Despite myriad barriers to healthcare for many queer and trans people, some providers are knowledgeable, skilled, and welcoming when it comes to treating members of the LGBTQ community. Philly is home to some of those doctors, one of whom is Nancy Brisbon, physician at Mazzoni Center.
“Everybody should leave a provider visit feeling like whatever was discussed, that they feel affirmed and supported, and hopefully a little better,” Brisbon said. “With a plan, not with a plan, whatever the conversation has been. But [they should feel like] ‘wow, that person took time with me, and really heard me.’”
At times, however, that is not always the experience of LGBTQ patients in doctor’s offices and hospitals. Brisbon pointed out that many LGBTQ patients often already come into a medical provider’s office in a vulnerable position, and sometimes they encounter the added stress of discrimination.
“Maybe you’re scared about something that you’ve been experiencing, or something you haven’t said out loud to anyone else before,” Brisbon said. “Healthcare providers should just be able to respond to that — that’s supposed to be what we want to do and what we’re good at. Whatever one’s bias may be, you should really be able to train yourself out of it so that it doesn’t impact someone else’s life and healthcare.”
Elizabeth Coffey Williams, a trans advocate who lives in Philadelphia, is one of Brisbon’s patients. She discussed the importance of having a doctor who understands the specifics of any patient’s needs, especially the multidimenstional nature of LGBTQ health.
“It’s crucial that they understand their patients and actually have the competence,” Coffey Williams said. “With a transgender history, it’s not like we are that extraordinarily different from anyone else. But when it comes to things like hormone replacement therapy and/or referrals to specialists, it’s of the utmost importance that we have a doctor who knows who we are and what our needs are.
“With someone like Nancy Brisbon, who is so extraordinarily unassuming, she just brings it all to the table in a way that makes me know that I am in hands that are not just competent, but I’m in hands that genuinely care about me as a human being.”
According to the study “Discrimination and Barriers to Well-Being: The State of the LGBTQI+ Community in 2022,” 23% of LGBTQ respondents said they put off or avoided seeking medical care in the last year due to disrespect or discrimination from a healthcare provider, compared to just 7% of non-LGBTQ respondents. Additionally, 21% of LGBTQ survey respondents said they also delayed or avoided getting preventive screenings because of the same issue. Respondents who are trans, trans people of color and LGBTQI+ people of color said that they postponed or avoided medical care or health screenings at higher frequencies.
“Even in 2023, it’s just astounding how many folks still come in having had somebody say something that was really inappropriate or insensitive or mean to them, or prohibited them from getting some care,” Brisbon said. “It remains super important that folks have access to people who understand them, who want to take care of them, who want to join with them in the journey of their health. Respect is right at the top of that list.”
Billie Swiggard, staff physician at Mazzoni Center, said that misunderstandings, misdiagnoses, stigma and marginalization of LGBTQ people by medical providers stems from ignorance, inexperience and “outright bigotry,” made worse by a belligerent political climate.
“Mistrust and outright fear of ‘the system’ are distressingly common in our patient population,” Swiggard said. “Yet when approached with courtesy and understanding in a welcoming space, by staff members with similar lives, trust is established. We then apply our experience with the special clinical needs of LGBTQIA+ folks, often using our own lives for examples.”
Since the pandemic, healthcare providers continue to experience challenges to administering care safely, both for physician and patient. Brisbon pointed out that roughly 500 people are dying from COVID-19 in the U.S. each day, so doctors and the general public still need to take precautions. As a doctor, Brisbon prioritizes navigating new ways of delivering care.
“How do you keep yourself safe from the many viruses that are out there but still have a life that keeps you engaged and interacting with other people,” she asked rhetorically. “That kind of social relationship is super important for health as well. I think we’re trying to figure out that balance of, how is telemedicine still playing a role in delivering care? How much more creative and flexible can we be continuing to keep people mindful that this illness isn’t gone?”
Last year’s mpox outbreak presented yet another challenge on top of the lingering COVID pandemic. “It’s been a really complicated, stressful few years,” Brisbon said.
It’s also important for LGBTQ patients to advocate for themselves. In order to get the most out of their healthcare, patients should ask questions, come prepared to doctor’s appointments, bring a friend or family member to appointments for support, and schedule multiple visits if they are dealing with various health issues, according to Brisbon.
“I try to remain open and hear what’s coming, try to meet patients where they are,” Brisbon said. “Maybe they’ve had traumatic experiences in the past with healthcare providers. I often will apologize for all of that, and try to make a reset for them so that they can feel like this is a trusted environment, that there’s not going to be any judgment. Hopefully, there’ll be a little laughter in the conversation that will be able to connect us as fellow members of the same community, and move forward with whatever their needs are.”
In addition to addressing basic health questions pertaining to blood pressure, diabetes and diet, Brisbon strives to address non-medical factors that may impact health, such as food insecurity, lack of transportation, lack of social support, and whether a patient has someone they can turn to when they’re feeling sad.
“I think lots of folks in marginalized communities don’t have those kinds of supports, or their supports are really stressed,” Brisbon said. “So I think it’s us keeping all of those things present and doing what we can to make sure that their health doesn’t suffer in that environment.”