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S1E22 breaking-the-barriers-to-lgbtq-healthcare

Natalia Sobery20min

Susan Carl

00:01

Many times gay or transgender people don't necessarily, first of all, they don't go to doctors, they don't go to health care providers because they've experienced discrimination in the past. They don't get preventive health screenings, as the hetero norm people will get, because they're not going to the providers, providers may not be comfortable bringing up those topics with, say a transgender male if you still need a pap smear. And that is not a topic that a lot of healthcare providers are probably comfortable approaching.

Steve Fast

00:37

Critics of the American healthcare system will say it is replete with inequity. Much of the criticism revolves around cost and access. However, even with those barriers put aside there are gaps in care that are specific to certain areas of the patient population. One of those areas of uneven care is the LGBTQ patient population. This is random acts of knowledge presented by Heartland Community College. I'm your host, Steve fast. today's podcast guest is working to address LGBTQ health care concerns in her role as an educator. Let's learn more.

Susan Carl

01:12

I'm Susan Carl, and I'm nursing faculty here at Heartland Community College.

Steve Fast

01:16

So recently, you have worked towards advancing your career you received a grant and you are pursuing the Family Nurse Practitioner certificate. How does that fit in your career so far, and what you hope to do?

Susan Carl

01:33

I think it enhances the knowledge that I already bring to Heartland meaning that I am a registered nurse. I've practiced in that capacity for 15 years now, after getting my nursing degree here at Heartland. And the advanced knowledge that I'm getting through my further studies gives me a deeper understanding and I think makes it easier for me to explain things to students then.

Steve Fast

01:58

So one of the things that you mentioned you're pursuing, as maybe a focus for a practice is addressing LGBTQ healthcare needs. Let's talk a little bit about that there are a lot of subtle ways in which LGBTQ patients might not be getting equal treatment with what some people would call like a heteronormative style of treating people, what are some of the things you see that could be gaps in our healthcare system for those particular patients? That's a big question.

Susan Carl

02:32

It's, and it's hard to answer with just one simple thing. There are so many complexities that play into it. Some of the research that I've looked at outlines how you can't just focus on one aspect of a person's care. For example, you can't just focus on the fact that someone's a lesbian or gay or transgender, because they may also have ethnicity brought into play and socio economic issues, religion, culture, so many things play into how people perceive they're being treated. But in the flip side of that, the carers bring those things to the relationship as well. So it's just so complex.

Steve Fast

03:20

Are there barriers that might be social barriers that keep certain patients from even seeking care in the first place? Are there things that some patients might not want to talk about, but for instance, I'm thinking of young people, there might be concerned that they might not bring up something to a health care provider that might be related to mental health stress that they have at school, or other health issues that they might have that in their report to a doctor. They're not giving the full story?

Susan Carl

03:51

Absolutely. Especially with young people. There's such a pressure to fit the norm, so to speak, and anything that they perceive as being different about themselves, they're not likely to volunteer to anyone, especially someone, they're just meeting for the first time. And I think that making any patient but especially young people, comfortable initially, setting the tone, that it's a safe environment, that they won't be judged, that you are there to listen and help them in whatever way you can. And establishing that report may take more than one visit, unfortunately, and the way we seem to do things now in healthcare is so based on speed and getting as many people through as possible, that doesn't always set a good stage for that relationship building.

Steve Fast

04:48

You mentioned some of the research that you have read. Is there enough research on the LGBTQ population and any specific health risks? so that they may face

Susan Carl

05:01

there is research, unfortunately, I mean, up to this point, it's been kind of hit or miss. And it's been an area that I think we're getting better at. But one of the things that I found is that the National Institutes of Health made sexual and gender minorities health disparity population for research, meaning that they're going to be better able to focus on that population more intentionally, than perhaps has been done up to that point. We know there are disparities, but looking deeper into why those disparities occur.

Steve Fast

05:41

What are some of the disparities that you see that they are aware of that they're looking into,

Susan Carl

05:47

for example, lesbians are less likely to get preventive services for cancer, they're more likely to be overweight or obese. Okay, we know that, but why we want to be able to get to that why, in order to better be able to address that, and perhaps prevent it. Many times gay, or transgender people don't necessarily, first of all, they don't go to doctors, they don't go to health care providers, because they've experienced or may have experienced discrimination in the past. Therefore, they're not getting problems may be identified early on, when they're more treatable. They don't get preventive health screenings, as the hetero norm people will get, because they're not going to the providers. Flipside providers may not be comfortable bringing up those topics with, say, a transgender male, if you still need a pap smear. And that is not a topic that a lot of healthcare providers are probably comfortable approaching. So there's work to be done on both sides of the issue, I think,

