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Everyone.

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Good evening everyone.

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I like that.

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Good evening everyone,

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and welcome to this year's
Larner College of Medicine

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Vito Imbasciani George DiSalvo
LGBTQ Health Equity Lecture.

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My name is Dr. Margaret Tandoh

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and I'm the Associate Dean

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for Diversity, Equity and Inclusion.

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I would like to welcome you all,

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both here and our friends
joining us online,

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and thank you for being at this event.

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And now I'm gonna introduce Dean Page,

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Dean of the Larner College of Medicine

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to get us going.

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Before I do that though, Dr.
Longsbarry, for our students,

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please log in for your attendance,

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M1, M2,

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and then if you having any trouble,

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please let Dr. Longsbarry know. Okay?

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Now I'll turn it on to Dean Page.

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Dean page?

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Thank you very much, Dean Tandoh,

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it's wonderful to see you all here.

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Exciting.

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Dean Zale and I decided
to wear our white coats

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to remind the second
years that you've had them

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for almost a year now.

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And just to incentivize
the first year students

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that we're looking forward

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to sharing the white coat
ceremony with you next month.

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It's really my pleasure
to welcome you all today

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and hello to everybody
in Zoom world as well.

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We've got a packed house here

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and this is really a special event.

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This is the 10th annual Vito
Imbasciani PhD, MD class of 85,

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and George DiSalvo, LGBTQ
Health Equity Lecture,

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which this year is entitled
Gender Affirming Care

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as a Model of Health Care.

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I'd like to express my personal gratitude

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to Dr. Imbasciani and Mr. DiSalvo.

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Vito and George, we're
tremendously grateful

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that you could join us here today.

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Would you please stand up and
let us recognize you, please?

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That was completely off script.

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They're going to have it with me later,

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but it's only proper that we
acknowledge your generosity

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and allowing us to deepen our
understanding and knowledge

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of the issues of the LGBTQ healthcare.

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We really appreciate the
support you've given us

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over the last 10 years,

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and we're grateful for
your enduring generosity.

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This was the first,

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and may still be the
only endowed lectureship

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at any medical school in the United States

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that concentrates on issues

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of furthering the goals of healthcare

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by shining a light on the
specific needs of this population.

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This lecture is consistent
with our college's core values

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and our statement on professionalism,

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which emphasizes that we treat everyone

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with cultural humility,
kindness and respect.

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And we recognize that we must fully commit

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to promoting equity and
support of our community

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and every community.

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That this makes for a better, more diverse

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and inclusive society.

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It makes us better doctors.

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I'm especially pleased
that we get to hear today

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from a visionary healthcare
leader, Dallas Ducar,

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who serves as Chief Executive
Officer of Transhealth,

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a pioneering organization committed

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to transforming healthcare.

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I'm personally really
looking forward to this talk,

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having spent the last hour with Ms. Ducar

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and learning about her
story and her commitment

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to the position that she's in.

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And here to introduce our
speaker is now Dr. Pamela Gibson,

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who serves as professor

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in the Department of Pathology
and Laboratory Medicine

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is faculty advisor

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for the Medical Student
Gender Sexuality Alliance

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and Vice Chair for Culture and Inclusion

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in Department of Pathology
and Laboratory Medicine.

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Please join me in welcoming Dr. Gibson.

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Thank you, Dr. Tandoh and Dr. Page.

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I especially wanna thank Vito
and George for being here

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and for your generosity and
creating this lectureship.

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This has become an integral
part of our curriculum

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as it's now it's required

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for first and second year students,

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and it is an important component

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of our continued learning as a community

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related to our LGBTQ Health.

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And I wanna welcome everyone here.

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I have the honor of
introducing Ms. Dallas Ducar,

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our keynote speaker.

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She's the founding Chief
Executive Officer of Transhealth.

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She's a visionary healthcare leader

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who started this pioneering organization,

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which is committed to
transforming healthcare.

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Transhealth is the first
standalone transmedical

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and mental healthcare
organization in the nation.

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Dallas, in addition to
being CEO and president,

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holds several degrees and appointments.

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She's an advanced
practice registered nurse

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with a master's in nursing,

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certified as a psychiatric
mental health nurse,

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and is a fellow of the
American Academy of Nursing.

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She's trained in narrative therapy,

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mindfulness based stress reduction,

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informed consent, harm reduction,

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patient-centered care and community-based

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participatory approaches to care.

