UPMC Pinnacle strives to be on the cutting edge of health care. In November of 2017, the Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health published Discrimination in America: Experiences and Views of LBGT Americans. Many statistics show that the LBGTQ community has special obstacles which they must overcome. Pinnacle’s Dr. Dr. Thomas Z. Pineo and Tina L. Nixon, MHA, CDE, Vice President Mission Effectiveness, Diversity & Inclusion, assure reader’s they’re on the job when it comes to knocking down obstacles.
Central Voice: Research from many sources underscores special obstacles and unique stressors for LGBTQ patients when searching for health care. What are the stressors?
Dr. Thomas Z. Pineo: These stressors precede patients look for health care. 39
% of LBGTQ people are rejected by family members or friends, 30% are threatened or physically attacked, 21% are treated unfairly by an employer, and 32% of LBGTQ youth miss at least one day of school each month because they feel unsafe or uncomfortable. For transgender individuals, 56% report violence in their homes, 51% report physical abuse, 30% were fired or denied a promotion due to bias, and 41% attempt suicide. As a health system, these statistics are concerning. Our job is to identify these stressors and partner with our patients.
CV: And these stressors only compound health issues?
TP: Health care is our society’s only 24/7 safety-net. Feelings of isolation and vulnerability are quite common when any individual feels the health care system is unwelcoming or unavailable to them.
CV: These stressors are up close and personal?
TP: Remarkably, 11% of LBGTQ patients report that providers use excessive precautions or even refuse to touch them. 28% of transgender patients reported being harassed in medical settings and 19% reported being denied medical care. Transgender individuals have had so many bad experiences in health care that nearly 27% reported being denied care because of their transgender status, and 23% did not see a doctor when they needed to because of fear of being mistreated as a transgender person.
CV: What is Pinnacle’s inclusiveness based on?
TP: Our services are based on SOGI, which is an acronym for sexual orientation and gender identity. Many forward-thinking health systems across the country are working through SOGI projects just like we are.
CV: Break down SOGI in patient terms.
TP: Anyone who spends any amount of time in health care knows that health care is a very complex system. Furthermore, patients’ lives depend on their health care system managing their name and their data properly. Names and pronouns form an important link between a patient’s identity and their lab work, progress notes, radiology results, surgical procedures, legal rights, and any other of a number of data points. Rolling out a SOGI project means allowing an individual patient to have a legal name that exists alongside a preferred name. This connection must remain rock solid for all aspects of the patient’s care, from blood draws, to food service, to X-rays, to surgery, to therapy, and to bedside conversations. Safety first! In health care, making a mistake about a patient’s identity could cause real harm.
CV: Give readers a real-life example of how inclusiveness plays out day-to-day.
TP: I knew a mother who had a pre-adolescent child who was male assigned at birth and was given the name Michael (not a real name). Michael was in a supporting home and felt comfortable talking to her parents about how she felt. Even though the world thought she was a boy, she knew she was a girl. Later, she would learn that these feelings had a name, gender dysphoria, and that she was transgender.
CV: But not everyone knew of Michael’s circumstance?
TP: As she got older, she had to engage with the medical system which required occasional trips to the lab for blood work and hormone levels. This particular day was a busy day at the lab with lots of patients in the waiting room. Her medical facility did not have the ability to accommodate her pronouns (she, her, hers) or her preferred name (Michelle). When her mother asked the receptionist that her daughter be referred to as Michelle, she was told that they could not do that because her legal name was Michael. A name change would mess up the lab work and the billing.
CV: And then what happened?
TP: Michelle sat in the waiting room with her mother for a couple hours until finally she was called by the lab technician. In front of a crowded waiting room “Michael?” was called. Michelle was presenting female and to respond to the name Michael meant she was going to have to “come out” in front of a room full of strangers, an experience she had had before. She looked at her mom and her mom understood. That day it was too much. They decided to come back another time when the waiting room was less crowded.
Unfortunately, this is the reality for many transgender patients who are trying to engage with a binary health care system. In order to receive the life-changing and lifesaving health care they need they have to abdicate control over their own coming out process. Or worse, they have to endure confusion and sometimes hurtful comments about their gender identity. The health care system is alienating some of society’s most vulnerable patients.
CV: And Michelle’s experience prompted action by Pinnacle?
TP: Motivated by people like Michelle, UPMC Pinnacle’s Diversity and Inclusion Committee founded ways to help a historically binary (either male or female) health care system create space for nonbinary patients (patients whose gender identity, gender expression, or sexual orientation are something other than straight or cisgender). Making space for nonbinary patients in our electronic health record was an important step in creating a safer and more affirming environment for the LBGTQ community.
CV: Now in place, the SOGI system works?
TP: Recently we had a mother arranging surgery for her child. When she was asked about her child's sexual orientation and gender identity she responded, "Well, that is something we are working through." The conversation continued for a bit, and the final arrangements were made for the surgery. When her child came in for surgery, the affirming name and pronouns were used.
CV: Is institutional support is vital to the success of SOGI-like inclusiveness?
Tina L. Nixon: We integrated the SOGI system platform as an ongoing effort to live up to our values and to provide quality services to a population that has historically been overlooked and marginalized. Training staff was the right thing to do. We stepped insuring we had a process to ask about a patient’s sexual identity and orientation so that we provide the appropriate prevention, screening, and treatment services.
CV: So far, the results of implementing the SOGI system have yielded…
TLN: Anecdotally, we have had an overall positive response from patients. When patients are truly comfortable with their providers, and staff is confident in their ability to the use appropriate terminology and capture information in a respectful way, it lessens the stress that comes with visiting a medical care facility. Our efforts will pave the way in providing comprehensive and affirming care to our LBGTQ patients.
CV: At the end of the day there is hope?
TP: There is hope to be found within each of us. We each have the ability to chip away at barriers experienced by the LBGTQ community. It can be as simple as acts of kindness or professionalism. It might be a question about pronouns or preferred name. It might be as simple as wearing a rainbow pin on a uniform to let people around you know that your space is a safe space for members of the LBGTQ community. Our goal at UPMC Pinnacle is to cultivate a sense of belonging in our diverse health care community. When people feel cared about, it is so much easier to care for them.