Akhil Vaid, MD, left, and Girish Nadkarni, MD, MPH, right, are working to make artificial intelligence models more feasible for reading electrocardiograms, using a novel transformer neural network approach.
Electrocardiograms (ECGs) are often used by health providers to diagnose heart disease. At times, irregularities in the recordings are too subtle to be detected by human eyes but can be identified by artificial intelligence (AI).
However, most AI models for ECG analysis use a particular deep learning method called convolutional neural networks (CNNs). CNNs require large training datasets to make diagnoses, which spell limitations when it comes to rare heart diseases that do not have a wealth of data.
Researchers at the Icahn School of Medicine at Mount Sinai have developed an AI model, called HeartBEiT, for ECG analysis, which works by interpreting ECGs as language.
The model uses a transformer-based neural network, a class of network that is unlike conventional networks but does serve as a basis for popular generative language models, such as ChatGPT.
Here’s how HeartBEiT works as an artificial intelligence deep-learning model, and how it compares to CNNs.
HeartBEiT outperformed conventional approaches in terms of diagnostic accuracy, especially at lower sample sizes. Study findings were published in npj Digital Medicine on June 6. Akhil Vaid, MD, Instructor of Data-Driven and Digital Medicine, was lead author, and Girish Nadkarni, MD, MPH, Irene and Dr. Arthur Fishberg Professor of Medicine, was senior author.
In this Q&A, Dr. Vaid discusses the impact of this new AI model on reading ECGs.
What was the motivation for your study?
Deep learning as applied to ECGs has had much success, but most deep learning studies for ECGs use convolutional neural networks, which have limitations.
Recently, the transformer class of models has assumed a position of importance. These models function by establishing relationships between parts of the data they see. Generative transformer models such as the popular ChatGPT utilize this understanding to generate plain-language text.
By using another generative image model, HeartBEiT creates representations of the ECG that may be considered “words,” and the whole ECG may be considered a single “document.” HeartBEiT understands the relationship between these words within the context of the document, and uses this understanding to perform diagnostic tasks better.
What are the implications?
Our model forms a universal starting point for any ECG-based study. When comparing our model to popular CNN architectures on diagnostic tasks, HeartBEiT ended up with equivalent performance and better explanations for the model’s thinking and choices using as little as a tenth of the data required by other approaches.
Additionally, HeartBEiT generates very specific explanations of which parts of an ECG were most responsible for pushing a model towards making a diagnosis.
What are the limitations of the study?
Pre-training the model takes a fair amount of time. However, fine-tuning it for a specific diagnosis is a very quick process that can be accomplished in a few minutes.
HeartBEiT was compared against other conventional AI methods on diagnostic measures, including left ventricular ejection fraction ≤40%, hypertrophic myopathy, and ST-elevation myocardial infarction, and was found to perform better.
How might these findings be put to use?
Deployment of this model and its derivatives into clinical practice can greatly enhance the manner in which clinicians interact with ECGs. We are no longer limited to models for commonly seen conditions, since the paradigm can be extended to nearly any pathology.
What is your plan for following up on this study?
We intend to scale up the model so that it can capture even more detail. We also intend to validate this approach externally, in places outside Mount Sinai.
Learn more about how Mount Sinai researchers and clinicians are leveraging machine learning to improve patient lives
AI Spotlight: Forecasting ICU Patient States for Improved Outcomes
When Can a Patient Come Off a Ventilator? This AI Can Help Decide
The annual Dubin Breast Center Fact vs. Fiction symposium provides a forum for Mount Sinai’s nationally recognized physician-researchers to share the latest breakthroughs in breast cancer care and to answer questions related to cutting-edge topics in adolescent and women’s health.
More than 160 guests attended the event on Monday, May 22, raising more than $180,000 in support of the Center. Held at the Harmonie Club in New York, the event was the most attended ever and sold out for the first time.
Leading the event were Mount Sinai Health System Trustee Eva Andersson-Dubin, MD, who founded the Center, which is part of The Tisch Cancer Institute, and Elisa Port, MD, FACS, Chief of Breast Surgery and Director of the Center.
