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Caring For The LGBT Community Through Psychiatry and Sociology

levounisPetros Levounis, MD, MA is a psychiatrist specializing in behavioral health and addiction medicine, as well as LGBT mental health. He currently serves as chair of the Department of Psychiatry at Rutgers New Jersey Medical School and chief of service at University Hospital in Newark, New Jersey. He has also been extensively involved in investigating the social determinants of health–particularly LGBT mental health–throughout his medical training and career as a physician.

Before assuming his current role, Dr. Levounis was at Columbia University Medical Center in Manhattan, New York. He also served as director of the Addiction Institute of New York and chief of addiction psychiatry at St. Luke’s and Roosevelt Hospitals from 2002 to 2013.

Dr. Levounis earned a BS/MS degree in chemistry and biophysics from Stanford University. He then received his medical education at the Stanford University School of Medicine and the Medical College of Pennsylvania. During his time at medical school, he took time off to do research on the social determinants of health at Oxford University, and earned a Master of Arts degree in Sociology at Stanford. In 1986, Dr. Levounis moved to New York City where he did his internship in internal medicine and residency training in psychiatry at Columbia-Presbyterian Medical Center, and then completed his fellowship in addiction psychiatry at New York University Medical Center.

Dr. Levounis has authored and edited many published peer-reviewed papers, articles, and books on addiction psychiatry.

I first spoke with Dr. Levounis for a psychiatry piece I wrote for MedPage Today on the decline in the number of psychiatrists in the United States. I then had the opportunity to sit down with him to hear more about his career that expands through many disciplines and outlets of creativity.

ND: Can you tell us more about your background in biophysics and chemistry that you studied at Stanford as part of a combined BS/MS program?

Dr. Levounis: At Stanford, we were encouraged to pursue dual-degrees. When I was an undergraduate, I did a master’s in biophysics along with a bachelor’s in chemistry. Having an analytical background, my undergraduate research was in biomedical engineering. During my master’s program, I pursued research on waves. Some of my work was done on computer simulations of contraction waves of the urinary bladder’s smooth muscle, and some on the waves of the oceans. The research was very mathematical in nature, but I also got to spend time in nature, on the shores of the Pacific Ocean in Monterey Bay, which was both awesomely inspiring and thoroughly distracting.

ND: You also obtained an MA in sociology and participated in research at Oxford University, examining the role of socioeconomic status in patient-physician relationships. Can you tell us more about your research at the intersection of sociology and medicine?

Dr. Levounis: When I started medical school in 1986, the HIV/AIDS epidemic was in full swing. Being an openly gay man and living in the San Francisco Bay Area in the 1980s, I found myself becoming more and more drawn to the social aspects of medicine. I decided to do research on how social class dictates the questions patients ask their doctors.

I discussed my ideas with Dr. Count Gibson, my mentor who chaired the Department of Community Medicine, and I remember him saying: “Oh Petros, you’ll have a tough time defining social class around here. Go to England.” To my amazement, within a couple of months, Stanford had arranged and fully supported my going to Oxford, England, for a semester to pursue my research. I worked with a primary care physician and interviewed dozens of patients at clinics and at their homes. Oxford is a lot more socioeconomically diverse than people often imagine, and we saw patients from all walks of life. Interestingly, even though my preceptor and I made our own, independent determinations of socioeconomic class of our subjects, our results were 94% congruent!

One of the key findings of this research, built on previous sociological studies, was that people from lower socioeconomic strata asked fewer questions. Our unique contribution to this line of work was that we found an even higher correlation between quality of questions and socioeconomic class. For example, someone from a lower socioeconomic class would very rarely ask about alternative treatments or potential side effects of medications, while someone from a higher social class would ask “informative” questions more frequently.

ND: What led you to choose psychiatry out of all of your choices?

Dr. Levounis: My father is an internist, and I always thought that there was a good chance I would become an internist myself. However, in my third year of medical school, I had an attending in psychiatry who was absolutely brilliant: Dr. Kristin VanZant from Philadelphia. Dr. VanZant was spectacular on all fronts, and I said to myself: “I want to be just like her!”

When I told my father that I was thinking of going into psychiatry, he loved the idea. He told me that the most interesting part of his practicehe specializes in asthmawas the 10% of his patients who had primary psychiatric issues, such as panic attacks masquerading as asthmatic crises. He said to me: “Why limit yourself to 10%? Go for a 100% of an amazing life!” My mother, who is a nurse, was less enthusiastic about my choice. She thought I could become too emotionally invested in my patients’ lives and possibly get depressed. I don’t think that turned out to be the case.

ND: Why did you specialize in substance use disorders and behavioral health over all of the other choices you had?

Dr. Levounis: My two major scientific interests have been small thingssuch as atoms and molecules explored in chemistry, and big themessuch as the social determinants of health. Addiction medicine combines aspects of the two very eloquently, so I was naturally attracted to it.

I was also awarded a Betty Ford scholarship while in medical school, which gave me the opportunity to live closely with patients facing substance use problems. Spending a week at the Betty Ford, essentially being treated like a patient in a highly experiential program, was eye-opening to say the least. At that time, I realized I wanted to work with this heavily stigmatized group of people combining science, sociology, and public policy.

ND: You also specialize in LGBT Health.  Can you please share some of the challenges of the LGBT community you encounter, as well as some of the work you have done in this arena?

Dr. Levounis: Right now, we are at a crossroads of understanding sexuality in a way that’s broader and more sophisticated than ever before. A lot of it has to do with transgender health. In the past couple of years, transgender health has been coming of age and has been informing—and transforming—all of LGBT health, and sexuality in general.

Our current research efforts use big data research techniques to explore sexuality and health. We have started to analyze data from dating apps and dating sites in the LGBT community with some pretty interesting results. For example, in one study of over 14,000 users of a popular dating site, we examined gay men, straight men, gay women, and straight women, in the context of smoking cessation. Lesbian smokers had approximately half the rate of wanting to quit smoking than the other three groups, which had similar rates of motivation to quit. One possible interpretation of these findings suggests that, for better or worse, lesbians may be more accepting of themselves than the rest of us.

Some of the “big data research” findings are uncomfortable, such as interracial dating patterns, and we have a lot more work to do figuring out what they mean and where to go from here. One thing is certain, however: ignore them at our own scientific and clinical peril. Earlier this year, I gave a talk at Boston University on Grindr’s impact on the LGBT community, and it was sold-out. The title of the talk was “It’s Not OK Not to Know What Grindr Is.” You cannot be a good doctor in 2016 without having some sense of what’s going on out there, in our patients’ everyday lives.

ND: Overall, you have an extremely illustrious career that also includes extensive involvement in writing books and articles and communicating through news outlets. What are specific things you recommend for physicians who aspire to have a dynamic career like yours?

Dr. Levounis: OK, that’s not easy, but let me give it a shot… Scan the world around you, look for people you want to be like, and try to unpack how they operate—what goes into the mix, what makes them such good role models for you. On the other hand, also look for people whose lives you’d like to, well, avoid. The anti-mentors. Look at what traps they might have fallen in and try to stay clear of them—both the traps and the people.

Finally, do not underestimate the things you are good at. We are brought up with the idea that passion is life’s ultimate driver. “Go after what you love, and you’ll be great at it,” is what we are taught from a very young age. And there is truth to that. However, I have found it helpful to also think of this relationship of passion and excellence in reverse: Look at what you are naturally good at and hone in those skills. It is quite likely that passion will follow.