Ashlee Williams, MD (Host): A first visit to a doctor's office can be stressful for anyone, even more so for LGBTQ+ or gender-diverse patients. From navigating questions about gender identity to finding an inclusive healthcare team, accessing quality healthcare can be daunting.

Welcome to the Healthier You podcast. I'm Dr. Ashlee Williams. And today, I'm joined by Dr. Keith Egan. He is a board-certified Family Medicine physician practicing primary care. He is also the Assistant Medical Director of Kaiser Permanente's Pride Medical Clinic. And today, he's going to talk to us about how LGBTQ patients can ensure they are seen, heard, and supported in their healthcare journey. Thank you so much for joining me today, Dr. Egan.

Keith Egan, DO: Thank you for having me, Dr. Williams. Happy Pride Month!

Host: Happy Pride Month! Okay. So, let's just start with why it's important for an LGBTQ+ patient to find a doctor they are comfortable with being open with.

Keith Egan, DO: The physician-patient relationship is just that. It's a relationship. And the more a doctor knows and understands about you as an individual, the more that they can provide tailored, patient-centered advice that fits your individual circumstances. So, being out with your physician and being open with your physician can allow the physician to provide robust conversations about a variety of topics, things like preventative healthcare, sexual health, gender-affirming care, mental healthcare services, family planning, and these all need to be individualized.

So, take, for instance, preventative healthcare. Screenings, such as cancer screenings, may vary in what screening is recommended, what age it's recommended, and what type of screening is recommended based on someone's sexual orientation or gender identity, treatments that they might have had in the past. Vaccinations, what vaccination is recommended for an individual and what age might vary based on sexual orientation or gender identity or other factors. And screenings such as osteoporosis might vary as well. So, being open with your provider, letting them know as much about your history as you're comfortable sharing can really help them tailor those recommendations to your individual healthcare needs.

Other things such as sexual health can vary a lot for LGBTQ+ individuals. Being able to have an open discussion with your provider about who you're having sex with and what type of sexual practices you like to partake in can really help the provider have an informed discussion with you, not only about what screenings might be needed and what preventative services might be added to keep you safe, but also to make sure that you're having a healthy and fulfilling sex life.

Gender-affirming care is a very individualized service as well. Being able to talk with your provider about your gender identity helps them know you better as a person, as an individual, and also helps them let you know about different services that you may or may not be interested in, things like hormone therapy, mental healthcare services tailored to the gender-diverse community that can support you throughout your journey, case management options, or gender-affirming surgeries.

Also, mental healthcare services. Going through big life transitions like coming out, like going through gender-affirming care services can put a lot of stress on an individual, it can change the way that you interact with the individuals around you. And having a behavioral health provider or a support group through the behavioral health department be there to support you along the way can be extremely helpful as well. So, being in a position where you can talk with your provider about what you're going through, what you plan on going through, can help them get you into the correct services. For instance, here at Kaiser Permanente, we have an LGBTQ+ specialty service within our behavioral health program that the providers can help to get you in, so you're seeing providers who are experienced in caring for providers in your particular circumstances.

Also, family planning and fertility services are unique needs that the LGBTQ+ community might have and what they need from those services might be different from other populations. So, the more the provider knows about you, the more they can refer you to the right people.

Host: Yeah. It's really so great here at Kaiser Permanente how we have such an inclusive healthcare team. And you touched a little bit about coming out to your doctor. How important is that and how can a patient come out to their doctor?

Keith Egan, DO: It's very important for a lot of reasons. Patients should never feel pressured to come out to their doctor if they're not comfortable, but we can talk about it more on how to find that. But finding that provider who you're comfortable coming out with and having that open discussion, both you, as a patient, feel more comfortable in the room, which is very important, so you feel free to ask questions, and lets your provider tailor medical advice to your particular life situation. So, I think through kind of a variety of different strategies, patients should make sure that they're with a primary care provider where they feel open having those conversations.

Host: Do you have any suggestions on how one might go about finding a physician who's an ally, who you're comfortable with, and who's accepting of your identity?

Keith Egan, DO: Yeah. So, there's a lot of different strategies for trying to find those providers. And here at Kaiser Permanente, we try to make it as easy as possible to find providers. One thing is just to kind of have a conversation with the provider that you're currently comfortable with, if you have a primary care provider who you generally are very comfortable with and have a relationship, but you haven't talked to them about your sexual orientation or gender identity. So, you can approach that conversation in different ways and see how they react. You could think about strategies like writing down what you want to tell them, what you want to come out to them about ahead of time. You can send it in a secure message ahead of a visit and kind of give them a heads up so that you and the provider go into the visit on the same page and you don't have to worry about getting that information out there. You can write it down on a piece of paper and read it to the provider if that's easier or have the provider read that to you. You can bring a supportive family member or friend with you who can be there and help you with the conversation.

But researching what provider you're going to see is important too. If you don't currently have that primary care provider or other provider who you're comfortable having that conversation with and being open with, looking for the providers who have experience working with the LGBTQ+ population can be helpful.

So at Kaiser Permanente, we have a few ways to make that easier for patients. We have a LGBTQ+ preferred providers list, which is available on our website. That's a list of providers from all over our region from Virginia to DC and Southern Maryland to the Baltimore region of providers who have raised their hand and said, "Hey, the LGBTQ+ population is a population that I'm passionate about, that I care about, and that I'm experienced in caring for." And so, you know going into one of these providers that that's something that they are looking for in the care that they provide, and that they have experience having those conversations.

