A story based on real world experiences…
Jill Stevens listens as the nurse calls out for “Jack Stevens.” Jill shudders involuntarily for a moment, gets up and approaches the perplexed nurse. Jill discreetly informs the nurse that Jack is still her legal name but that she has been living full-time as Jill, a transgender woman, for more than a year and her records need to be updated.
Fiction? No, unfortunately this is a common occurrence. It’s also one of the many patient experiences that can be remedied using the “Patient-Centered Medical Home” framework.
Texas is home to an estimated 140,000 transgender Texans including an estimated 13,800 youth. Transgender people reside across our state—in urban, rural, and suburban areas, not just in one or two large cities. And experts tell us that many of them experience significant barriers to medical care.
On April 5th, medical professionals had an opportunity to explore and learn from members of the transgender community and healthcare providers treating large numbers of transgender patients and LGBTQ+ people at the Texas Primary Care and Medical Home Summit. They identified steps to apply the framework to coordinate services provided by physicians, midlevel providers, nursing staff, social workers, and transgender patient navigators/advocates in order to support the needs of transgender patients and their families.
Fitting the framework’s puzzle pieces together is an important step in creating culturally competent healthcare for transgender people and viewing the patient as a “whole person.” This is not the typical experience for transgender people and many others in the LGBTQ+ community. Patient-Centered Medical Homes enable medical providers to support each patient with a range of needs including housing, social services, behavioral health support, and all aspects of their physical health and wellness.
In many ways, transgender people, and to a lesser extent most members of the LGBTQ+ community, remain invisible inside the health system. Invisibility severely limits our ability to conduct patient-centered outcomes research because we can’t create large enough cohorts, or groups of similar people, to understand the medical consequences for treatments.
Collecting information about sexual orientation and gender identity (SOGI) in a respectful, engaged, and thoughtful manner is vital. Approximately, 62% of transgender people currently live full time in a gender that is different from the one on their original birth certificate. The remaining 38% are not “out” creating the need to rigorously protect a person’s privacy. SOGI data better informs medical providers to help transgender patients meet their total health needs.
The term carpe diem, or seize the moment, fits. Texas has the second largest number of transgender people of any state. Primary-Care Medical Homes for transgender people can advance their health.
PrismHealth North Texas played a significant role in making this discussion a reality through their generous support. The session—Implementing Patient-Centered Medical Homes for Transgender Patients and Families, and other members of the LGBTQ+ Community—was not only the first LGBTQ+ session at the 6-year old Summit, but is also the first to focus on providing culturally competent transgender healthcare using this framework.
Several of the panelists are transgender: Dr. Jamison Green, the immediate past president of WPATH, the World Professional Association for Transgender Health; Lou Weaver, Equality Texas Foundation’s transgender program coordinator and TransFORWARD: Texas Transgender Health co-director; and Mikayla Avery, Patient Advocate/Gender Care Coordinator at KIND Clinic in Austin. Three of our panelists represent healthcare organizations facilitating the care of roughly 5,000 transgender patients in different states. We appreciate Dr. Sue Bornstein, director of Texas Medical Home Initiative; Stephanie Ondrias, Texas Health Institute’s director of education and events; and, the Summit’s Steering Committee in making this important and unique opportunity available.
John Oeffinger is the director of eLearning and Training at the Texas Health Institute, and co-director of TransFORWARD: Texas Transgender Health