Penn Medicine recently welcomed Dr. Kevin Kline as its first medical director for LGBTQ+ Health. Kline brings to the role his expertise as assistant professor of family medicine and community health and as a clinician at Penn’s Perelman School of Medicine. The Penn Medicine Program for LGBTQ+ Health is dedicated to providing top-notch LGBTQ+ culturally competent health care, and strives to improve access to care, standards of care and LGBTQ+ patient experiences at Penn.
In his past and current work as a clinician, Kline sees patients who are part of the LGBTQ+ community and gets their feedback on what aspects of health care are working and what needs to be reformed — from the larger health care system to the offices at Penn.
“Getting that feedback continuously directly from patients helps give the community a voice of what’s happening, what the actual needs are so that what we are working on is something that the community actually needs or is asking for, and not something that we think is the right thing but don’t have any feedback about,” Kline said.
As director of LGBTQ+ Health, Kline oversees the patients that more than 20 faculty members and 30 residents treat, who keep him informed of what their LGBTQ+ patients are saying about the care they receive.
Kline’s past experiences as a gay patient in health care settings help him stay focused on the work he does at Penn, he said.
“While I’m a white cis man and I have plenty of privilege in my life, I’ve also had plenty of historically bad experiences in health care and understand where the fear and the discomfort with healthcare is coming from for a lot of people,” Kline said. “Having experienced that myself and being shamed in visits for asking for PrEP, and being afraid to out myself to a provider not knowing what the response I would get would be — especially at a younger age when I didn’t know how to advocate for myself — that was really hard. For a long time, I didn’t get the care I needed because I was afraid of what would happen if I outed myself to my doctor.”
According to Center for American Progress report “Discrimination and Barriers to Well-being: The State of the LGBTQI+ Community in 2022,” 23% of LGBTQI+ survey respondents said that they put off or avoided getting medical care that they needed in the past year because of disrespect or discrimination from a doctor or other health care provider. Just 7% of non-LGBTQI+ respondents reported the same.
“I kind of carry that personal experience with me and that fear and shame that I had in a health care setting as something that we have done to so many people in our community as a health care system historically, and that we’ve caused harm and we’ve caused trauma,” Kline said. “It has led to people avoiding care or not getting the care that they deserve.”
One of Kline’s first orders of business in his new position is to partner with his colleagues in Penn’s Program for LGBTQ+ Health to create and standardize guidelines to enhance the quality of LGBTQ+ cultural competence in the larger health care system. Making it easier for patients to access specialist providers who are LGBTQ+-competent is also part of that plan.
Over the past year, Kline has been working with colleagues LZ Mathews, patient navigator, and Rosemary Thomas, director of operations at the Program for LGBTQ+ Health to devise concrete standards for what it means to be an LGBTQ+-affirming primary care and speciality care provider. Up until now, providers at Penn and other health institutions can self-identify as LGBTQ+-affirming without having to go through a verification process.
“For a while, that was better than what existed because there was nothing before that,” Kline said. “But we need to move beyond that and actually know what that means for us when we say that person is affirming, but also be transparent with patients about what that means when they are seeing a provider and going to a specific practice. I think [that project] is going to really help improve the quality of care so that patients know where the best place to go is right at this moment.”
Not only will these new standards help patients find LGBTQ+-affirming providers, it will help providers refer queer and trans patients to the right specialist, especially if they don’t typically refer patients to that specialty or don’t know of doctors practicing within that specialty, Kline said.
Kline also plans to work to improve LGBTQ+-affirming education, training and professional development opportunities for Penn doctors and staffers. In addition to accomplishing this on the provider level, Kline and his colleagues are working on forming a partnership to ensure that employees in all aspects of a clinical practice, including front desk staff, nurses and medical assistants, are LGBTQ+-competent.
“You could have a great interaction with a provider but if you had a terrible interaction with the call center or the front desk or the [medical assistant] or anyone on your way in or out, that can be a barrier to people coming back to get care,” Kline said. “We know that increases disparities when people aren’t accessing the care that they need.”
As such, Kline and the team created a few different training modules that focus on specific health care roles instead of generalized LGBTQ+-competency training. That training is now available, and will hopefully be part of mandated training down the line, Kline said.
On the provider level, LGBTQ+-competence should begin with teaching medical students, Kline said.
“If we continue to not teach this in medical school, people are going to continue to graduate without the right amount of knowledge about LGBT+ health,” he said.
To guard against this, Kline will work with Peter J. Vasquez, associate professor of clinical obstetrics and gynecology and faculty director of the gender and sexuality curriculum at Penn Medicine, to teach residents, fellows, faculty and attending providers.
Mathews and Thomas have been working to determine which providers at Penn are already doing the work to increase their knowledge of LGBTQ+-affirming care.
“Some of those practices don’t need anything additional; they’re been doing a great job already,” Kline said. “Some need a little bit of help; some need a lot of help and education. We’ve been working right now practice by practice doing that work.”