In her opening remarks, Dr. Port emphasized the Center’s continued commitment to providing the most advanced treatment options to all patients.
“The Dubin Breast Center has become a destination in breast cancer care, not only in the city, but in the country and the world. We’re getting patients coming from all over, knowing that the care we deliver is exceptional,” she said. “It’s important to note that what really distinguishes our Center is that we don’t treat patients with breast cancer. We treat people, and we treat people regardless of the ability to pay—that’s always been part of our mission.”
Panelists from left: Amy Tiersten, MD; Christina Weltz, MD; Gylynthia E. Trotman, MD, MPH; Laurie Margolies, MD, FSBI, FACR; and Jeffrey Mechanick, MD.
Dr. Port served as moderator for the discussion with a panel of Mount Sinai experts, which included Amy Tiersten, MD; Christina Weltz, MD; Gylynthia E. Trotman, MD, MPH; Laurie Margolies, MD, FSBI, FACR; and Jeffrey Mechanick, MD. Watch the recording of the event here.
Dr. Tiersten, a renowned medical oncologist, addressed the challenges faced by women of child-bearing years with breast cancer. She pointed to exciting results of a recent clinical trial that studied 500 women aged 42 and under with Stage 1-3 breast cancer, who had been taking certain cancer-fighting medications for 18 to 30 months; these women paused their drug regimen for two years while they attempted to conceive, carry a pregnancy, and breastfeed. About 75 percent of the women in the trial had at least one pregnancy during that time, with no negative effects on their babies. Importantly, the study also found that none of the women appeared to have a higher risk of breast cancer recurrence.
That information was life-changing for Suzanne Foote, a Dubin Breast Center patient who shared her inspirational story at the event. She began regular screenings in her 20s, after learning that she has an inherited PALB2 gene mutation that carries an increased risk for developing the disease. Her mother died from breast cancer when she was only 43. Suzanne Foote was diagnosed in 2019, less than a year after marrying her husband, Mark.
“It was a tremendous shock,” she said, “which reverberated further when we realized cancer would be a hurdle in our quest to start a family.”
Thankfully, her cancer was caught early. Even so, she had a bilateral mastectomy to reduce the chance of the disease returning. Drs. Port and Tiersten also recommended that she undergo in vitro fertilization since some treatments for breast cancer, such as certain types of chemotherapy, can cause infertility. Later on, after consulting with Dr. Tiersten, she decided to take a break from therapy to get pregnant. Her twins, Peter and Josephine, were born at Mount Sinai in September of 2022.
“I was lucky to spend time with the amazing doctors at the Dubin Center. As a result of the time that they spent, here I am, enjoying the best time of my life,” she said. “JoJo and Pete are turning eight months, and I’m still healthy and cancer free.”
The Dubin Breast Center was created in 2011 to provide comprehensive, personalized care for every aspect of breast health, from prevention of disease through survivorship. It offers a full range of services—including the most advanced diagnostics and leading-edge treatments—in one convenient, state-of-the-art location. The Center is also unique for its emphasis on holistic therapies, such as massage, yoga, and meditation, which can promote healing and improve one’s overall well-being.
From left to right, Peter Palese, PhD, Horace W. Goldsmith Professor of Medicine; Miriam Merad, MD, PhD, Mount Sinai Professor in Cancer Immunology; Özlem Türeci, MD, Chief Medical Officer of BioNTech; Uğur Şahin, MD, Chief Executive Officer of BioNTech; Dennis Charney, MD, Anne and Joel Ehrenkranz Dean of Icahn School of Medicine at Mount Sinai
One of the great tools that helped turn the tide of the COVID-19 pandemic was the use of vaccines, which prevented millions of deaths and hospitalizations in the U.S. and around the world. Key vaccines were those based on messenger RNA (mRNA) technology, which provide information for the molecules that teach the cells in the body to generate proteins used by viruses or cancers, allowing the body’s immune system to recognize and fight off future infections or transformed cancer cells.