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She's also a faculty member

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at the University of
Virginia School of Nursing,

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Columbia University,

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and the Massachusetts
General Hospital Institute

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for Health Professions.

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She's extremely active
in shaping health policy

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related to equity, ethics
and gender affirming care.

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She serves on multiple board of directors

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that work to improve access and quality

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for the transgender community.

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As you'll hear today, Dallas
is passionate about advancing

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gender affirming healthcare in novel ways

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that can serve as a
model for all healthcare.

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Welcome, Dallas.

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Hello. Everyone hear me?

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Wonderful.

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I'm here today to talk about
gender affirming healthcare

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and how gender affirming healthcare

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can serve as a model
for all of healthcare.

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For folks who might feel
like this is the DIA lecture

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or the lecture, that's kind of
the cherry on top of it all.

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I believe that this is foundational.

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It's foundational to being good doctors,

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it's foundational to
being good clinicians.

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This is, I believe a model of care

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that really can shape how we practice

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in any clinical environment.

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So what I hope to do
today is talk a little bit

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about gender affirming care.

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I'm not gonna really go into depth about

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how to provide gender affirming care,

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hormone therapy, different surgeries.

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All of that can be learned elsewhere.

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But I wanna get down to
the philosophy of this,

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the philosophy of what it
means to affirm a patient,

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the philosophy of what it means

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to care for someone holistically.

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And then give some examples

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from our own clinic of Transhealth.

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And then talk about what we can do

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in really a world that is scary right now

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for gender affirming care.

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Really a world that has more news items

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related to gender affirming
care than I've ever seen.

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Raise your hand if you've
seen gender affirming care

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in the news in the past month.

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Yeah. Every major medical organization

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supports providing gender affirming care,

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and yet we've seen it become
a extremely hot button issue

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and centerfold to political
campaigns specifically.

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So we're gonna talk a little
bit about advocacy too.

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So today we will analyze
the present landscape

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of gender affirming healthcare
environment in the US.

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We'll understand strategies

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for providers to deliver
individualized and attentive care

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for trans and gender diverse patients.

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And we'll assess and
implement effective strategies

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to promote organizational change.

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So I wanna start by
redefining what we talk about

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when we talk about good healthcare.

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So what we know is that healthcare,

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pathologizes bodies and identities.

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Think about when you walk into a room

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and you're assessing the patient.

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You're looking for someone
that's in distress, usually.

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You're looking for someone who's in pain.

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Maybe if someone's barreled over,

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you're wondering what's wrong,

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you're working through an
assessment right there.

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Healthcare teaches us to start with a lens

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of what's wrong with you, rather
than what's right with you.

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And that's really critical
to being a good clinician,

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being a good provider, being good doctor.

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But gender affirming care
tries to flip that on it's head

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and says, we are actually
gonna lead with affirmation

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and we're gonna say what's right with you.

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Now, gender affirming healthcare

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is based on informed consent as well.

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Who here is filled out or
given an informed consent form?

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So it's not just the form itself,

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it is actually asking how
one should be referred to

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how they should be referred,

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and who they should be referred to.

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Using the right pronouns
with the right person

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when you're on the phone,

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knowing if you have informed consent

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to talk about someone's
gender identity or sexuality.

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And trauma-informed care,

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ensuring that the care that we provide,

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that everyone that we work with,

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we assume that someone may
have experienced trauma

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and start with that conceptualization,

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so as to not re-traumatize the individual.

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So that we can then instead say,

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"Where do you wanna be and
how do we help you get there?"

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So gender affirming healthcare

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is really putting the
patient in the driver's seat.

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It's asking where do you wanna go

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and how do we help you get there?

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And I believe that care for
a gender diverse individuals

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can be a model for all of the
healthcare that we provide.

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So if we look at models of gender

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and we think about where we
first interacted with gender,

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if we think about something
as early as the NICU,

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for example.

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If you're assigned female
at birth, people may say,

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"Oh, she's so delicate.

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"Oh, she'll get through this."

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Or if you're assigned male at
birth, "Oh, he's a fighter,

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"he's tough, he's got this."

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The language that we use with children

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before they have any
identification of gender,

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when the child is pre-verbal,

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gender is used linguistically
around that child everywhere.

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And the associations that we have too.

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Now, if we think to family,
think back to your chores.

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Who here was asked to wash
the dishes in your family?

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What about carrying out the groceries,

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carrying in the groceries, rather?

