quality healthcare. These barriers are realized by values decisions that we as a society have made: who we elect into positions of government power, how we allot our funding away from universal healthcare, and how through a history of redlining and over-policing that stems from slavery and racism, much of our health care is carried out through anti-poverty, anti-black, anti-people of color policies that actively push people out of receiving quality healthcare.
PPMW: At PPMW, the majority of our patients identify as women and are people of color. What does that mean to a gay man who is working with a population that does not share your lived experience?
AS: I've done a lot of work in my adult and professional lives to do my best to identify, unlearn, and actively counter a lot of the white saviorism that was ingrained in me a lot growing up. I have put in a lot of conscious work to identify where I stand in that system and have focused a lot of my work on trying to both unlearn and actively dismantle that system.
I think the most important part of my practice that I have worked very hard to implement as much as possible is trauma-informed care and understanding how to do my best to minimize that harm. And my hope is that through actively pursuing training in trauma-informed care, learning the history of how the field of gynecology was birthed from the atrocious abuse of black slave women, and how those oppressive structural forces continue to cause harm to women of color – especially in this country — that if I'm going to choose a profession to go into where I feel like I have something to offer, both in interest and in skill, I want to continue as a white man working to dismantle and destroy those structurally oppressive forces that continue to perpetuate harm on humans.
We need to take the ego out of this. And if we have manifestations of racism in our practice – in my practice – what can I do to work to dismantle those? It's not a matter of denying that they exist, it's a matter of acknowledging that this exists and saying, "What am I going to do about it?" And I think the only thing that I am capable of doing is continuing the work of identifying those areas and continuing the work of minimizing my active harm while ramping up my efforts, advocacy work, policy work, writing, and compassionate clinical care to dismantle those structural barriers and harms. I'm lucky to have actively pursued certain trainings that help give me the skills to help create health care environments where people feel safe and where people feel cared for.
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