As a gay man, physician Kevin Kline feels a kinship with the LGBTQ patients he treats at the Penn Medicine Program for LGBTQ Health. He believes that he can empathize with the hardships they face.
“I feel responsible for advocating for them, both on a personal level, a patient-by-patient level, and also as a community,” he said.
The program, which began in 2013, is aimed at “providing the best care for the LGBTQ community in a safe and friendly environment.” That includes care that is culturally competent and free of judgment. The program also seeks to assure equity and opportunity for LGBTQ employees and is supported by Penn Medicine’s Center for Health Equity Advancement.
Recently, Penn Medicine received national acclaim, being designated a “Leader in LGBTQ Healthcare Equality” by the Human Rights Campaign Foundation, which focuses on LGBTQ issues.
Kline, also a clinical assistant professor of family medicine and community health at Penn, spoke to us recently about the program.
I didn’t come to Penn until 2015, but there were several areas that were seen as areas for potential growth, both internally – for the staff – and for the LGBTQ patient community, whose access to care and options for care were historically limited.
Not just in Philadelphia, but across the country, medical education has not strongly focused on LGBTQ health; it’s rarely taught in medical schools or residencies. So, the downstream effect is there are fewer providers who are comfortable caring for this population. Even if the providers are supportive and recognize the importance of it, they feel uncomfortable because their education was often nonexistent.
This is especially true for those trained in the ‘90s and before. There wasn’t a robust recognition of the need to care for this population and the specific health concerns that they might have.
In the bigger picture, it’s really not that different. A lot of it is trauma-informed care that we should be providing for everyone.
Trauma-informed care, which is not a new concept and is not specific to this population, takes into account a complete picture of a patient’s life — their past and their present, how that has affected their health and how that has affected their health behaviors that could lead to positive or negative outcomes. But the systemic traumas of racism, transphobia and homophobia often lead to marginalized populations with greater problems.
There are specific health concerns that are largely related to health disparities for the LGBTQ population. Overall, there is a lack of access to quality, informed care. Some of the specific areas include gender-affirming hormone therapy for transgender and gender-diverse people, as well as gender-affirming surgeries for those same populations. There is increased incidence of HIV within the LGBTQ population. Now that we have medications that both treat HIV and prevent HIV transmission, it’s important for providers to feel comfortable providing them.
For a lot of trans people, it becomes traumatic to have the courage to bring that up to a provider, and then to be met with a lack of knowledge about what the next steps even are or, at worst, to be met with hostility.
Unfortunately, yes, it is unusual. Programs like this don’t exist in many parts of the country. Bigger academic health systems like Penn may have similar programs, and some smaller programs have been developed in the last decade or so. But by and large, the LGBTQ community is still underserved.
Our program does multiple things. It includes health education for staff and providers within Penn Medicine as well as advocacy for institutional change and visibility, including working on human resources policies that are inclusive for LGBTQ employees of Penn Medicine. We want to be a welcoming place for this population.
It also includes research, because there’s a lack of it, especially when it comes to trans care.
We’re working to increase patient access to both primary care and specialty care, and helping them navigate health care once they’ve been seen at Penn.
The best indicator that the program is having a positive effect on the community is that the number of patients we see continues to grow.
We are also giving care to these patients in more areas. For instance, a patient might present for hormone therapy, but once they’re here, we can provide them with the primary care that they may have lacked before. Because many LGBTQ people don’t know where they can seek care — where it’s safe to do so or where they will be welcomed — many avoid care. They end up not having the primary care and preventative care that we all need.
When they come to us, they’re often surprised and grateful. It’s one of the great parts of the job, to be able to offer that to people.
I want all of our graduates, no matter what area they want to go into, to leave feeling comfortable taking care of LGBTQ patients. When a patient comes in and asks about hormone therapy, the correct response is to talk about it, not say “I don’t know how to do that” or “I’m not comfortable with that.” We’re not there yet, but we’re making strides.
Another ideal would be that patients no longer have to put out effort to find someone who is an LGBTQ-competent provider. That they could ask to be seen at Penn for primary care or specialty care, and whoever they see would be competent and affirming. The patient wouldn’t have to worry about who they’re going to see and if it will be a good experience.
I’ve experienced it myself, as a patient. When I was a medical student, we heard the stories over and over again, of patients coming out to their providers, asking for care, and being told that the provider doesn’t do that, and they’ll have to go somewhere else.
We don’t get it right every time, but we’re creating a space where a patient can come and feel safe and know they’re getting competent, up-to-date care.