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Now thinking about yard work, for example,

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thinking about different
divisions of labor,

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some people depending on the
gender roles in your household,

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might have had different
divisions of labor in your family

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and based on your culture too.

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And so the way family
structures are developed,

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the way schools, what
schools we might be able

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to have access to.

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I went to a all boys
school, a Catholic school

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and was not allowed to go
to the all girls school.

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What school we go to,

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what educational
opportunities we can afford

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based on where you are
in the United States.

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What healthcare access
you might have right now

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if you have access to
reproductive healthcare.

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Where you might be incarcerated.

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All of this, is defined by your gender

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and how society interacts with gender.

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Male physicians still
get paid more on average

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than female physicians.

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Same in nursing too,

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in a predominantly female oriented field.

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And so it's an economic issue as well.

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This isn't just, you know,

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it's talking about gender,

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but it's talking about all
the intersections of gender.

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And then how race and ethnicity
intersect in these as well.

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00:14:04,710 --> 00:14:07,770
So what we know is that 50 to 70%

262
00:14:07,770 --> 00:14:10,690
of all trans and gender diverse people

263
00:14:11,610 --> 00:14:15,040
report based on recent
studies, report discrimination

264
00:14:16,320 --> 00:14:18,843
and large scale mistrust.

265
00:14:20,833 --> 00:14:23,130
50 to 70%.

266
00:14:23,130 --> 00:14:25,830
So if you are trans or gender diverse,

267
00:14:25,830 --> 00:14:29,190
you are less likely, much less likely

268
00:14:29,190 --> 00:14:31,320
to trust your healthcare provider.

269
00:14:31,320 --> 00:14:33,330
That number increases at the intersection

270
00:14:33,330 --> 00:14:35,193
of race and ethnicity.

271
00:14:36,990 --> 00:14:39,870
And what we know too
is that if we are able

272
00:14:39,870 --> 00:14:41,670
to provide a patient-centered,

273
00:14:41,670 --> 00:14:44,820
trauma-informed holistic approach,

274
00:14:44,820 --> 00:14:48,510
that we'll see higher patient retention

275
00:14:48,510 --> 00:14:51,300
and we'll see more patient satisfaction.

276
00:14:51,300 --> 00:14:55,140
And so this, and what we
know across the research too,

277
00:14:55,140 --> 00:14:57,900
is that access to care is just not enough.

278
00:14:57,900 --> 00:14:59,670
We just don't have enough access

279
00:14:59,670 --> 00:15:03,273
to specialized LGBTQ competent care,

280
00:15:04,200 --> 00:15:06,390
but especially care for trans
and gender diverse people,

281
00:15:06,390 --> 00:15:09,085
especially when we're
seeing it being increasingly

282
00:15:09,085 --> 00:15:11,640
politicized across the country

283
00:15:11,640 --> 00:15:13,090
and banned in certain states.

284
00:15:15,780 --> 00:15:18,870
So what we know, at least
according to more recent reports,

285
00:15:18,870 --> 00:15:21,360
is that in terms of discrimination,

286
00:15:21,360 --> 00:15:24,270
nearly half of trans people
report discrimination,

287
00:15:24,270 --> 00:15:27,250
including 68% of trans responsive color

288
00:15:28,560 --> 00:15:31,923
more than half report
postponing or avoiding care,

289
00:15:32,820 --> 00:15:35,733
including 60% of trans
respondents of color.

290
00:15:37,050 --> 00:15:38,700
And experiencing insurance denials

291
00:15:38,700 --> 00:15:41,200
around 46% of all trans people

292
00:15:42,453 --> 00:15:45,003
and 56% of trans respondents of color.

293
00:15:47,250 --> 00:15:51,240
So there's a good reason not
to trust healthcare providers

294
00:15:51,240 --> 00:15:52,890
if you're trans,

295
00:15:52,890 --> 00:15:55,340
and especially if you're
a trans person of color.

296
00:15:59,100 --> 00:16:02,500
We also know that around
40% of trans people

297
00:16:03,390 --> 00:16:05,253
report suicide attempts.

298
00:16:07,050 --> 00:16:11,463
This isn't suicidal ideation,
this is a suicide attempt.

299
00:16:12,810 --> 00:16:16,830
This is a staggering number
compared to the national average

300
00:16:16,830 --> 00:16:18,153
of suicide attempt rates.

