LGBTQ say they're ignored, abused by doctors. These Bucks, Montco providers are listening

It was an early April morning when Gavin Fernandez woke up in a panic. His entire bed was soaked in blood.

At first, Fernandez, a transgender man, thought the blood may have just been from a heavy period, but when he stood up to go to the bathroom the situation quickly worsened.

He wondered if his IUD, an intrauterine hormonal device meant to prevent pregnancy, had failed and if the blood was from a miscarriage.

An emergency room doctor told Fernandez there was nothing abnormal in his tests. The physician insisted the bleeding was due to his gender-affirming hormones, then sent him home with orders to see his OB/GYN in a week.

At home, Fernandez began to experience intense cramping. It was then that he read the discharge paperwork.

The ultrasound technician's note said his IUD was "embedded in the posterior fundal myometrium." The contraceptive had begun to puncture the uterus.

“Had I not read every single note on my discharge paperwork, there might be a chance I would have been hospitalized with a perforated uterus,” said Fernandez, who had the device removed three days later at a nearby Planned Parenthood.

The situation left him feeling frustrated and scared to seek out health care in the future.

“[The physician] did not seem to care about my health once he heard I was transgender. He told me that my IUD was 'slightly out of place' but was not the cause of the bleeding. I left without any sort of medication to quell the bleeding and without any sort of real answers,” said Fernandez, 22, of West Chester.

For people in the LGBTQ community, stories like Fernandez’s are all too familiar, advocates say.

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What is it like to go to the doctor as an LGBTQ person?

Overall, LGBTQ individuals are more likely to have a negative experience when seeking health care compared to heterosexual and cisgender people, studies show.

Nearly one in four transgender people avoid seeking needed health care due to fear of discrimination or mistreatment based on their gender identity, according to a national survey from the Center For American Progress. The survey also found that 8% of lesbian, gay and bisexual adults and 29% of transgender adults reported that a health care provider refused to see them because of their sexual orientation or gender identity.

“I am sick and tired of having my health care diminished to one single aspect of my existence. It is exhausting, unprofessional and can kill me,” said Fernandez, who works for a reproductive health provider in Bucks County and various areas in the state.

Throughout his career, Dr. Raymond Cattaneo, who works for the Einstein Health Care Network in Philadelphia, has seen many LGBTQ patients with hesitations about seeking care.

“It's important to understand that sexual and gender diverse people have had not-good experiences with the health care field in the past. Trans patients actually report high levels of physical abuse by medical professionals, nurses and doctors,” said Cattaneo, a pediatrician and LGBTQ Pride Program clinician for Einstein.

At the Pride Program, Cattaneo works to fill the health care void that impacts the LGBTQ community and create a safe space for patients with a team of trained doctors.

Cattaneo described the Pride Program as "a one-stop shop for sexual and gender diverse patients." The program offers hormone therapy and gender-affirming top surgeries as well as patient support groups.

"The people who are a part of this program are appropriately trained. They use correct language. They understand the importance of asking about things like pronouns. They understand the importance of the way that they ask questions to their patients. It's one place where people can get comprehensive care," said Cattaneo.

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Lack of access to LGBTQ health care

However, for many LGBTQ patients, finding a provider that can meet their needs is one of the hardest obstacles.

Evan Lempke, who identifies as transmasculine, said when he began his transition process in 2009 it was difficult to find the necessary resources.

At the time Lempke lived in Scranton, and the nearest LGBTQ health care provider was a four-hour drive to Philadelphia to receive hormone therapy.

“The drive was a really big toll on me. That's why I didn't really see a lot of doctors,” said Lempke, 31, who now lives in Allentown and works in Bucks alongside Fernandez.

Lempke said in the time since his transition, resources have become more widely available online, but there is still a disconnect between LGBTQ patients and health care providers.

Lempke said he is often met with doctors who lack experience with transgender patients. As a result, he said doctors frequently blame any medical issue he is facing on his hormone therapy.

“It's still seen as something that is an outlier. It's not seen as important as type two diabetes or high cholesterol. It's seen as a specialty,” said Lempke.

Physician education key to addressing disparities in LGBTQ care

One way to combat health disparities in the LGBTQ community is to further education among medical professionals, said family medicine physician Dr. William Callahan.

Callahan strives to make patients comfortable by not making assumptions based on gender identity.

He said attending LGBTQ health and wellness conferences is just one way to learn more about the community's needs.

“It requires a level of understanding. To get that understanding requires not only some experience, which can, of course, come in time, but it's also going out and educating yourself,” said Callahan, who works for Jefferson Health – Abington.

In April, the Jefferson Lansdale Hospital, which is part of the Abington network, received the LGBTQ+ Healthcare Equality Top Performer designation from the Human Rights Campaign Foundation for its commitment to providing inclusive and equal access to health care for the LGBTQ community. Einstein Medical Center Philadelphia, which is also part of Jefferson, also was recognized, as were Einstein Medical Center Elkins Park, MossRehab and Einstein Medical Center Montgomery.

The designation evaluates health care facilities on their policies and training in LGBTQ+ patient-centered care; their LGBTQ+ patient services and support; employee benefits and policies; and patient and community engagement.

Dr. Richard Levine, a leader of the LGBTQ primary care practice Virtua Pride Primary Care in Marlton, New Jersey, said education regarding LGBTQ patients is still limited in medical schools.

“Most primary care providers are not going to know anything about gender-affirming care,” he said.

Levine, a gay man, has had patients drive over two hours to his practice, citing they wanted care from an LGBTQ doctor. He said knowing the unique issues facing the community is crucial to understanding its members' needs.

He pointed to certain cancers that are more common in the lesbian population than for cisgender females, and common sexually transmitted diseases for gay men.

Levine said another benefit of an LGBTQ-centered practice is the ability to refer patients to specialists that are sensitive to the community's unique medical care.

“I had a patient who saw me who wanted pre-exposure prophylaxis for HIV prevention, and was told by his physician, ‘If you just wore a condom, you won't need to go on PrEP’ and refused to give that patient PrEP,” said Levine, explaining that PrEP and condom usage are not mutually exclusive.

According to the Centers for Disease Control and Prevention, one in three primary care doctors and nurses haven’t heard about PrEP, yet it can reduce the risk of getting HIV from sex by more than 90%.

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LGBTQ community wants acceptance and understanding from doctors

For some patients, small gestures have a lasting impact.

Carlin Robinson, a transgender male, was able to start testosterone hormone therapy at age 13. He was connected with doctors at the Einstein Pride Program during his transition.

Carlin said the doctor’s actions helped him feel understood and accepted throughout the process.

“I think something that really helped was when I was first going to [Einstein], the first few times, I talked to the doctor without any guardians in the room. So that gave me time to talk about what I felt without someone judging me,” said Carlin, who's now 14 and lives in Egg Harbor, New Jersey, an hour and 30-minute drive from Einstein's Philadelphia location.

Fernandez and Lempke agreed that for health care to become truly culturally competent, medical professionals need to see LGBTQ patients as equals and not individuals with issues that need fixing.

“It's like, we're just here. We think a little differently in the pink flesh stuff that we walk around in every day. It's just a different way of existing, but it's not a problem,” said Lempke.

“I would love just a more general understanding that someone's identity is not their whole existence,” Fernandez said.

This article originally appeared on Bucks County Courier Times: How doctors in Bucks, Montgomery counties are helping LGBTQ community