Transgender Healthcare Is A Challenge In Rural Areas

Jun 25, 2020

June marks Pride Month each year. Previously, we published a conversation between a local doctor and his patient on transgender healthcare. One of the topics they discussed was the learning curve doctors face when treating patients in the trans community.

Other doctors echo this point, saying they’ve had to do their own research and training to be able to treat the patients who’ve come to them for care.

Kurt Martin is an internal medicine doctor with Southern Illinois Healthcare. He’s been treating trans patients, as well as other patients in the LGBT Q community, since the early 90s.

“So when I first came here, there was there was no discussion of treatment for transgender issues. And that has certainly gotten much better, although it's still sadly lacking. finding somebody to actually do the hormone tests,” he said. “It's not something that's generally trained in medical schools. So people feel uncomfortable with giving the medications that they haven't been trained to do. Haven't had a lot of exposure in the past.”

Alex Garrido, a family practitioner with SIH, said his previous experiences with trans patients led him to continue that work when he moved to southern Illinois.

“I felt that I had to kind of step up to the plate, I guess, for the area, and I started to do the things that are only seen during residency, like hormone replacement for trans people that not too many primary care physicians are comfortable with,” Garrido said.

Studies show medical schools don’t often include enough specific instruction on healthcare for the LGBT population. For Garrido, though. there’s no excuse for doctors turning away patients, even if they haven’t received specific education on trans healthcare.

“You know, in medicine, nowadays, anything you want to do. You just study and read on it. And if you're willing to do it, you can probably do it medicine wise,” he said. “It's a combination of empathy for your patients and the knowledge that you have, but the knowledge can be readily available for any physician.”

For other doctors, it’s also a matter of support from their practice. Poorva Talapatra is a counselor with Shawnee Health Service. She is part of a team of doctors who volunteered to go through extensive training, to help the organization better serve LGBTQ patients.

“So we had this one year training about a year ago that just ended this January. From a training site in Boston, it's called the Fenway Institute. And it was under sort of the national LGBTQ Health Education Center,” she said. “That gives us so many sort of newer sort of understanding of how the challenges are, that [we] have absolutely no idea about.”.

All three doctors said they’ve heard patients talk about the difficulty finding care. Martin also said his willingness to treat these patients, hasn’t always been well-received by his colleagues.

“I was one of two doctors early in HIV in Southern Illinois, who was treating patients with HIV. And I I received all sorts of skepticism about transgender patients in the waiting room, or even just gay patients that time. So yeah, I caught a fair amount of feedback, there was a negative variety from colleagues,” he said. “And quite frankly, you know, to this day, I probably look at those people a little bit differently, and not in a positive way because the feedback was just not called for.”

Martin said he’s seen a shift in attitudes over the years. But patients still struggle to find doctors who are willing to learn what is needed to treat trans patients, especially when issues arise.

Garrido said he’s heard of people being turned away because doctors don’t feel comfortable providing the care they want.

“What I hear the most is that it's difficult to get somebody that is willing to help them with hormone replacement,” he said. “ I remember one patient that has a heart problem with the hormone replacement side effects from the hormone replacement. And the option given is, you should not be on hormone replacement period. Instead of finding a way to make sure that the patient has what the patient needs to make sure that the side effects don’t come back.”

Talapatra says it doesn’t just take direct discrimination to make someone feel unwelcome.

“I think It's a broader area of like, oh, the way they look at me, the way they talk to me and feel respected, I feel discriminated [against],” she said. “Or maybe they're not sensitive to the pronouns that they're supposed to be.”

She said the team approach at Shawnee has been well-received by patients, who know they can find treatment for mental and physical health that will accept them. Still, not everything can be done locally — patients seeking gender reassignment surgeries still have to travel outside the area for care.

“Yes, we need culturally competing providers, there's no doubt we need them,” Talapatra said. “[To] understand how we can help the patient feel comfortable, just the way you look at them, the way you give them a stare, the way you talk to them. I mean, everything changes the dynamic as soon as the patient walks in your office.”

But once people know they will be accepted, word spreads. All three doctors said the number of LGBTQ patients they see has grown thanks to referrals. Garrido said he’s proud to have that as his reputation.

“I want to be perceived as a non-judgmental precision provider where anyone can come to me and I'm gonna, I'm going to give them the service that they would get if they were my family,” he said.