The Icahn School of Medicine at Mount Sinai honored the efforts of executives of German biotechnology firm BioNTech, which partnered with Pfizer to develop and make available one of the most widely used COVID-19 vaccines in the country, during its 54th Commencement on Thursday, May 11. Uğur Şahin, MD, Chief Executive Officer of BioNTech, and Özlem Türeci, MD, its Chief Medical Officer, received honorary Doctor of Science degrees.
Research into mRNA technology for vaccines goes back to the 1990s, and has grown in leaps and bounds since, said Dr. Türeci in a guest lecture hosted by the Marc and Jennifer Lipschultz Precision Immunology Institute, held separately from the Commencement.
The COVID-19 pandemic provided an opportunity for the technology to be adapted at a large scale, and the momentum gained and lessons learned was only the starting point to pave the way for greater heights for the development of mRNA vaccines, she said.
In this Q&A, Drs. Şahin and Türeci spoke about what the future of mRNA vaccines could look like.
After two years of COVID-19 vaccines:
An estimated 18 million hospitalizations were prevented
More than 3 million deaths were avoided Source: New York City-based foundation The Commonwealth Fund
Percentage vaccinated in United States by manufacturer:
Pfizer/BioNTech: 60%
Moderna: 37%
Johnson & Johnson: 3% Source: Centers for Disease Control and Prevention
What are some active areas of research in which mRNA technology is being worked on?
Dr. Şahin: There are investigational cancer vaccines in which mRNA technology is being used to deliver instructions to generate antibodies or cytokines. This technology can theoretically be used to deliver any bioactive molecule.
Our focus at the moment is the development of cancer vaccines, and one special application of cancer vaccines we’re working on is the so-called “personalized cancer vaccines.” mRNA technology is particularly well suited to deliver a vaccine that consists of mutations of the tumor identified from the patient.
Dr. Türeci presenting to members of the Marc and Jennifer Lipschultz Precision Immunology Institute.
What is it about mRNA technology that makes it so well suited for cancer vaccines?
Dr. Türeci: We have been interested in cancer vaccines all along, and tried different technologies, and mRNA is the delivery technology that comes with its own edge. Its immunogenicity is very versatile and its transience has the potential to lead to a favorable safety profile. These characteristics are the reasons why we chose mRNA to deliver cancer antigens.
Any solid cancer could be appropriate for application. We have ongoing clinical trials in melanoma, head-and-neck cancer, pancreatic cancer, and non-small cell lung cancer.
Beyond cancer vaccines, we believe any bioactive cancer immunotherapy that is based on protein could be delivered by mRNA.
What about non-cancer diseases? Is mRNA technology suitable there?
Dr. Türeci: There are other areas, such as infectious diseases, in which mRNA could have an advantage. As long as you have the right protein structure to stimulate an immune response, you can theoretically also use mRNA here.
There are clinical trials in infectious diseases: COVID-19, for example, but also malaria or shingles.
What are some current limitations of mRNA technology? And how are researchers working to overcome those?
Dr. Türeci: We are very far advanced in the delivery component of the technology, and these advancements have made COVID-19 vaccines, as well as cancer vaccines in clinical testing, feasible. However, if you want to target specific organs, you need specialized, targeted delivery technologies.
For example, if you want to address something in the brain, you need a delivery technology that brings the mRNA into the brain. There may be monogenetic diseases in which the sample protein is deficient in the organ, and so limits how the mRNA can be expressed there.
So the lipid nanoparticle used to contain the COVID-19 vaccine, for example, might not be applicable for any other organs?
Dr. Türeci: This delivery technology was specifically designed and developed to deliver mRNA to the lymphatic system. If the mRNA needs to be delivered to different organs, it required new formulation.
When the public first became aware of mRNA technology through COVID-19 vaccines, there was skepticism. Do you envision similar skepticism as new mRNA vaccines roll out, and if so, how can we dispel such skepticism?
