A student-sponsored seminar in 2011 and a senior physician who graduated from medical school in 1982 and another who is completing a residency, sparked a professional partnership that led to the opening of special clinics and national recognition for physician education. Health system after 10 years.
An accidental meeting between internist Nicole Nicely, MD, and family medicine resident Catherine Imborek, MD led to the establishment of the University of Iowa (UI) Health Care LGBTQ Clinic in a transgender student group-produced program. The clinic was initially open only one night a week. But now it offers a full range of services delivered in a welcoming and affirming environment to some 14,000 patients in the LGBTQ + community, including many who travel a long way to get there.
The clinic serves as a catalyst for equal treatment and inclusion efforts of LGBTQ + patients, visitors and employees across the University of Iowa Health Care Enterprise, which includes hospitals and clinics at the University of Iowa, which are members of the AMA Health System Program.
These efforts have been recognized by the Human Rights Campaign Foundation, which has named UI Health Care as the LGBTQ + Health Care Equality Top Performer. Scores 95 (out of 100) on its 2022 Health Care Equity Index.
The index measures the LGBTQ + involvement of the system’s patient, visit and employee discrimination policies. This requires staff training on LGBTQ + cultural competence, and whether employees have equal health insurance benefits, resource groups for employees, recruitment efforts involving LGBTQ +, and support for employees undergoing transgender transition.
Three other AMA Health System program members — Atlantic Health, Henry Ford Health and Virginia Mason Franciscan Health — have also earned Human Rights Campaign Foundation honors. The AMA Health System program equips leadership, physicians, and care teams with resources that help advance the future of medicine. Also, find out more about the AMA LGBTQ Advisory Committee, which addresses many important issues of interest to LGBTQ + medical students, residents and colleagues, LGBTQ + doctors, patients and their direct allies.
Dr. Lynch is the co-director of the LGBTQ + Clinic and clinical professor of family medicine at the University of Iowa. Imborek took the time to reflect on the clinic’s success, as the growth of gender-affirmed care has created more options and access for transgender patients. , And the political climate that threatens to reverse those gains.
AMA: Can you explain the importance of the Human Rights Campaign Foundation’s recognition?
Dr. Imborek: Our clinic gives us a lot of momentum as an organization and is in some ways a driving factor — but this recognition is for our entire University of Iowa Health Care Enterprise. This makes more sense because it is clear that UI Health Care — from all of our personal clinics to all of our individual units in the hospital — has our people up and down who have accepted our commitment and our commitment to providing welcome and confirmation. Care.
AMA: The Origin of the LGBTQ Clinic Can you tell the story of how Nisli joined?
Dr. Imborek: It was an accidental meeting. Dr. Nisli is very humble — so I toot her horn. Dr. Nisli is an exemplary ally of this community. You may ask: “How does an idea come true?” Sometimes, it involves allies who are in a position of privilege or power, who jump into the champion and achieve something.
That is the role played by Nicole. At the time we met he was a general internal medicine doctor for more than 20 years and probably had more than 2,000 patients. She had a patient who was identified as a transgender woman. And Nicole personally felt that she was not equipped to look after that patient, and because of that one patient, she attended the event to learn more.
I went to that panel because I was diagnosed as lesbian, and I was just finishing up my residency and I was joining the faculty here and starting my own practice in our outside clinics. I went to the source to figure out what kind of intake demographic questions we should ask all of our patients. We both went to the mic during the questionnaire, and she then grabbed me and said: “Hey, I’m thinking about starting an LGBTQ + clinic. You want to do that with me? “I was wondering if this would happen because the university is a large and slow-moving machine that is not yet a faculty and has not graduated from residency.
You need to have persistence, diligence and support to get things done. I had no idea how much political capital and personal effort Nicole was willing to put into it. I think we’ve built a great team in terms of knowing how to navigate the system, and I’ve had the experience of being a queer member. Fresh from community and residency, it also has time and energy.
AMA: The way the LGBTQ clinic operates comes from listening to what patients want to hear from their doctors, says Dr. Drew. Said Nisli. What have you heard from patients you haven’t learned in residency or medical school?
Dr. Imborek: One of the most important things we have learned is the power of language and the intention to do it in advance with all of your staff training – it really has to go beyond the doctor. A patient may eventually make a visit, where they may come face to face with their doctor or other healthcare professional, who may be passionate, educated, and ready to offer that patient a wonderful, respected, medical expert. Ideal visit.
But the patient already had to communicate with the other three to four members of the health care team. And if they don’t get some basic training on LGBTQ + rules, use of pronouns and calling patients by the name they recognize, that entire encounter may already be ruined. Some of the most important things we have learned about how traumatic it is for patients — especially those who identify as non-sexist or non-binary — to be misunderstood by being referred to by incorrect pronouns or by their so-called “dead.” Name. ”That is usually their given name, not the name they use.
We knew how important it was to make sure we had cultural competency training for all of our staff, but we also knew how important it was to keep things in place to implement some of the common things we do. We knew we had to get the priority name on the labels we use in the various places you go to in the health system. We have been able to do such things across the entire enterprise, which is a game changer. We were able to add information about someone’s preferred name and someone’s pronoun, and sexual orientation or gender identity or “SOGI” directly into the medical record. This information about pronouns, preference names, gender identity, and assigned sex at birth is captured in the electronic medical record as separate data fields and follows patients as they navigate the health system. , Doctors and other clinical staff can quickly access information such as whether a person has ovaries and uterus, where you have to worry about whether they are pregnant. These things are important not only to establish rapport and be respected, but also when making medical decisions.
AMA: Where do your patients live?
Dr. Imborek: Most of our facilities are located within Johnson County and I would say most of our patients come from outside this county. So people think the LGBTQ + clinic operates in Iowa City because it’s full of all these weird people.
But there are also a lot of weird people in rural Iowa, and they can’t reliably accept gender-affirmation and / or LGBTQ + – affirmation concerns, so they come into our system. Pre-COVID, they drive and now we — combined with telemedicine, like many other places — we are able to offer that option.
This, in particular, is something that our LGBTQ + patients really like. Half of my patient visits are via video.
AMA: How has this medical field changed?
Dr. Imborek: When we started it 10 years ago, we were probably one of the first educational institutions to set up an LGBTQ + clinic. Since then, more and more clinics have opened, both academically and outside, which is great.
There is a widespread acceptance, and there are many doctors who recommend hormones and most surgeons who do gender-affirming care. We have seen most insurance companies cover these procedures and match with what the AMA said years ago: gender-affirming care, including hormones and procedures, is medically necessary.
Then, at the same time, we have recently seen an exponential, horrific increase in the anti-LGBTQ rate and, in particular, the anti-trans and anti-trans youth bills proposed and passed in state legislatures.
There are some really horrible things that can be done to criminalize the care of sexy children. This is a terrifying trend and hopefully, science and proven medical evidence on the benefits of gender-affirmative care will win.