There’s something Q about LGBT Healthcare

We’re undergoing a paradigm shift here in the communities across America and it centers around the rights and privileges of the LGBTQ community (hereafter just referred to as “the community”). Recent headlines and laws have sparked conversation and debates not only on news networks but at our dining tables and in our cafes. And it’s a conversation that needs to be had.

I was generally aware of the struggles faced by the community. I knew they were being discriminated against by bakeries, book stores, and coffee shops. I had no idea that doctors, dentists, and nurses were also on that list. And I didn’t know that battle lines were being drawn right here in Portland. I thought the struggle was only felt in the midwest, the bible belt, and the deep south. I was in a bubble.

It was a patient of mine, a member of the community, that burst my bubble. This patient told me that I was the first medical professional to make him feel comfortable, safe, and listened to. I questioned him, unsure of what he meant. His story of discrimination by those in healthcare floored me. This isn’t the Portland I know. This is unacceptable. I had been aware of clinics and providers that catered to the community specifically. I always thought that in a place like Portland, they weren’t necessary. But after that moment, I had an amazing appreciation for them and I realized I needed to educate myself on the  matter. So I reached out to a colleague with the full intent of blogging the conversation so that my readers could also be made more aware and to highlight a professional in the field and a champion of LGBTQ healthcare.

I reached out to Dr. Cohen, DC, MS of Q Chiropractic in NE Portland. She is a graduate of the University of Western states here in Portland where she received both a Doctorate of Chiropractic and a Master’s of Sports and Exercise Science. Her main areas of focus are sports chiropractic, LGBTQ+ and trans specific care, and exercise-based rehab.

Dr. Bekah Cohen

Dr. Cohen, you specialize in LGBTQ+ health, can you define that for us?

Dr. Cohen: My background is in sports chiropractic and rehab, but I developed a passion for working with the LGBTQ+ (lesbian, gay, bisexual, trans, questioning) community. Ultimately, my goal is that everyone who comes to my clinic ends up feeling validated and affirmed. Outside of just being an LGBTQ+ affirming clinic (which I want to clarify includes the non-binary and gender non-conforming community), I’m also constantly trying to learn about more specific things I can do to help people feel better in their bodies. I work a lot with people to try to improve the symptoms that come along with things like using hormone therapy, wearing a chest binder, having gender-affirming surgical procedures, or even just the postural issues that can result from feeling uncomfortable in your body.

What inspired you to go above and beyond for this community in your clinic?

I was really blown away by some of the statistics I’d seen regarding the barriers the queer/trans community face to accessing healthcare, and I’ve experienced a fair share of negative healthcare experiences myself.  I really wanted to do my part to reverse that.  So now I work with a lot of people of the LGBTQ+ community, including people who fall in between and outside of traditional gender roles. I happily treat everyone, but I do make a special point to make sure members of the queer and trans community know that I’ll do my best to make sure they get the care they need.

Can you elaborate on some of those statistics? It’s hard to believe that in PDX 2016, this is an issue.

It’s really easy, especially here in Portland, to think that discrimination of the LGBTQ population is no longer happening, but that’s just not true. A 2002 study found that 6% of practitioners in the US were uncomfortable treating LGBTQ patients. As recently as 2011, 24% trans and gender non-conforming patients reported being denied equal treatment at a doctor’s office or hospital, and 70% reported experiencing discrimination in healthcare settings. So, this climate of discrimination absolutely still exists, and it leads people in the community to delay or even forego necessary health services

How is this discrimination displayed? What does discrimination look like in a modern progressive city?

While there are definitely still cases of blatant discrimination, there are other more subtle, but equally damaging, ways this population experiences healthcare inequality. Some of these may seem  like “minor slip-ups,” but  they can actually by really triggering –  such as asking the lesbian patient who checks the box for “married” about her husband, or giving her a lecture on “safe sex”  after she’s indicated that she is sexually active but does not use condoms. We live in a heteronormative society, and all these little assumptions can feel really invalidating to members of the LGBTQ community. So, is it that surprising that despite having equal risk of cervical cancer, that lesbian and bisexual women are 10x less likely to be screened for it? The issues for trans people are even more prominent, and a lot of it has to do with the fact that providers simply aren’t educated about queer and trans health needs. In fact,  50% of trans patients report consistently having to educate their healthcare providers about their health needs. By far, the most alarming statistic I’ve come across is regarding the rates of suicide attempts, so consider this a trigger warning for that, but the rates of suicide attempts are also much higher in the LGBTQ community , and staggeringly increased in the trans community (41% trans* people vs 1.6% in the general population), and this percentage jumps to 60% when a trans people who have been denied health care services.

It almost sounds like this general lack of knowledge by providers in discriminatory in nature.

Even if there isn’t intentional discrimination at play, if providers aren’t taking the time to ask about people’s sexual orientation and gender identity, they’re going to miss a lot of important information. If your intake forms don’t ask the right questions, you may never know that your trans-identified male patient still has a cervix, and still has residual breast tissue despite having had top surgery. If you don’t take the right steps to know that, you’re definitely not going to be primed to suggest that they be receiving the necessary preventive services and screenings for these organs – and that is both dangerous and negligent.

What can be done to close the gap on good LGBTQ healthcare?

Our job as providers is to help people, and that starts with coming from a place of compassion rather than judgement – no matter what the scenario is. A lot of it comes down to education. A common story is that of the trans person going to the doctor and being denied care because the provider claims not to know how to treat trans patients, and they’re not necessarily wrong, but that’s not a good enough excuse. There’s little to no education on queer and trans health in most medical and health institutions, so that obviously needs to change. But for current providers, there are all kinds of online resources from institutions like the Fenway Institute and The Center of Excellence for Transgender Health. Ultimately, I think the most important thing we can do is to educate ourselves and to not put that responsibility on the patient.

If one of my readers or someone they know is in need of care and prefers a specialized, fully inclusive and LGBTQ friendly clinic, I highly recommend they book an appointment at Q Chiropractic with Dr. Cohen. Not interviewed but well respected and recommended for primary care of internal and hormonal disorders is Dr. Angela Carter of Sacred Vessel Natural Medicine.

To keep in the loop for future topics or to put in a special request, check me out on Facebook!

Yours in health,

Dr. Lell