Dr. Türeci: Skepticism can only be addressed by transparent communication, through the disclosure of data, and proper education. I think there is a zeitgeist of skepticism. That skepticism isn’t necessarily specific to mRNA technology. But once they start to understand the mechanisms behind the technology, and the rationale of why we’re working on it, we can start to dispel it.
Do you foresee mRNA technology to grow exponentially into the future?
Dr. Şahin: Yes, mRNA vaccines could be really big, but it will happen slowly. It will take a few more years, but we are starting to see really promising candidates using this technology.
Following a successful drive to get New Yorkers vaccinated against mpox—previously known as monkeypox—last summer, mpox cases in New York City waned just as quickly as they had spiked. The city declared an end to its outbreak in February this year.
However, an uptick of mpox cases in Chicago in May has health experts and officials concerned about a possible return of outbreaks nationwide. The Centers for Disease Control and Prevention issued a health alert in May, informing clinicians and public health agencies about the new clusters and calling on them to raise awareness about treatment, vaccination, and testing.
Between April 17 and May 5, 12 confirmed and one probable case of mpox were reported to the Chicago Department of Public Health. Nine (69 percent) of 13 cases were among men who had received two vaccine doses, and all cases were among symptomatic men. None of the patients was hospitalized.
The virus is most commonly spread through direct contact with a rash or sores of someone who has it. It can also be spread through contact with clothing, bedding, and other items used by someone with mpox.
Symptoms usually start in 3 to 17 days, and can last two to four weeks. Common symptoms include rash or sores that look like blisters—on the face, hands, feet, or inside the mouth, genitals, or anus. Flu-like symptoms such as sore throat, fever, swollen lymph nodes, or headaches are common too.
In this Q&A, Erick Eiting, MD, MPH, Medical Director for the Emergency Department at Mount Sinai Beth Israel and for the Urgent Care Center at Mount Sinai-Union Square, discusses what people can do to protect themselves from mpox and the importance of being fully vaccinated.
What is mpox and should I be worried about it?
Mpox is an orthopox virus (a genus that includes smallpox and cowpox). In spring and summer of 2022, we saw a pretty large number of infections here in New York City, across the country, and even across the globe.
Because of a widespread vaccine campaign, we’re now seeing far fewer infections than we had been seeing in the summer of last year. However, we’ve recently seen a small increase in the number of infections in New York City.
Should I be concerned about it now?
We recently saw a fair number of cases—in fact, there were 13 recent cases in Chicago over a relatively short period of time. And even though the number of infections that we’ve seen across the country has been relatively low, this number has been an increase from what we’re used to seeing.
And that’s really causing us to pay more attention to what’s going on and to make sure that we’re being vigilant in case those numbers continue to rise.
Fast facts about mpox
3,821
Cumulative mpox cases in New York City in 2022
70
Number of daily cases at the peak of mpox outbreak
20
Number of cases in New York City from February to May 2023
45%
Percentage of fully vaccinated at-risk individuals in New York City
Top Three Most Vaccinated Regions
California (306,000 doses)
New York City (153,000 doses)
Florida (94,000 doses)
What can I do to prevent it?
The first, and probably most important, is to make sure that if you are concerned about mpox—if you believe you may have risk factors—you really need to get fully vaccinated. Fully vaccinated means that you received two doses of the JYNNEOS® vaccine, at least four weeks apart.
Two weeks after you’ve received that second dose of the vaccine, you are considered to be fully vaccinated. So if you’re not fully vaccinated, that is probably one of the most important steps that you can take to prevent getting mpox.
The next part is making sure that you’re having conversations with people like sexual partners. Anybody who may have symptoms at the time could potentially pose a risk for infection, and it’s important to have those conversations.
We don’t consider mpox to be a sexually transmitted disease, but we do know that it comes from close physical contact. So having those conversations is really important, and even asking sexual partners about their vaccination status is also an important step.
