Nathan Quinn came out as transgender at 17. However, he found his identity became a barrier to finding an adequate medical professional.
Although Quinn, now a 21-year-old UF psychology senior and president of the UF Pride Student Union, came out before college, he said he didn’t feel comfortable seeing any ordinary doctor in Gainesville.
“We are often misunderstood or flat-out denied care due to our identities,” Quinn said.
After a long search, Quinn found a medical physician in the UF Health network who took transgender patients in order to access care in Gainesville.
“Luckily, she had sought out the education she needed to help trans patients who were otherwise being denied care,” Quinn said.
Although Quinn found a doctor who he trusted, other LGBTQ+ patients cannot say the same, said Merry-Jennifer Markham, associate director for medical affairs at the UF Health Cancer Center.
Inclusion at Shands
Last year, UF Health Shands formed an employee committee composed of people who personally understand the difficulties in the medical field for members of the LGBTQ+ community, said Ed Jimenez, CEO of UF Health Shands.
This particular committee is different from what is seen elsewhere because of its direct connections with the LGBTQ+ community, he said.
Before its formation, individuals in the hospital would voice ideas and suggestions, but it’s now organized as an employee committee fully focused on patient care, patient education and how to integrate families, Jimenez said.
“We live in a community in Gainesville that is very open and progressive,” he said. “For us, it’s really second nature to be inclusive and to be thoughtful and open to new ideas.”
Jimenez said he hopes patients will feel more comfortable as the word gets out about physicians being more inclusive.
“We’re trying to create another resource, but we have to be aware that sometimes when you’re trying to be helpful, you can sort of inadvertently be abrasive or be demeaning or not be inclusive,” he said.
Jimenez said UF Health Shands wants to spread the word about inclusion and seek advice from the employee committee to gain insight on the best way to inform the LGBTQ+ community.
UF Health also added new optional questions to the registration process this past April, said Ashok Srihari, an endocrinologist at UF Health Shands.
Srihari said these questions are under Sexual Orientation and Gender Identity on the registration, and it’s a whole field in the electronic medical record.
Questions include the patient’s gender, gender identity and pronouns in order to improve medical care, Srihari said.
“This is the first step with patients in this community, and we do not want to push them away by misgendering them,” Srihari said.
Researching Risks
When physicians take care of patients, Markham said they have to be sensitive to everything about the patient because certain characteristics may lead to increased medical risks.
“We know that African-American men have higher rates of aggressive prostate cancer, and that’s an example of how somebody’s racial and gender makeup actually impacts their risk for cancer,” Markham said. “The same holds true with the LGBTQ+ population in that there are certain things oncologists need to be aware of.”
Researchers from UF Health Cancer Center, the University of Miami’s Sylvester Comprehensive Cancer Center and the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida received a $150,000 grant on Aug. 1, 2017, from the Florida Academic Cancer Center Alliance. The grant allotted $50,000 to each institution for a training course.
All three cancer centers have an interest in reducing health care disparities in the LGBTQ+ population, Markham said.
The entire grant was used on the pilot program “Curriculum for Oncologists on LGBT Populations to Optimize Relevance and Skills,” which was designed to train oncologists how to properly approach treatment for patients who are LGBTQ+.
“This program was designed in terms of [LGBTQ+ patients’] interactions with the health care community and how physicians need to be sensitive to their needs while understanding of some of the things that may be important to them,” Markham said.
There’s data to show people who identify as LGBTQ+ may be more reluctant to go to a physician with a problem, Markham said.
“They may not feel like they’re as welcomed,” she said. “Especially if the problem is a very personal one, like somebody who is a transgender woman who may have prostate cancer – that is a very sensitive issue for that particular patient.”
Markham said all of the oncologists involved in the study had patients who had a delay in their diagnosis of cancer because of difficulty navigating the health care system due to being LGBTQ+.
“We all really just felt strongly that eliminating health disparities is really important, and one important way to do that in this community was actually educating the physicians,” Markham said.
Since the grant was funded, it took an entire year to do the background research. The researchers met with focus groups, which included members of the LGBTQ+ community, as well as physicians, oncologist and advocates.
Markham said, through the feedback, they developed an online training module which was then tested by 15 to 20 oncologists at each institution.
“The feedback was actually very overwhelming,” she said. “People really seemed very interested in this kind of training and felt that it would be useful for their practice.”
The pilot is over, and the course is currently in the refinement stage of the educational module in order to make it a sustainable course, Markham said.
The research team is in the process of applying for a larger grant in order to make this happen.
Part of the training included ways to identify a medical practice as being welcoming.
“Simple things like the signage in the waiting room or asking patients when they come in what pronoun they prefer to be called is part of the training,” Markham said.
Markham said she hopes these efforts will translate to patients feeling more comfortable and, in turn, reduce delays in getting care.
She said the course is important for colleges to be able to take this kind of cultural competency training but probably more important for anybody in the health care setting.
“Eventually, the goal is to make this course available through some mechanism, nationwide, for oncologists in any setting to take it,” Markham said.
From Quinn’s experience, these measures are necessary, and he said UF Health Shands should require trans-specific medical education to all doctors.
“Trans individuals face the most discrimination and ignorance from medical professionals and many doctors blame a lack of training and need help from their patients on trans health care,” Quinn said.
Quinn heard about the inclusive policies UF is planning to implement and said he hopes for a better future for the LGBTQ+ community.
“Some doctors are improving but many still deny care and remain ignorant,” Quinn said.
Markham and other researchers hope to turn this issue around in the coming years with the physicians and the communication process.
“I think it’s going to take education on both sides,” Markham said, “but we had to start somewhere. I think starting with the physicians was crucial just to raise awareness amongst that group about some of the barriers that our patients face.”
Nathan Quinn is a 21-year-old UF psychology senior and president of the UF Pride Student Union. “I didn’t go to any doctor before finding someone I would be comfortable seeing. I luckily was able to find a doctor in Gainesville before moving here for college,” Quinn said.