Steve Fast

06:54

Well, it's interesting that you mentioned, there is a reluctance, or at least there's a seeming reluctance amongst certain members of the population to even go to the doctor go to a healthcare provider, one would think that the history of non acceptance would play into that, perhaps younger people don't understand the grasp of the fact that LGBTQ people were criminalized in certain states until fairly recently. So when you're going into a doctor's office, into any kind of healthcare situation, and you're filling out forms, and you're reporting things officially, that's something that, you know, there was an unspoken element to that where you could be very worried about trusting someone,

Susan Carl

07:40

right, it was a huge issue. And I think a lot of that carries over like you mentioned, it may not necessarily be the case anymore, but people are still very cautious. And it's kind of that once bitten, twice shy proverb that if you have experienced anything, or even heard of perhaps an associate of yours, because word of mouth works very well, both ways, good or bad. And if you know of a provider, that perhaps their office staff, or even the provider themselves, have not been welcoming, or I don't necessarily want to say accommodating, but they have not been accepting, then you're much less likely to seek out that Provider A and I know anecdotally, that there are places where, unfortunately, it still occurs in Bloomington Normal today, where people are not accepting, and they don't necessarily hide the fact that they're not accepting. And that's unfortunate.

Steve Fast

08:46

I think that there might be two different types of problems. You have an intentional bias, unintentional discrimination, and you have, I would imagine, probably a fair amount of institutional discrimination. That's not intentional, but it's built into the system. It's built for a very specific type of patients, right? It's not accommodating, which in addressing the second one, and maybe the first one to what kind of training do you see out there for for healthcare providers to understand the full aspect of what their patient population might be like?

Susan Carl

09:25

I have actually been looking for things that I could involve myself in my formal education thus far. And I am not knocking anyone. It doesn't include a lot by way of providing health care to LGBTQ plus populations. And again, it's, it's becoming more prevalent, but even in the textbooks that I have now that I'm using, there may be a chapter on lesbian health care and It's very generic, so to speak. And one thing that I recently found was that the GLM a, they're the Gay Lesbian Medical Association, they've put out a book for healthcare practitioners outlining just primary care for that population. So that's something anyway, there are conferences put on by, I guess you would call them special interest groups that you can attend. But as far as formal education, I think that's an area that we're still severely lacking in, whether it's nursing, or physicians, it's just not included

Steve Fast

10:43

in the resources. It sounds to me like, there are some, but it also sounds like there's somewhat limited. So if somebody wants to be proactive in their practice in their office, and offer this training, or mandate this training to their staff, it sounds like that it's not something from the National Institutes of Health or instances available or anything of that sort.

Susan Carl

11:06

Not that I found so far. I don't, I'm not gonna say it's not out there. But it's not something that I've found so far. I've looked on like the Center for Excellence for Transgender care GLM A, and there are a few other sites that I am aware of. And you have to specifically search for this type of training. It's not something that I've really seen come across my field division as a nurse, just as a continuing education topic. And believe me, we get inundated with continuing education opportunities. And this is one that may pop up occasionally, but it's not common.

Steve Fast

11:49

Earlier, you mentioned that there are a couple of specific health concerns. But I would imagine there are probably others, as well. And some of those might have to do with environmental concerns. I know that there is some research that indicates that there could be people trying to self medicate, because of things that they've had to deal with regarding young people. There's a higher suicide rate amongst LGBTQ young people, there is some documentation to say that substance abuse amongst some of those young people becomes a thing. And some of those factors might have to do with the environment. They're in how they're accepted. Is that not accepted? Right? How right, you're right, what sort of work is being done in that and how important is it for somebody that is seeing a patient to have any kind of training so they can steer a patient towards a more healthy lifestyle, or whatever treatment might exist for mental stress or mental health issue?

Susan Carl

12:48

There. Again, I think it starts with the relationship that you have with the patient and being able to glean that information from them, that they feel comfortable enough to share with you that they are having problems at home, or maybe they don't have a home. Depending on where you encounter patients, you have to determine where they're at at that point in time. And then absolutely, knowing what resources are available that you could refer them to, as a practitioner, we can't solve every problem, but we need to know the resources that are available that may be able to help those patients for transgender and LGBTQ youth. Unfortunately, they make up a large percentage of the homeless population of kids. And generally, it's because their parents are not accepting of their lifestyle. And that, as you mentioned, starts this whole kind of snowball process of survival, basically. And, you know, I can only imagine that they find themselves in situations where they do what they have to do to survive. And that may include using substances, illegal drugs, whatever, in order to cope or live. And that carries on into adulthood. So even if they potentially get out of the homeless situation, then you have these, perhaps substance abuse, addictions that have already formed, that are going to follow them along if they're untreated. And that leads to any number of other health problems. So it's, you know, like I said, it's just a snowball effect. Unfortunately,

Steve Fast

14:29

it sounds like in those particular instances, finding healthier way to deal with situations early will pay some longer dividends for those patients.