The third thing is, if you’re concerned that you may have symptoms that are consistent with an mpox infection—and that could be a rash, which is often very painful, as well as fever, body aches, and chills—then it’s really important that you seek medical care as soon as possible. Some studies have shown that that the vaccine can be helpful in preventing mpox infection even after you’ve been exposed. Or that it can make the infection less severe.
If I have only taken one dose of the vaccine and have not completed the series, do I only need to take one more dose? Or do I have to go through the whole series again?
Anybody who’s received one dose already of the JYNNEOS® vaccine only needs one additional dose. You want to make sure that at least four weeks have passed since you’ve got the first dose. You need to get that second dose of the JYNNEOS vaccine in order to be fully vaccinated.
If I had taken both doses last year, should I consider taking another dose?
At this time there is no recommendation for getting a “booster” shot for the JYNNEOS® vaccine, and possibly there may not even be any additional benefit. So at this time we’re not recommending any further doses: two doses are fully sufficient, and if you’ve gotten both of those doses, you’re considered to be fully vaccinated.
Am I adequately protected if I complete my vaccine series now? Am I still protected if I had completed my series last year?
Yes, you will absolutely be protected. You have to keep in mind that no vaccine is perfect; no vaccine will prevent 100 percent of infections. But this is about the best protection that you could potentially have. So if you’ve already gotten those two doses, and two weeks or longer have passed since then, you are fully protected.
Can I stay home if I have symptoms? Who should be seeking treatment?
If you are presenting with symptoms, you should absolutely be seeking treatment. One of the most important steps is getting tested and making sure that we’re confirming the diagnosis of mpox. One of the beneficial parts about this disease is that very few people will go on to have very severe symptoms.
It’s only a very small number of people who have died. The people who are most at risk are people who have some kind of advanced weakened immune system, people who are pregnant, and children.
On an average day, New York has an air quality index of 30, considered “good.” Because of current wild fires in Canada, the score has risen to 160 and above, in the “unhealthy” range.
You have probably noticed the hazy skies throughout the New York City area. Health experts say everyone should pay close attention. That poor-quality air is unhealthy, especially for vulnerable people, including those with asthma or heart conditions, as well as younger kids and older adults.
The poor air quality, the result of wildfires in Canada, is expected to persist for several days, and it’s something you can actually feel. Experts say you should consider limiting your time outside, especially if you are exercising or doing strenuous tasks; keeping your windows closed at home; and wearing a high-quality N95 or KN95 mask if you need to go out. Those most at risk should stay indoors.
“Many people may have noticed the hazy conditions, but not realized they should be concerned—especially younger people and the elderly, who are at greater risk,” says Linda Rogers, MD, Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine) at the Icahn School of Medicine at Mount Sinai. “I think we all should be looking out for the most vulnerable; they are the ones that are at most risk right now. But this has crossed a threshold where the public will feel this.”
Click here for more specific information for parents about kids and air quality.
In this Q&A, Dr. Rogers, who is also Director of the Adult Asthma Program, offers a number of other tips, including what type of mask to consider wearing, whether to turn on your air conditioner, and who is most at risk.
How bad has the air quality been in New York City because of these wildfires?
Our air quality has been in a zone that’s considered dangerous to health, and not just dangerous to sensitive populations. We crossed the threshold where there may be some health effects noticed in otherwise healthy individuals, and it’s something that’s probably hazardous to people who are either elderly, very young, or have underlying heart or lung disease, or other sort of significant health conditions. It’s not something people are normally aware of, though most people going outside will realize that something is up.
Linda Rogers, MD, Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine)
How can I tell what the air quality is like in my neighborhood right now?
A good way to see what the air quality is like right now, where you live, is the website AirNow.gov. This site offers a composite score for what we call the big five pollutants—ground-level ozone, particulate matter, carbon monoxide, sulfur dioxide, and nitrogen dioxide. A good score is less than 50. On an average day in New York, we are around 30; we have pretty good air quality. Once it starts getting up over 50, there may be risks for sensitive people. During August, this score can reach 100, due to a combination of heat, humidity, and pollution. Recently the score has risen to 160 due to the wildfires. Any of the common weather apps people have on their phones are also a good source of this information.
