LGBTQ+ Panel Discussion: Follow-Up Q&A

In honor of Pride Month, RVU’s Marketing Department hosted an LGBTQ+ Panel Discussion centered on the challenges faced by physicians and patients who are part of the LGBTQ+ community. Over 60 students, faculty, and staff attended the panel discussion to hear and learn from guest speakers Dr. Jill Pitcher, Professor of Family Medicine, and Zoe Roth, OMS II, President of the Student Government Association (SGA) on the Colorado campus.

Moderated by Jack Strickland, OMS II, Vice President of the SGA and member of the LGBT+ community, and Sebastian Ramos, OMS II, the questions focused on both the physician’s and the patient’s perspectives. Dr. Pitcher shared her experiences as an LGBTQ+ physician, noting that, for her personally, instances of intolerance from fellow physicians or healthcare teams were few and far between, if she noticed them at all. SD Roth spoke about her experiences in physician offices as both a patient and student and the importance of creating safe spaces in that setting.

After the event, Dr. Pitcher and SD Strickland answered follow-up questions from students, faculty, and staff.

How can you help trans people feel more comfortable as the provider? In the past, I had a patient share with me that she is trans, as well as her concern about being judged by previous providers.

Dr. Pitcher: “I have found this the most difficult situation to respond to. Providers are under more scrutiny in our reaction in every way. I believe trans patients have been the most mistreated; they will be the shyest [patients] and sometimes defensive. The mistreatment may not have been intentional, and it is too easy to leave an impression that does not resemble what we believe we conveyed. If this is known to us before we begin the interaction, what will get things off to a good start will be reminding ourselves of the importance of our verbal and non-verbal communication to represent the open and secure environment we want to offer.

“Personally, treating the interaction like we would if we were speaking to a friend and balancing this with the professionalism our patients expect will convey the acceptance that they, and everyone, deserve to have. If the patient reveals a fear due to a prior judgment, the skill you now know to immediately reflect is how difficult that had to have been for them.

“It is also helpful to demonstrate an understanding of how such prior judgment is a powerful motivator for a patient to be closed-off, skeptical, or defensive toward any subsequent physician or healthcare provider. It may add a few minutes to the visit as we allow the patient to tell their story if they wish to, but it would be time well-spent as this immediately creates more trust. I cannot think of a more important value to establish with any patient.”

SD Strickland: “From the start of the patient visit, show that you are an inclusive provider, whether that be pamphlets in the waiting room [and] signs in the office or exam rooms, have the staff with pronouns on nametags. Even rainbow lanyards or pins goes a long way to let the patient know this is a safe place. As a provider, you should educate yourself on the issues and come knowledgeable to the patient visit to be able to help. Start the interview by telling them your pronouns and asking the patient their preferred pronouns. Ask a totally inclusive sexual history and don’t assume anything. Ask about preferred partners.”

While rare, there are occasional patients who act very aggressively. For example, MtF trans patients who demand pap smears or claim discrimination. These are, most likely, patients who have experienced trauma. How would you recommend we go about diffusing these kinds of situations while minimizing any offense?

Dr. Pitcher: “Like in the previous question, reflect it back to them. Recognize their justification about the anger they feel and let them tell the story or express what they need with all of your attention. If you listen genuinely, many will feel diffused by this.”

“Also, remember  you cannot ‘understand’ or ‘know how they must feel.’ Just listen and even ask a clarifying question. Those who become circular—saying the same thing several times—or give prolonged answers (beyond the reasonable time for the visit) need to be redirected out of respect to other patients’ time. You can also ask if discussing their story for that visit, instead of the initial reason they came in, would be the best help you could offer that day. That itself could be the redirecting question.

“You are there to be a compassionate listener, but you also have a task at hand with them and with your other patients. You can ask to be respected in this way, as well. I believe this will result in a good visit most of the time. This is also a particularly good time to consider, and get permission for, a chaperone for sensitive exams. We teach this as good practice, and you will see this is often not done unless there is a particular need.”

SD Strickland: “I do not know how to handle this one, to be honest. But all I can think about is just make sure to approach the situation from the softer side and make sure to use de-escalating techniques and educate yourself as the provider. Understand that you will not completely understand what they are going through but just support them as much as you can.”

How was [Dr. Pitcher] accepted early in her career [compared to today]? Did she sustain a lot of negative behaviors from people and other doctors that she worked with?

Dr. Pitcher: “Early on in my career, I had to struggle with a shift in this part of my identity. I grew up with wonderful parents in a family where the sky was the limit for life choices. I did not need encouragement to pursue anything, just a reminder now and again that I had to earn it. So, once I knew this was true for me, no one was going to talk me out of it. That also meant I could see no reason to not be accepted as much as I accepted myself and I found it easy to miss or ignore anything less than. Being bullheaded has its advantages at times.

“I did develop a conscious desire to not challenge anyone’s bias as long as it did not limit our interaction or work in any way. My lifestyle does not factor into the relationship or interaction I have with literally anyone except my partner. I also feel that, over time, it seemed true and helpful to let people get to know me as a professional and a person who cares about others and who will work hard to accomplish what I am trusted to do. Then, if my lifestyle becomes known, it will fit what I hope is a good framework and challenge poor biases that may exist.

“This is the long way to say: I am not sure how I was accepted or not; it did not matter to me. Perhaps, the way I grew to represent the most important values as a person and as a physician seems to have prevented or diffused negativity. If there was any there, it was rare at best.”

I personally know a nurse who is moderately anti-LGBTQ+ and who had received an awareness training that was ineffective in its goal of making the staff more sensitive to LGBTQ+ individuals’ health concerns. The nurse ended up being more resentful to the pro-LGBTQ+ awareness movement. How can we work to instill a culture of acceptance in our staff so that the first people our patients see immediately start to make them feel welcomed and accepted? How can we make sure our training is hitting home?

Dr. Pitcher: “Some people have deep-seated feelings. Our responsibility is to offer the opportunity for learning and self-reflection toward a shift or growth in the direction we feel best for our practice and patients. We do have that right and responsibility as physicians to control our practice in this way. We do not, and should not, assume that we have control over how any individual will respond to this request. We are not responsible for how an employee decides to feel and act, except for how it impacts our patients.

“This represents an employee who does not fit the practice and is not a reflection of the physician or the other staff. If a gentle, but direct conversation is not fruitful for change after the training has been completed, this staff member needs to find another office to work, when you are in control of this. When you are not, the most I can offer is to do your absolute best to represent yourself as caring and attentive to your patients. You are not responsible for this other person and cannot fix how a patient will feel about an interaction with them. Just do your best to be better, and control what you can control.”

SD Strickland: “For me personally, if this was my practice, I think having a conversation and trying to work with the nurse to figure out where the disconnect is coming from and really stressing the importance of being all-inclusive in the workplace from the start of the visit. Maybe the issue at hand is just a miscommunication, so that’s why talking and trying to bridge the communication gap will do more in the long run. Unfortunately, sometimes hard conversations need to be had.”

Due to the video hosting platform, the event recording will only be viewable by members of the RVU community.