Host: And that includes not just primary care, right, Dr. Egan? It includes our specialists as well, correct?

Keith Egan, DO: Right. So, one of the great things about our Preferred Providers Program, is that it's not just primary care. You will find pediatricians, OB-GYNs, dermatologists, cardiologists on there, and behavioral health providers among a number of other specialties. So even if you find yourself in a situation where you want to go see a dermatologist who is really experienced in working with this population, or you want to see a therapist or a psychiatrist who's really experienced in working with this population. Cardiologists, we have a lot of options there for patients.

Host: Dr. Egan, it's so amazing how many resources that we have here at Kaiser Permanente. Can you tell us a little bit more about Pride Medical?

Keith Egan, DO: Yeah. So, Pride Medical is a new program and resource that we opened up almost three years ago now, based out of Capitol Hill Medical Center in Washington, D.C. And it's a program that's really aimed at getting our most experienced providers in LGBTQ+ care together to create a supportive clinic environment for patients.

This clinic currently includes three primary care providers and two OB-GYNs who have a vast amount of experience in providing care to the LGBTQ+ community. We do a lot of sexual health, a lot of gender-affirming care among many other resources that we provide to patients. We also work closely with our case managers in our behavioral health program and the preferred providers that I mentioned in order to provide streamlined care.

At Pride Medical, you'll know walking into the door of Capitol Hill Medical Center that you're going to have a seamless healthcare experience and that you're going to be seeing a provider who is experienced and the type of concerns that you might have walking in. So, we hope that all of our patients can come in comfortable and without having any of the barriers that we've discussed earlier in this discussion.

Host: Yeah. And I love that you've also provided access for people who can't get into the city. Can you talk a little bit about that?

Keith Egan, DO: Yeah. So in addition to coming in in person to our Capitol Hill Medical Center, Pride Medical offers a lot of video appointments to our patients so that we're able to see patients throughout the Mid-Atlantic region who may not live close by, it may not be convenient for them to come in, or they may just be more comfortable doing a video visit.

Oftentimes for at least introductory conversations and sometimes for followup appointments, an in-person visit isn't needed. And so, that's an option for our patients to link in to one of our prime medical visits, see one of our providers, all through a video visit from home.

Host: No, that's great how accessible you make it for everyone.

Keith Egan, DO: And I'll also point out that all of our providers here have physician profiles listed online. And these profiles can give you clues about what their history is as far as their experience that they have. And so, you can look for providers who specifically mention, like I do in my physician profile, an interest in LGBTQ+ care. You can look for physicians who are members of medical associations like the Gay and Lesbian Medical Association, like the World Professional Association for Transgender Health, as providers who go the extra mile to get continuing medical education and other resources from different physician groups.

And then, there are providers with various certifications. So for instance, I have recently been certified by the World Professional Association for Transgender Health and Gender-Affirming Care, which is kind of an additional way that I was educated on providing care to this community.

Host: Congratulations!

Keith Egan, DO: Thank you. All of those physician profiles are there for patients to browse through before they choose a provider. And if you ever go to a provider and you're not comfortable with the conversation that you've had, any Kaiser Permanente member can change their primary care provider or other care provider at any time. So if you're not feeling that same comfortable environment that you're looking for, there are lots of options out there.

Host: I love that. Do you have any advice for someone who may not be ready to come out to their friends and family? Is there a way that as a physician you can partner with your patient to help them through that?

Keith Egan, DO: So if you've been able to find that provider who you feel comfortable with, they are a great resource to start that conversation with, come out to your provider. If they're the first person that you have come out with, they can provide you with support and encouragement and resources. Keep in mind that physicians, whether they're primary care providers or other types of specialists, are bound by confidentiality. We all have to follow HIPAA, the federal guidelines that make sure that your privacy is kept with any medical conversations. And so, it can be a safe space where you know the boundaries and you can share that information and get that out to that first person.

I remember the first time that I came out to my primary care provider. She was one of the first people that I came out to. I was terrified going into that visit. I think my pulse was through the roof. My blood pressure was very high. I was so nervous and all I could think about was how she was going to react. And if that was going to be a positive conversation or if I was going to walk away from there, kind of more nervous than I was going in. And I was very lucky to have a provider who did have some experience working with the LGBTQ+ community, and was able to offer me some support. And so, finding a provider who has that experience is really important.

Host: Yeah. Thanks for sharing that personal story, Dr. Egan. And thank you for all of this great information. We learned a lot about how LGBTQ+ individuals can find culturally competent care that suits their individual needs.

For review, one, having a good relationship with your doctor is important, especially if you identify as LGBTQ. When you're out to your physician, they can provide more personalized care. Two, it's okay to be nervous about coming out to your physician. You can prepare yourself for the conversation by writing down what you want to say and bringing a loved one to the appointment. Three, when looking for a physician who is an ally, do your research and consider scheduling a consultation with a few different doctors before you make your decision. And four, a trusted physician can be a valuable source of support and guidance for individuals who may not be ready to come out to their friends or family.

Physicians keep information strictly confidential and have access to resources that can help you during the coming out process. For more LGBTQ+ resources from our experts and other health advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcasts. If you enjoyed this episode, be sure to share it with others who may find it helpful. Thank you from all of us at Kaiser Permanente. Be well and Happy Pride!