What does it mean when the air quality reaches the unhealthy levels we have seen lately?
That’s the red zone. That’s where even healthy members of the general public are going to feel it. The effects on the general public may be mild; it may just be a matter of feeling irritation in your nose or throat. But for really sensitive groups, this is a level that could trigger asthma attacks or flare-ups of other lung diseases, and pose a risk for those already at risk for heart attacks and strokes.
What safety precautions should I take when air quality is at an unhealthy level?
The best thing to do is stay inside with the windows closed. If you have to go outside, make it as short as possible. I don’t think anybody should exercise outdoors while the air quality is at these levels. When you’re exercising, you are taking in more of these contaminants. It depends on your personal circumstances, but when levels are between 100 and 150, you may want to consider limiting outdoor exercise, especially kids.
Should I wear a mask?
You should consider wearing a high-quality mask, such as an N95 or KN95 mask. Surgical-style masks will not be helpful. Those masks offer at least partial protection from viruses transmitted by droplets, but they do not protect you from the extremely small particles that are being produced by these wildfires. And even the N95 and KN95 masks cannot protect you from the gases, such as carbon monoxide, that are being produced by the fires.
What about working outside?
I think it depends on your underlying health, your age, your circumstances, what the work involves, and what the air quality is in the area that you’re working. If you have to work outside, a high-quality N95 mask will be a great idea if it’s possible for you.
Does it help to use my air conditioner?
Air conditioners vary tremendously in terms of how old they are, how they’re built, and what kind of filters they have in their use. Closing your windows and using an air conditioner is better than having the windows open. Ideally, your air conditioning system has a high-efficiency filter. Air purifiers can also help.
Who is most at risk?
Young kids are more at risk because they tend to breathe at faster rates with higher volumes. When there’s an elevated pollutant like this, they’re generally getting more exposure. The elderly are at higher risk for heart and lung disease and have other underlying health conditions. Those with lung diseases, notably asthma and chronic obstructive pulmonary disease (or COPD), are often sensitive to environmental triggers like this, or changes in weather, temperatures, and humidity. Many of those with asthma, for example, often reach out to their doctors in advance to make sure they have emergency medication on hand. But it can be different for those with heart conditions.
What should people with heart disease know about this?
People with heart disease may not be aware that they are at increased risk, but these high levels of pollutants have been linked to visits to emergency rooms with cardiovascular conditions. People who are at risk may want to consider staying indoors to the extent possible. It’s also important to note that there may be a lag in the onset of symptoms. It may take a while for the contaminants you are breathing in to have an effect on your blood vessels. That is why we may sometimes see a lag in visits to the emergency department. The health effects can persist and escalate from 24 to 48 hours after the air quality levels are at their worst.
What are the signs that the air quality is affecting a typical, healthy person?
When the air quality index gets above 100, and then over 150, as it has recently done, you’re going to feel throat irritation, nasal irritation, nasal congestion, runny nose, sore throat—almost cold-like symptoms except without a fever. Some people may feel chest discomfort and headaches. These aren’t particularly dangerous. But for those with underlying conditions, such as lung disease and allergies, they can cause more severe debilitating symptoms. The air is unhealthy for everyone, but some groups are at risk of significant health effects.
Details of the air quality index from the federal government’s AirNow.gov site.
It’s not uncommon for people to put off seeking medical care. The process can be stressful, especially if you feel your health care provider doesn’t really understand you and your special concerns. That can be even more true for some patients, such as those in the LGBTQ+ community.
In this Q&A, Barbara Warren, PsyD, Senior Director for LGBT Programs and Policies in Mount Sinai’s Office for Diversity and Inclusion, explains how to find a provider with specific experience in LGBTQ+ health issues, how that can help alleviate stress and improve health outcomes, and details Mount Sinai’s approach to offering compassionate care. Dr. Warren, who leads Mount Sinai’s implementation of lesbian, gay, bisexual, transgender and gender diverse (LGB/TGD) culturally and clinically competent health care, is also an Assistant Professor of Medical Education at the Icahn School of Medicine at Mount Sinai.
