Teagan Vaughn & the Road to Global Gender-Affirming Care

Teagan Vaughn:  At Equitas Health, my role is to help people engage with care. For transgender and gender non-conforming people, living in a cisgender-dominant society creates considerable barriers to gender-affirming care. Trans folks experience higher rates of violence, homelessness, and unemployment, among other things. Then you have the barriers within the healthcare system itself.

SM: What are some of those barriers?

TV: Well, there is the issue of being able to get in and see your doctor due to scheduling or access to transportation. Then, once you get there, does your provider actually know what gender-affirming care is and how to provide it? There are financial barriers: filling out Medicaid and Medicare applications and trying to fill in the gaps when something is not covered. In addition, there are folks who are uninsured or underinsured. At Equitas Health, our providers often have to address one or more of these barriers to get patients access to the medications and services they need.

SM: How has COVID-19 affected your ability to help people overcome these barriers?

TV: Typically, if you are transgender and live outside of an urban center, accessing gender-affirming care can be challenging. Since Equitas Health pivoted to telehealth in response to COVID-19, we are able to reach more people in those rural areas and folks whose work schedules and access to transportation might make it difficult for them to see us in person.

Also our free statewide home delivery means our gender-affirming care patients do not have to worry about going to their local pharmacies who might not have their medications readily available or where they might experience transphobia.

SM: Once you have overcome these barriers to care, what are some of the specific needs of the transgender community you are able to address at the pharmacy?

TV: In gender-affirming care, we think about different comorbidities: when a person has more than one presenting condition. Fulfilling both the mission of Equitas Health and the mission of Transgender Awareness Week, I dedicate a lot of my time to our PrEP services. I was involved in establishing our policies and procedures for providing PrEP to increase access to PrEP for the people who need it the most, including Trans folk who are often at increased risk for HIV.

SM: It sounds like gender-affirming care can be an effective conduit to the type of whole person healthcare that Equitas Health strives to provide.

TV: Once you have a transgender person engaged in care, you have a patient who, like any other patient, will have ongoing and evolving healthcare needs. Whether it’s heart disease, smoking cessation, prep for HIV, or folks living with HIV, Equitas Health’s gender-affirming care has been the gateway to better health for many transgender people. That is something that I really work hard to do, and I am incredibly proud of that work.

SM: I can tell you that your work is making a huge difference in people’s lives. I had the pleasure of interviewing a transgender man who lives in northern Kentucky and receives care at our new Cincinnati Medical Center. He told me that he was grateful that he no longer had to trick his healthcare providers into giving him the care he needs to support his transition.

TV: Even for me, with a doctorate in the healthcare field, I was in situations where I had to be less authentic in order to access care.

SM: How does your experience receiving gender affirming care, inform your experience of providing gender-affirming care?

TV: Before becoming a patient of Mimi Rivard, our new Director of Gender-Affirming Care at Equitas Health, my providers tended to focus on things not related to gender identity, gender dysphoria, or anything trans-related. Once, I went to a counselor when there was something else going on in my personal life that was completely unrelated to being Trans. But this person, for whatever reason, chose to hone in on that when the whole reason I was there was to talk about trans things and my gender identity.

From my perspective as a provider, that is completely unimaginable to me. I see people during office visits. So someone comes to me with a genuine concern about their risk for HIV, and all I want to talk about is their high blood pressure?  That is not how that works.

SM: Where do you think that failure to listen to a patient comes from?

TV: I think there are several factors. As an Equitas Health provider, I practice patient-centered care. If someone walks in with a specific healthcare goal, I have to make that goal central to their treatment plan. I can make them aware of other important issues they might decide to address. Ultimately, if their goal is their top priority and I have a hang up about that or refuse to assist them with that goal, then I should not be seeing that patient, or any other patient for that matter. That’s something not all providers understand.

SM: How does this disconnect occur?

TV: While a lot of medical programs and educators really try to enforce a person-centered care model, few people go beyond a superficial understanding to adopt a patient-centered approach as their philosophy of care. Other providers who have not come to grips with their implicit or explicit transphobia often see gender identity and trans-ness as a result of other medical issues.

