CLINICAL UPDATE
JUNE 2019
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An Interview with Kym Boyman, MD FACOG
What were your reasons for wanting to become trained in LGBTQ-affirming care?
As health care providers, most of us have an innate drive to serve each of our patients as expertly as we can, ideally with deep empathy and rich knowledge. Unfortunately, and while it is beginning to improve, it has been uncommon for medical training programs to incorporate any or much training in LGBTQ health. So it behooves each of us to find other opportunities to gain the knowledge and skills we need to become the most affirming providers we can be for our LGBTQ patients. At Vermont Gynecology, and for me personally, this has been a core value and top priority all along.
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What did you learn from your training that surprised you?
Clinicians use - generally without ill intent but also without awareness - quite gendered language, especially regarding so-called "women's health". It is helpful and humbling to be made aware of how alienating this can be, especially for many gender diverse patients. We can all work to make our language more inclusive, for example, talking about "parents" and not just "mothers" when discussing pregnancy related issues.
In your opinion, what are the reasons for the divide between traditional health care and making patients who identify as LGBTQ feel supported and comfortable?
LGBTQ folks in our culture have been marginalized and devalued for so long, and health care providers on the whole historically have lacked the knowledge, skill, compassion, and/or comfort level to provide culturally competent care. Queer patients have often avoided health care altogether, and/or have been closeted when seeking care, in order to avoid risking ridicule or harm. Increasing visibility and gradual empowerment, accompanied by increased medical awareness and knowledge, are slowly helping contribute to needed changes. It is heartening, for example, that upwards of 12% of current medical students at the Larner College of Medicine (UVM) self identify as LGBTQ. These students are leading the charge for needed changes in the curriculum and will ensure our continued and improving collective ability to provide supportive, comfortable, and high quality health care to LGBTQ patients.
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"I love coming here -
I always feel welcome and cared for - never judged.
It's just a nice place with
good people, where I feel
safe being honest."
VT Gynecology Patient
How has your approach changed and what changes, if any, in care outcomes have you seen or do you expect to see?
As a member of the LGBTQ community myself, I was always predisposed to want to care for LGBTQ folks, and I sought out and joined a practice that already had an excellent reputation and track record in treating diverse patients. But when I was in medical school and residency, there was no mention of transgender medicine in the curriculum, and we had no role models for providing gender affirming care. Early in my career, it was clear that there was a void regarding trans care in our community, and with encouragement from trans folks, I sought out additional training and knowledge. We also brought a trainer to our office to educate our whole team.
It has been and continues to be enormously gratifying to provide a medical safe haven for
LGBTQ patients over the years, and to help folks to achieve their wellness goals and navigate health challenges.
What would you tell other health care professionals who are considering how to better support patients who identify as LGBTQ?
Do not be afraid. Take the initiative to educate yourselves about the LGBTQ community and our sometimes unique health care challenges and needs. If you don't know, ask. Create a welcoming environment in as many ways as possible, ranging from forms with inclusive language, to not making any assumptions - ever - about patients' sexual orientation and/or gender identity, to being as skilled as you can be. You will be rewarded in spades.
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NEW CDC Policy
Addressing Barriers to
Health Care
Breast Cancer Screening & Diagnostics for Transgender Women
Transgender women (male-to-female), who have taken or are taking hormones and meet all program eligibility requirements, are eligible to receive breast cancer screening and diagnostic services through You First. While CDC does not make any recommendation about routine screening among this population, grantees and providers should counsel all eligible women, including transgender women, about the benefits and harms of screening and discuss individual risk factors to determine if screening is medically indicated.
The Center of Excellence for Transgender Health and the World Professional Association for Transgender Health have developed consensus recommendations on preventive care services for the transgender population. Those recommendations include "for transgender women with past or current hormone use, breast-screening mammography in patients over age 50 with additional risk factors (e.g., estrogen and progestin use for 5-10 years, positive family history, BMI > 35)."
Breast Cancer Screening & Diagnostics for Transgender Men
Transgender men (female-to-male), who have not undergone a bilateral mastectomy and meet all program eligibility requirements, are also eligible to receive breast cancer screening and diagnostic services through You First.
Cervical Cancer Screening & Diagnostics for Transgender Men Transgender men (female-to-male) who have a cervix or had a total hysterectomy for a pre-cancerous condition or cancer and meet all other eligibility requirements are eligible to receive cervical cancer screening and diagnostic services through You First.
Also, You First can pay for a member to have an office visit for a pelvic exam to determine if the member still has a cervix, a member may not know if she had a partial or full hysterectomy related to a pre-cancerous condition or cancer. It is important to note that members who have had a partial hysterectomy still need Pap smears.
Treatment for Breast Cancer or Cervical Cancer/Pre-cancerous Condition
Any individual screened by the You First program who has breast or cervical cancer or pre-cancerous condition is eligible for the Breast and Cervical Cancer Treatment Program.This program provides Medicaid coverage for treatment and also covers additional services such as primary care, specialist services, transportation, physical therapy, limited dental, mental health counseling, eye exams, and more.
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