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Many members of the LGBTQIA+ community avoid seeking necessary health care because they’re afraid they’ll be mistreated, but that can harm their health outcomes.
Providence Swedish launched the LGBTQIA+ Program to better serve the community and make medical services more accessible to those who face barriers to care.
The program provides services, including health care navigation, to patients and cultural competence training to caregivers.
Improving the health outcomes of the LGBTQIA+ community
When he was a kid, Kevin Wang, M.D., medical director for Providence Swedish’s LGBTQIA+ Program and family physician at the Providence Swedish First Hill Family Medicine residency clinic, recalls his family doctor asking him during visits if he had a crush on a girl at school.
“I already knew I liked boys,” Dr. Wang says. “It made me feel like, ‘Oh, is there something wrong with me?’ I didn’t feel like I could be open with him.”
That non-inclusive approach to health care is what Dr. Wang now works to combat as a family medicine doctor himself.
“(Often) physicians have stereotypes influencing their care,” he says. “Let’s say a cis-gender, gay male comes in and tells their provider they’re gay, and that provider says, ‘Oh, we should be testing you for HIV, gonorrhea, chlamydia and syphilis.’ They make an assumption the patient is promiscuous, when he could be in a committed relationship. On the other hand, a straight person comes in, and no one even has that conversation with them because it is assumed they’re monogamous.”
The most recent U.S. Transgender Survey, from 2015, found that 23% of respondents reported not seeking necessary health care because they were afraid of being mistreated as a transgender person. And one-third of those who did see a health care provider in the year prior reported negative experiences because they were gender noncomforming. Negative experiences, according to the report, included being refused treatment, verbal harassment, physical or sexual assault, or “having to teach the provider about transgender people to get appropriate care.”
Health care organizations need to become more informed about the LGBTQIA+ community, Dr. Wang says — the history, terminology and disparities that affect everything from an individual’s legal rights to their ability to access health care.
The care a patient receives from an informed provider can be “transformational” in helping to undo any past traumatic or victimization experiences in the health care setting, he says, and in leading to better health outcomes.
In 2010, when he started working at Providence Swedish, Dr. Wang began developing LGBTQIA+-informed curricula for the residency program. That led to lectures and a conference, which eventually caught the attention of the leadership team.
Providence Swedish’s LGBTQIA+ Program
In 2020, Providence Swedish launched an initiative to assess how it could better serve the LGBTQIA+ community. The work, led by Dr. Wang, included conversations with community members, organizations, Providence Swedish leadership and national programs.
The initiative produced four major takeaways for next steps:
- Provide clinical support for providers, so they can offer comprehensive services to the LGBTQIA+ community.
- Get better at data gathering, input and reporting.
- Implement culture changes that focus on advocacy, education, cultural awareness, historical trauma and listening sessions.
- Improve care coordination by increasing accessibility to Providence Swedish and surrounding health care organizations to better the well-being of LGBTQIA+ patients.
Providence Swedish chose to move forward in every area and turned the initiative into a permanent program for public health. Providence Swedish’s LGBTQIA+ Program, housed in the Office of Health Equity, Diversity and Inclusion, provides patient services — including health care navigation — to bolster empowerment for individuals seeking gender-diverse care and treatments.
Health care navigators connect patients to gender-affirming primary and specialty care clinicians, surgeons and mental health professionals. The team also connects patients — such as those dealing with issues like homelessness or substance use disorder — with social services and resources like food, housing and financial assistance. Support and referrals for identification documents, legal assistance, health insurance, support groups for young people and community events are also available.
LGBTQIA+-informed training for caregivers
In addition to patient services, Providence Swedish’s LGBTQIA+ Program provides specialized clinical support to teams to ensure caregivers are up to date on the latest advancements, so they can deliver high-quality care to LGBTQIA+ patients.
To date, more than 60 Providence Swedish clinicians have completed the program’s nonclinical transgender health training. Gender-affirming clinicians not only have a better understanding of the medical needs of their patients, such as the proper screenings in the correct clinical settings, they also open the door to building stronger health relationships overall.
As part of the program, Providence Swedish also started collecting voluntary SOGI (sexual orientation, gender identity) in patient intake systems, which helps improve and uncover health disparities through data. The sharing can help clinicians build relationships and provide higher-quality care, including around behavioral health. Patients can choose to share pronouns, sexual orientation, gender identity, legal sex and sex assigned or designated at birth.
Patients can decline to answer or choose not to disclose any of the above information, as well. “Having the ability to document this information is just one step in demonstrating to our LGBTQIA+ patients we see them,” Dr. Wang says. “We’re here to listen to our community and prioritize their needs the best way we can in a sustainable way. We have work to do, and we’re not perfect. But the best way to do the work is by doing it together, listening and doing our best to respond to our communities.”
Kevin Wang, M.D., is a cis-gender, gay family physician who sees patients at the Providence Swedish First Hill Family Medicine residency clinic. He graduated from Wayne State University’s School of Medicine in Detroit and completed his residency at Oakwood Annapolis’ Family Medicine Residency Program. He then went on to complete an OB-GYN fellowship at Providence Swedish First Hill Family Medicine.
Dr. Wang currently serves as the medical director for Providence Swedish’s LGBTQIA+ Program and is clinical faculty for the First Hill family medicine and OB-GYN residency programs. He is active in regional and national LGBTQIA+ and reproductive health community engagement and advocacy.
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