There is a lot of gatekeeping, both perceived and real, in the medical community, which contributes to a pervasive imbalance of power in the patient-provider relationship. This imbalance, difficult to overcome for a cisgender person, is often amplified for transgender and gender non-conforming people who have to push back against ignorance and intolerance at the doctor’s office. On top of that, every transgender or gender non-conforming patient has their own unique goals that they are trying to achieve as they navigate their transition and attempt to realize their gender identity and expression. Dangling the key to the gate over a patient’s head does not make for a great patient experience. Instead, providers need to hand the key to patients, so they can swing that gate wide open.

SM: When did you get the key?

TV:  I used to be a patient at another doctor’s office well known for gender-affirming care. My experience there was okay. It was not horrible. Overall, they do good work. There were just small interactions that left me less than enthused. I started looking at different places I could go. I had friends who were seeing Mimi, and everything I heard from them was stellar. From start to finish, their experience was excellent. I switched to Mimi and Equitas Health, and my experience has been exactly as my friends described it.

I have had some health scares unrelated to my gender transition, since I started seeing Mimi. Her handling of those as my primary care provider was also exceptional. Anytime that I have concerns, thoughts, or questions, Mimi listens and takes everything I say into consideration.

SM: How has Mimi’s commitment to patient-centered care affected your healthcare journey?

TV: It has allowed me to achieve better health. It is like I’m driving a car with the most intuitive and patient-centered GPS system available! Mimi knows how to get me where I want to go, and I still get to drive the car.

SM: With this in mind, how does Mimi’s new role as Equitas Health’s inaugural Director of

Gender-Affirming Care shift that patient-provider power imbalance?

TV: This is the goal of Gender-Affirming Care at Equitas Health: listen to the patient, figure out where they want to go, how they want to get there, and let them drive the car. The opportunity to work with Mimi was the main reason I wanted to work at Equitas Health, because of my experience with her as a patient. My positive patient experience with Mimi sets a high bar for the experience I want my patients to have with me.

SM: From patient to colleague, what will your role be in building upon Mimi’s already successful model of gender-affirming care at Equitas Health?

TV: Internally, we are going to develop more robust policies and procedures, and training opportunities, which will be available to all providers and new providers in particular. The goal is to ensure every transgender and gender non-conforming person receives excellent gender-affirming care whether they see Mimi or any Equitas Health provider. We already have many providers who are doing just that. Part of our goal is to increase our provider pool, so that not only are they comfortable providing gender-affirming care, they excel at it. Once we have the internal training system in place, we can promote those trainings externally to improve gender-affirming care for the entire state of Ohio and beyond.

SM: As a pharmacist with your own transgender and gender non-conforming patients, how else will you work with Mimi to achieve this goal?

TV: Mimi and I will see patients collaboratively. The state of Ohio recently expanded collaborative practice agreements for pharmacists. Under these expanded agreements, pharmacists can manage drug therapy, order labs, and order testing for patients already seeing a nurse practitioner. Whether we see patients together or separately during the same visit, or schedule alternating one-on-one visits, patients will receive a dual perspective on their care. By sharing the patient load, we will be able to see more Gender-Affirming Care patients.

SM: And replicate this model with over pharmacists and providers?

TV: Eventually, yes, that would be the goal. We also would like to establish Equitas Health’s Gender-Affirming Care program as a database for research on Trans care. We have a very large patient pool, and there is not enough data available to the medical community about Trans care and gender-affirming care. By sharing what we know, we can support better healthcare for the Trans community nationally and internationally.

SM: Today Ohio, tomorrow…the world?

TV: Exactly! This is all about improving the health outcomes of transgender and gender non-conforming people everywhere, and that all begins with improving their experience as a patient.

National Transgender Week is November 13 – 19 and culminates with The Transgender Day of Remembrance on November 20. To learn more visit, glad.org/transweek.

Sean Moseley is a copywriter at Equitas Health.