More Than Just a Pronoun: Ethics of Sex/Gender Assessment in Pediatrics

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Pediatric rheumatologists and providers are uniquely positioned to build and foster relationships of trust with their patients. However, while providing care for the rheumatic condition, should physicians be allowed to inquire about the sexual orientation and gender identity of their patients?

In this episode, we tackle important questions about the ethical considerations during the development of treatment plans for pediatric patients with rheumatic diseases.

Karen Onel, MD, the chief of the Pediatric Rheumatology Division at the Hospital for Special Surgery, New York, along with third-year fellows in pediatric rheumatology Nayimisha Balmuri, MD, and Jacob Spitznagle, MD, speak with us about their clinical practice experiences and the importance of representing pediatric patients in a way that centers and considers their personhood holistically, especially among populations in which mental health issues and other psychosocial stressors are present.

Read the full transcript for this episode here.

An expert in pediatric rheumatology, Karen Onel, MD, cares for children and teens with arthritis and other autoimmune disorders. In particular, she diagnoses and treats systemic lupus erythematosus (SLE), juvenile arthritis (JIA), vasculitis, uveitis, chronic noninfectious osteomyelitis, dermatomyositis, and the periodic fever syndromes. Her goal is to work with patients and their families to create a long-term care plans that will lead to an improved quality of life.

Dr Onel’s research focuses on gaining a greater understanding of the causes of rheumatic illnesses, as well as evaluating the safety and tolerability of new treatments. She is collaborating with other institutions to define evidence-based best treatment practices for children with JIA, SLE, and recurrent noninfectious osteomyelitis.

Dr Onel is currently the chair of the American College of Rheumatology (ACR) Committee on Ethics and Conflict of Interest. She has authored numerous papers, reviews, and book chapters on pediatric rheumatology. In addition, Dr Onel serves as a reviewer for several scientific journals, including Arthritis and Rheumatism, Lupus, Seminars in Arthritis and Rheumatism, and Pediatric Rheumatology.

Nayimisha Balmuri, MD, FAAP, is a third-year pediatric rheumatology fellow at the Hospital for Special Surgery, New York, and a graduate student at Weill Cornell Medicine’s Clinical and Translational Science Center. Starting this summer, she will be an assistant professor at the Johns Hopkins Hospital in Baltimore, Maryland, and a Health Professions Fellow at the Johns Hopkins School of Education.

Dr Balmuri’s research focuses on improving access to quality health care across marginalized groups and evaluating the impact of social determinants of health on pediatric rheumatologic disease outcomes.

Jacob Spitznagle, MD, is a third-year pediatric rheumatology fellow at the Hospital for Special Surgery, New York. After earning his medical degree at Northwestern University Feinberg School of Medicine in Chicago, Illinois, he completed his residency in pediatrics at the University of California, San Francisco, and moved to New York for his fellowship.

Dr Spitznagle will be joining the faculty of the University of Washington’s School of Medicine as an assistant professor of Pediatrics and the Seattle Children’s Hospital as a pediatric rheumatologist in the summer of 2021.

Dr Spitznagle’s clinical interests include juvenile dermatomyositis, as well as the interplay of psychosocial stressors and rheumatic disease in adolescent patients.