Creating a Welcoming Clinical Environment for LGBT Patients

[SRWOLFE]

Good afternoon,

I wanted to share with all of you my scholarly project for family medicine. For my topic I wanted to focus on improving the clinical environment for LGBT patients, especially in more rural areas. I'm looking for feedback on this project as I plan on expanding it in the future. Let me know what you think!

Project can be found here: http://scholarworks.uvm.edu/fmclerk/163/

Abstract: The aim of this project was to develop a welcoming clinical environment for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients at Northern Counties Health Care (NCHC) and to serve as a model for community health centers across the nation that want to provide their LGBT communities with patient centered care that is affordable, compassionate and accessible. This was achieved by revising non-discrimination policies and new patient forms to be more inclusive of sexual orientations and gender identities, incorporating LGBT health learning modules into yearly provider and staff mandatories, and adding LGBT inclusive material into all waiting and exam rooms. The effectiveness of these interventions was evaluated using the Healthcare Equality Index (HEI) scoring criteria developed by the Human Rights Campaign. Future interventions include registering competent and sensitivity trained providers to the GLMA (Health Professionals Advancing LGBT Equality) provider directory, including data fields for sexual orientation and gender identity as part of the electronic health record (EHR) for all patients, conducting a community needs assessment with local LGBT groups such as Outright Vermont and NEK LGBTQ Advocacy Committee, developing a partnership with the DHMC Transgender Clinic for additional training in the management of hormone therapies, and measuring LGBT patient satisfaction through phone interviews.

I've uploaded the presentation to this post. For additional attachments check out the scholarworks link.

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[Guero]

Good afternoon,

I wanted to share with all of you my scholarly project for family medicine. For my topic I wanted to focus on improving the clinical environment for LGBT patients, especially in more rural areas. I'm looking for feedback on this project as I plan on expanding it in the future. Let me know what you think!

Project can be found here: http://scholarworks.uvm.edu/fmclerk/163/

Abstract: The aim of this project was to develop a welcoming clinical environment for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients at Northern Counties Health Care (NCHC) and to serve as a model for community health centers across the nation that want to provide their LGBT communities with patient centered care that is affordable, compassionate and accessible. This was achieved by revising non-discrimination policies and new patient forms to be more inclusive of sexual orientations and gender identities, incorporating LGBT health learning modules into yearly provider and staff mandatories, and adding LGBT inclusive material into all waiting and exam rooms. The effectiveness of these interventions was evaluated using the Healthcare Equality Index (HEI) scoring criteria developed by the Human Rights Campaign. Future interventions include registering competent and sensitivity trained providers to the GLMA (Health Professionals Advancing LGBT Equality) provider directory, including data fields for sexual orientation and gender identity as part of the electronic health record (EHR) for all patients, conducting a community needs assessment with local LGBT groups such as Outright Vermont and NEK LGBTQ Advocacy Committee, developing a partnership with the DHMC Transgender Clinic for additional training in the management of hormone therapies, and measuring LGBT patient satisfaction through phone interviews.

I've uploaded the presentation to this post. For additional attachments check out the scholarworks link.

This is fantastic! I'm working on something similar at our Med school and hospitals, but from an urban resource and policy perspective. I'm eager to see how this pans out! Once I have some more time, i'll peruse your attachments and try to offer some feedback. In the interim, if you have any questions, please feel free to pm me. Good luck!


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[desidoc_]

I'll take a proper look when I have access to a computer (which may be a few days) but from very briefly looking through I noticed that on page 5 you cited Maddy McKenna as a "transgender female" rather than a "transgender woman." If this is how they requested to be identified then that's no problem of course but I just wanted to make sure you weren't conflating sex and gender!

 

[SRWOLFE]

I'll take a proper look when I have access to a computer (which may be a few days) but from very briefly looking through I noticed that on page 5 you cited Maddy McKenna as a "transgender female" rather than a "transgender woman." If this is how they requested to be identified then that's no problem of course but I just wanted to make sure you weren't conflating sex and gender!

I made sure to ask beforehand! That's what they wanted me to write. I try my best to ask everyone, including patients I see, how they specifically want to be described or what pronouns etc to use. It's a habit now. I'll occasionally get a few weird looks from older, more conservative folks but the majority of people appreciate it.

 

[desidoc_]

I totally forgot about this - are you still looking for feedback?

 

[SRWOLFE]

I totally forgot about this - are you still looking for feedback?

Of course! Feel free to post here or to PM me.

 

[desidoc_]

Ok, on the patient form one important thing to add may be a note asking if contacting via phone or email is safe, and if leaving a message is safe. It may be that the patient provides their home phone number, or that family may have access to their cell phone. If the patient isn't out, then leaving a message addressing them by the correct name and pronouns may potentially out them. For gender identity, it's pretty harmful to only provide male, female, FTM, and MTF as options. A nonbinary patient wouldn't want to fall into the category of "other." They aren't someone who just inconveniently doesn't fit into any of the options you've given me and therefore need to be shunted into "other." You could easily make them feel more respected by simply providing "non-binary/genderqueer" and "two-spirit" as options. Furthermore, generally "male" and "female" refer to sex, while "man" and "woman" refer to gender.

I wasn't able to see the modules so this is all I have in the way of feedback.

 

[DanielLee5]

Great news!

 

[clinicalpresentations]

As a trans and mentally ill provider, I find the things I want most from the community is respect for our culture, and the acknowledgment that nonconforming gender identities are not a result of pathology.

We get a lot of pressure to conform and normalise, and psychiatrization is a particularly serious issue. There's just such a lot of pressure to present ourselves in a more normative manner when seeking out medical care. We either have to play into the sick role and be the "classic trans patient" - either butch up or femme up to meet their expectations of our presentation when seeking care for related issues - or we have to tone it down to avoid having our gender nonconformity become the central feature of every single medical visit.

My partner had hemiplegic migraine that was wreaking havoc with her nervous system function, and they insisted it was a somatoform disorder due to trauma. She had life threatening suicidal ideation on some of the meds - utterly out of the norm for her - but this naturally was interpreted as further evidence.

I eventually just pulled her out of that centre totally and had to find a different centre to go to for consultations because the doctor who had made the diagnosis was too high up in the hospital to be easily challenged, and it was just a pointless fight.

 

[mikebaines]

Great initiative!