301
00:16:20,370 --> 00:16:21,990
And as a psychiatric clinician,

302
00:16:21,990 --> 00:16:24,480
I don't know of any intervention

303
00:16:24,480 --> 00:16:27,240
that's as effective as what I see here,

304
00:16:27,240 --> 00:16:30,723
that this goes down 82% just with support.

305
00:16:33,120 --> 00:16:37,560
This is not something that's
inherent in transgender people.

306
00:16:37,560 --> 00:16:39,460
This is born out of a society

307
00:16:40,830 --> 00:16:45,153
that otherwise does not
support transgender people.

308
00:16:46,530 --> 00:16:48,660
And so one of the best
interventions you can do,

309
00:16:48,660 --> 00:16:49,923
just starting out,

310
00:16:51,480 --> 00:16:54,090
is actually asking about support,

311
00:16:54,090 --> 00:16:56,793
understanding support networks,

312
00:16:57,990 --> 00:17:00,440
understanding where people
receive their support.

313
00:17:01,860 --> 00:17:04,380
If we know that trans
folks don't have access

314
00:17:04,380 --> 00:17:07,590
to care predominantly
and experience distrust

315
00:17:07,590 --> 00:17:08,883
in healthcare systems,

316
00:17:10,680 --> 00:17:12,900
it's no wonder that
with a lack of support,

317
00:17:12,900 --> 00:17:15,000
especially familial support,

318
00:17:15,000 --> 00:17:19,260
so many trans people may
find it so difficult to live

319
00:17:19,260 --> 00:17:20,910
or get out of bed in the morning.

320
00:17:22,770 --> 00:17:24,600
And we know that this is much more likely

321
00:17:24,600 --> 00:17:25,923
with unsupported families.

322
00:17:27,270 --> 00:17:29,640
And so one of the most
important interventions

323
00:17:29,640 --> 00:17:31,440
that you can do, is begin to educate

324
00:17:33,000 --> 00:17:37,560
working with families,
especially if you're interested

325
00:17:37,560 --> 00:17:39,900
in pediatrics, for example.

326
00:17:39,900 --> 00:17:43,420
Especially if you're
talking about gender early

327
00:17:44,580 --> 00:17:45,580
and gender identity.

328
00:17:47,730 --> 00:17:51,360
And what's really staggering
here is that these individuals

329
00:17:51,360 --> 00:17:53,200
who responded to this survey

330
00:17:54,060 --> 00:17:57,273
are those who live to report suicidality.

331
00:17:58,920 --> 00:18:01,443
This number is actually likely higher.

332
00:18:05,280 --> 00:18:07,590
So there's something critical going on

333
00:18:07,590 --> 00:18:09,190
and something that we can do

334
00:18:10,110 --> 00:18:11,890
in providing patient-centered care

335
00:18:13,500 --> 00:18:15,900
and good comprehensive care.

336
00:18:15,900 --> 00:18:17,853
That's really pretty simple.

337
00:18:20,580 --> 00:18:23,020
So where are we right now

338
00:18:24,471 --> 00:18:25,503
on the landscape?

339
00:18:26,880 --> 00:18:30,120
Well, we're seeing
widespread disinformation

340
00:18:30,120 --> 00:18:33,000
that's propagating
across the United States.

341
00:18:33,000 --> 00:18:36,600
We're seeing people who
provide gender affirming care,

342
00:18:36,600 --> 00:18:40,773
be called child mutilators, for example.

343
00:18:41,824 --> 00:18:46,050
We're seeing that physicians and nurses

344
00:18:46,050 --> 00:18:48,753
are forcing this on kids.

345
00:18:49,680 --> 00:18:54,680
And over 20 state governments now

346
00:18:55,950 --> 00:19:00,690
banning gender affirming
care for kids in general,

347
00:19:00,690 --> 00:19:04,653
including discussing gender.

348
00:19:05,490 --> 00:19:08,523
When we know that kids begin
to explore gender early,

349
00:19:09,960 --> 00:19:12,873
including discussing gender
and sexuality in schools too.

350
00:19:14,520 --> 00:19:18,310
And so this medically informed care

351
00:19:19,230 --> 00:19:21,900
that has been practiced, we've seen since,

352
00:19:21,900 --> 00:19:24,600
I mean, we've seen histories
of kids in the United States

353
00:19:24,600 --> 00:19:28,450
transitioning as early as 19,20 now

354
00:19:29,460 --> 00:19:31,620
has become a cultural flashpoint

355
00:19:31,620 --> 00:19:36,150
that has then led to
vilification, ostracization,

356
00:19:36,150 --> 00:19:38,703
legislation and violence.