What are some of the biggest health challenges for the LGBTQ community?
One of the biggest challenges for LGB/TGD consumers is finding a provider and finding a health system that is both LGB/TGD clinically and culturally competent, and being able to go anywhere in that system, to any provider, to any setting, and feel safe, to feel that you are being treated both effectively and with compassion. This is something that we have taken lots of strides to make possible throughout the Mount Sinai Health System.
Why is it important to find a provider who has experience with LGB/TGD health issues? What can they offer?
One of the things that LGB and TGD patients should look for is a provider who understands their needs. Being lesbian, gay, bisexual, transgender and gender diverse isn’t a health problem in itself. But many LGB/TGD people have health issues that are related to something we call “minority stress.” Minority stress is any kind of stress that people can undergo that affects us both psychologically and physiologically—when we either have experienced or anticipate experiencing discrimination, bullying, or even violence. This is something that many people in the LGB/TGD community live with. Even if they themselves have had not had personal experiences, they know that there is a possibility of discrimination, and of misunderstanding by health care providers. This can create anxiety. When sustained over time, this anxiety can create health problems, not just psychological or health behavior issues.
“It is more important than ever that for those looking for an LGB/TGD affirming and knowledgeable health care provider, the provider understands that these stressors can affect an LGB/TGD patient’s experience of illness and recovery and work with that patient to understand and mitigate those effects,” says Barbara Warren, PsyD.
Can You Give an Example?
Sometimes if we are experiencing many stressors, we may overeat, or drink more alcoholic beverages, or not get enough rest or sleep. Increased and sustained anxiety in response to stressors can interfere with decision-making, memory, and effective functioning. Sustained stressors create a physiological response that leads to increased levels of cortisol in our bodies. Cortisol is known as the body’s stress hormone. It governs key body functions but too much cortisol can lead to a number of health problems, for example increased cardiovascular risk. It is important to note that stressors may be personal or interpersonal in our lives in terms of our current life circumstances like the loss of a loved one, or loss of a job or housing.
Recent threats to LGB/TGD safety and equity across many states in the form of legislation to deny gender-affirming care, banning books and public education inclusive of both racial and LGB/TGD history and representation, banning drag or any other behaviors that don’t conform to rigid and outdated binary gender stereotypes, have all been recent sources of what we are calling “minority stressors.” They have had the effect of increasing rates of depression, anxiety, and suicidality, especially among LGB/TGD young people. So it is more important than ever that for those looking for an LGB/TGD affirming and knowledgeable health care provider, the provider understands that these stressors can affect an LGB/TGD patient’s experience of illness and recovery and work with that patient to understand and mitigate those effects.
How do you find a provider who has this experience?
At the Mount Sinai Health System, we have a number of ways. First we have web pages that give you information and resources, including our LGBT web page. There are a number of other organizations that can help, including the Gay and Lesbian Medical Association and the World Professional Association for Transgender Health. You can email us at LGBTinfo@mountsinai.org, and we will answer your email and make a direct referral to providers around the Mount Sinai Health System that have special expertise.
In addition, we have a number of programs and a number of practitioners specializing in certain aspects of LGBT health. For example, our Institute for Advanced Medicine, which started as our HIV/AIDS program to serve the large gay and bisexual population, specializes in some of the health care issues that are facing LGB/TGD people. There are five locations throughout the city. Our Center for Transgender Medicine and Surgery is a national model for services to support undergoing a gender transition and TGD affirmative primary care. We take LGB/TGD health very seriously at Mount Sinai and offer ongoing training for all of our providers, our front-line workers—everybody from our security guards to our surgeons to create a safe and welcoming environment for our LGB/TGD patients, families, visitors, and employees.
It’s not uncommon for people to put off seeking medical care. The process can be stressful, especially if you feel your health care provider doesn’t really understand you and your special concerns. That can be even more true for some patients, such as those in the LGBTQ+ community.