Susan Carl

14:40

True. However, if you are in survival mode, right, you're doing what you need to do. You're not really thinking long term. I mean, the political climate that we're in right now seems to be attacking LGBT Q healthcare. You mentioned, like the institutional versus intention All, I think that kind of applies in both of those arenas. Unfortunately, the current atmosphere kind of makes it okay for individuals, or they feel like it's okay to discriminate.

Steve Fast

15:16

So going back a little bit, the example that you gave of, for instance, transgender patients, the healthcare provider, not knowing what sort of things to make clear to the patient. And patients in general, I think, especially young adults, health care, and self care is something that people sometimes have to find for themselves. And sometimes they get it from their parents. I think that if you have a parent that doesn't ever talk about your personal health care needs, like for instance, if when someone starts menstruating if dad's home, and mom's not, sometimes that can be a crisis for some people, especially if they don't if there's a gender identity issue where they don't necessarily connect with their mother or their father, in the same way they might be reluctant to ask certain questions or might not even know the questions that they should ask. I think that's probably something that gets encountered by any type of patient sometimes, right? Yeah, are there any particular issues you can think of that might be something that healthcare providers should look out for to let people know how to be healthy and how to engage in healthy behavior, and anything from letting kids know about STDs to proper hygiene and health,

Susan Carl

16:34

right, and that oh, boy, that's that opens up a whole nother Pandora's box of issues. I think, too, for especially transgender individuals that their opposite sex genitalia, what they were born with, frequently, they don't acknowledge that. So there would be a lot of lack of knowledge, and lack of not necessarily willingness, but maybe even inability to acknowledge that aspect of their care. So I think, as a provider, making sure that I bring it up, even if it's difficult for them to discuss, it's still part of their health care. And it's important to them, and their overall well being. Therefore, it's a topic that has to be addressed.

Steve Fast

17:27

I think also being able to start to deal with some of the concerns. When you're a young person you're finding yourself, you might not be too open to talking to anyone about some of the things that you are going through, and perhaps finding, you know, a better path to connect with your group, your tribe, whatever might curb some of the non acceptance issues you find at school, maybe even even at home and other places, right? Is there anything that you're doing in the classroom, or the heartland does in the classroom to help the students that are coming through the healthcare programs here, to kind of have better awareness of this part of the patient population.

Susan Carl

18:12

Recently, I found a video a short video clip that one of the New York hospitals uses as training for their staff, it's called to treat me you must know me. And it has interviews with providers and LGBT patients, and just kind of provides a snippet for some of their concerns that they've encountered during health care. I showed this video to one of my classes. And even coming from the background that I come from, I still had doubts about whether it was okay to show this video in my class. And I went ahead and did it. And afterwards, I got an email from a student who was thankful that I showed it, he identified as a gay male, but was too afraid to say anything during class, which I completely understand. We're just not where we want to be just yet. I think that I attended the Safe Zone Training here at Heartland. And I know you talked with a couple of those providers not too terribly long ago. And I feel like perhaps if more faculty went to that, and maybe incorporated some of the ideas from that training, I know one thing they recommended was putting in the syllabus, your preferred pronouns. And that is not necessarily for US per se, but it's for the students, for those that may identify so that they know you're an ally, you're a safe person. If they're having problems, they're more likely to come to you then so you can help. And I think that you In and of itself would be a huge step.

Steve Fast

20:02

Susan, thanks so much for coming in and talking to us about these issues today. Thank

Susan Carl

20:06

you for having me.

Steve Fast

20:12

Susan Carl is on the nursing faculty at Heartland Community College. She is a recent recipient of a nurse educator fellowship awarded by the Illinois Board of Higher Education, which she is using to obtain her family nurse practitioner certificate and she is seeking to specialize in LGBTQ plus health care. For more interviews, including a discussion of the Safe Zone Program mentioned earlier in this broadcast, check out our other random acts of knowledge podcast episodes on iTunes, Spotify, or audio boom. Thanks for listening

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