As a gay man, physician Kevin Kline feels like a blood relative of the LGBTQ patients he treats in the Penn Medicine Program for LGBTQ Health. He believed he could understand the difficulties they faced.
“I feel responsible to promote for them, on a personal level, on a patient-to-patient level, and also as a community,” he said.
The program, which began in 2013, aims to “provide the best possible care to the LGBTQ community in a safe and friendly environment.” That includes caring with cultural competence and without judgment. The program also seeks to ensure equity and opportunity for LGBTQ employees and is supported by Penn Medicine’s Center for Health Equity Advancement.
Recently, Penn Medicine received national acclaim, being named “Leader in LGBTQ Healthcare Equality” by the Human Rights Campaign Foundation, focusing on LGBTQ issues.
Kline, also an assistant clinical professor of family medicine and community health at Penn, spoke to us recently about the program.
I didn’t get to Penn until 2015, but there are plenty of visible areas for potential growth, both internally – for staff – and for the LGBTQ patient community, whose access to care and options for care are historically limited.
Not just in Philadelphia, but across the country, medical education is less focused on LGBTQ health; it is rarely taught in medical schools or residences. Therefore, the bottom line is that there are few providers who are comfortable caring for this population. Even when providers are supportive and aware of its importance, they feel uncomfortable because their education is always lacking.
This is especially true of those trained in the ’90s and earlier. There is no solid recognition of the need to care for this population and the specific health concerns they may have.
In the bigger picture, it’s not much different. Much of this is the trauma-informed care we need to provide for everyone.
Trauma-informed care, which is not a new concept and is not specific to this population, considers a complete picture of a patient’s life-their past and their present, how it is. affects their health and how it affects their health behaviors that can lead to positive or negative outcomes. But the systematic traumas of racism, transphobia and homophobia have always brought marginalized populations with many problems.
There are specific health concerns that are largely related to health differences for the LGBTQ population. In general, there is a lack of access to quality, knowledgeable care. Some of the specific areas include gender-affirming hormone therapy for transgender and gender-diverse people, as well as gender-affirming surgeries for the same population. There is an increased incidence of HIV within the LGBTQ population. Now that we have drugs that can treat HIV and prevent HIV transmission, it is important that providers are comfortable providing them.
For many trans people, it can be traumatic to have the courage to take that to a provider, and then be confronted with a lack of knowledge about what the next steps are though or, at worst, to be confronted with to hate.
Unfortunately, yes, it’s unique. Programs like these do not exist in many parts of the country. Larger academic health systems like Penn may have similar programs, and few smaller programs have been developed in the last decade or so. But overall, the LGBTQ community is still lacking in services.
Our program has a lot of things. This includes health education for staff and providers within Penn Medicine as well as advocacy for institutional change and visibility, including working on inclusive human resources policies for Penn’s LGBTQ employees. Medicine. We want to be a welcoming place for this population.
It also includes research, as there is a lack of it, especially when it comes to trans care.
We work to increase patient access to primary care and specialty care, and help them navigate health care once they can be found at Penn.
The best indication that the program is having a positive impact on the community is that the number of patients we see continues to grow.
We also provide care to these patients in many areas. For example, a patient may show up for hormone therapy, but once they are here, we can give them primary care that they didn’t have before. Because many LGBTQ people don’t know where they can seek care-where it’s safe to do so or where they can be welcomed-many avoid care. They end up without the basic care and preventive care we all need.
When they come to us, they are always surprised and grateful. It’s one of the big parts of the job, that people can offer that.
I want all of our graduates, no matter where they want to go, to leave comfortable caring for LGBTQ patients. If a patient comes in and asks about hormone therapy, the correct answer is to talk about it, not say “I don’t know how that is” or “I’m not comfortable with that.” We’re not there yet, but we’re taking steps.
Another ideal is that patients no longer have to try to find someone who is an LGBTQ qualified provider. That they can ask to be seen at Penn for primary care or specialty care, and anyone they see who is qualified and certified. The patient does not have to worry about who they will find and whether it will be a good experience.
I have personally experienced this, as a patient. When I was a medical student, we heard stories over and over, of patients going out to their providers, asking for care, and being told that the provider didn’t do that, and they had to go to another place.
We don’t do it right every time, but we create a place where a patient can come and feel safe and know they are getting worthy, up-to-date care.