Going To The Doctor Is Simple... Unless You're LGBT

Here's to health care access for all!

When Hannah Simpson went to the gynecologist's office for the very first time in her life, the receptionist called her by her last name when it was her turn to go into the exam room. The reason: the computer had the trans woman listed by her old first name.

"The receptionist, thank God, had the sense to call out 'Simpson' instead of something else," Simpson, 30, says. She attributed the mistake to a computing glitch due to a merger between two major hospital systems, but that didn't make the mistake any less galling to the Harlem resident and medical student, who had made the appointment and signed in as "Hannah."

"This is a seriously dangerous and disgusting and embarrassing thing that I was almost called by my old name at my first visit to the gynecologist," she recalls explaining to the staff at the office.  

This is the kind of mistake that will likely be avoided when an OB/GYN clinic in North Philadelphia starts offering office hours specifically set aside for lesbian, bisexual and transgender people. Starting on June 23, the clinic, which is part of the Einstein Healthcare Network, will have a staff of 10.

iStockphoto/Niyazz
iStockphoto/Niyazz

The idea for the special care originated years ago, according to Dr. David Jaspan, the chairman of the obstetrics and gynecology department at Einstein in Philadelphia, with Sharon Butterworth, a physician's assistant. "She came to me when I was not the chairman of the department and she said, 'We should really provide a niche practice for the lesbian community,' " he recalls. Jaspan was just a medical student at the time. More recently, Dr. Michele Style approached Jaspan about a patient she was caring for — a lesbian diagnosed with Stage IV cervical cancer, a disease that typically can be detected early through regular pap smears.

"The woman lives within walking distance of this particular hospital," Jaspan explains. "It wasn't that she couldn't access the care. It's that she did not access the care. In caring for the patient, Michele learned that this woman who had the cervical cancer is a gay woman and feared going to the provider. Michele came to me and said, 'We gotta do it.' "

Style tells Phillesbian, "I have met many members of the LGBTQ community who do not go to care because they feel marginalized and misunderstood by the health care community. We want to change that."

It's not just lesbians who are reluctant to go to the doctor and receive regular medical care out of fear of being mistreated and asked insensitive or non-germane questions. Trans people are, too. The focus of the discussion around Caitlyn Jenner has been about her "transition," which is dramatic to be sure, but trans people need mundane things such as basic medical care and preventative checkups just like everyone else. "The thing with trans care is a lot of it is people needing the same care as everybody else needs and feeling marginalized," Simpson explains. According to a 2010 survey conducted by the National Center for Transgender Equality and the National Gay and Task Force, 28 percent of transgender and gender-nonconforming individuals delayed seeking medical care because they feared discrimination and mistreatment.

Meredith Talusan, a trans writer and advocate, has reached similar conclusions based off of her interactions with transgender individuals. "There are a number of trans women that I've spoken to who are afraid to go to the doctor because of the fact that they're afraid of being treated like a freak," she says. "Or people who would pretend that they've had hysterectomies to try to revise their medical histories because they're afraid that as soon as they disclose that they're trans that somehow they would be treated fundamentally differently."

iStockphoto/Monkey Business Images
iStockphoto/Monkey Business Images

Talusan recalls an incident when she was at her doctor's office and a new nurse on staff asked for the date of her last period. Not wanting to launch into a lengthy explanation, she made up a date to satisfy the nurse. But afterwards, Talusan told her doctor, with whom she has a comfortable and trusting relationship, what had happened. "She was apologetic, of course, but she also took responsibility for informing the nurse," Talusan says.  "For me, it not necessarily that somebody would make that type of mistake — it's much more about the general environment of a particular practice that allows those types of mistakes to be made and yet still have trans people be comfortable." Talusan's doctor quickly apologized for the mistake and then went about fixing it so it wouldn't happen again.

As a medical student, Simpson understands why doctors and nurses ask non-inclusive questions that have the potential to make LGBTQ patients feel uncomfortable. "I don't blame doctors for asking certain questions because part of the experience of becoming a medical student is having things drilled into you. And they're drilled into us a certain way because they don't want us forgetting to ask certain things." For Simpson, the solution isn't to stop asking patients these questions, but to ask more questions of everyone. "They should be asking questions that are pertinent to me to every other patient too because, hey, you never know what questions are pertinent until you ask them," she says.

Creating the right environment for LGBT individuals is only part of the solution. For trans individuals, there are lot of "unknown knowns," as former Secretary of Defense Donald Rumsfeld would say, such as the impact of taking hormones for decades. "I'm on hormones, so that's kind of a consistent concern," Talusan mentions. "There haven't been long-term studies about the effects of hormones on trans women's bodies."

This means that doctors — primary care or OB/GYN — need to stay on top of the research and studies around these topics. That Talusan's doctor is at the forefront of many of these issues is reassuring. "I can always feel like I know what the latest is even if a lot of things are unknown. At least I have the comfort of knowing that I have as much of the information that's available," she says.

And that she has a doctor who is willing to acknowledge what she does and doesn't know. "I think what separates the good doctors from the ones you want to avoid are the ones that say, 'I don't know what this is but I'm going to learn and follow up with you,'" Simpson says.

Jaspan, who described the reaction to news of the new clinic as "overwhelming positive," hopes the North Philadelphia will be a resource to LGBT community. "We want to create a safe environment so that it doesn't matter who walks in," he says.

Cover photo: iStockphoto/Dangubic