357
00:19:40,530 --> 00:19:44,070
Violence on trans people,
violence against providers too,

358
00:19:44,070 --> 00:19:45,693
violence against physicians.

359
00:19:48,480 --> 00:19:50,520
And if we look at LGBTQ policy

360
00:19:50,520 --> 00:19:52,070
in the United States right now,

361
00:19:54,700 --> 00:19:58,327
we see many individuals,
especially in the south,

362
00:19:59,760 --> 00:20:03,750
continuing to fight
against a minority view

363
00:20:03,750 --> 00:20:08,610
for liberation and the
ability to express oneself

364
00:20:08,610 --> 00:20:10,910
and the freedom to be
able to express oneself.

365
00:20:13,080 --> 00:20:16,020
And specifically in the trans community,

366
00:20:16,020 --> 00:20:19,960
we see again, over 20 states now

367
00:20:21,210 --> 00:20:25,200
that have ban pediatric
gender affirming care.

368
00:20:25,200 --> 00:20:28,320
Some states now also attempting to ban

369
00:20:28,320 --> 00:20:31,080
access to adult care too,

370
00:20:31,080 --> 00:20:33,570
if people are following
Florida specifically.

371
00:20:33,570 --> 00:20:36,630
And Florida's Medicaid program

372
00:20:36,630 --> 00:20:40,050
and threatening to cut all adults

373
00:20:40,050 --> 00:20:42,723
from access to any gender affirming care.

374
00:20:45,180 --> 00:20:48,090
People that have been on
hormonal replacement therapy

375
00:20:48,090 --> 00:20:49,833
for their whole life.

376
00:20:51,240 --> 00:20:52,790
And then the state intervening.

377
00:20:58,920 --> 00:21:02,520
And we've also seen at least
as last Pride for example,

378
00:21:02,520 --> 00:21:03,870
does anyone recognize this picture?

379
00:21:03,870 --> 00:21:06,183
Raise your hand if you
do. Yeah, some folks.

380
00:21:08,128 --> 00:21:11,770
So you know, White supremacists
showing up at Pride marches

381
00:21:12,930 --> 00:21:17,930
with weapons attempting
to lament violence.

382
00:21:20,760 --> 00:21:25,760
And pediatric children's
hospitals as well being threatened

383
00:21:25,890 --> 00:21:28,053
with bomb threats too.

384
00:21:29,610 --> 00:21:33,600
In the end, especially as clinicians,

385
00:21:33,600 --> 00:21:36,780
we all want healthcare that cares

386
00:21:36,780 --> 00:21:37,893
for the whole person.

387
00:21:39,506 --> 00:21:42,720
And unfortunately, many
of those who might react

388
00:21:42,720 --> 00:21:46,260
with violence aren't really
gonna be hearing this message.

389
00:21:46,260 --> 00:21:51,260
And so instead, it really
relies on us as communities

390
00:21:51,840 --> 00:21:56,840
of providers, as clinicians,
as people who care as healers,

391
00:21:57,210 --> 00:22:01,650
to rely on facts to be
able to provide those facts

392
00:22:01,650 --> 00:22:05,073
and to be able to provide
access to quality healthcare.

393
00:22:07,353 --> 00:22:12,320
And so really what we're
seeing in the United States

394
00:22:16,288 --> 00:22:21,090
is an increase in violence
against healthcare providers,

395
00:22:21,090 --> 00:22:23,220
and especially in places that are caring

396
00:22:23,220 --> 00:22:24,150
for marginalized communities.

397
00:22:24,150 --> 00:22:26,490
And we need people to feel safe.

398
00:22:26,490 --> 00:22:28,920
And so part of the work
that we've been doing,

399
00:22:28,920 --> 00:22:31,380
at least at Transhealth
and our advocacy work,

400
00:22:31,380 --> 00:22:34,260
is to really ensure that
there's additional funding

401
00:22:34,260 --> 00:22:36,960
to ensure that providers
and the clinicians

402
00:22:36,960 --> 00:22:39,870
that health systems are safe

403
00:22:39,870 --> 00:22:42,143
so that people can provide
evidence-based care.

404
00:22:43,230 --> 00:22:46,800
Because I think the worry in
the gender affirming care space

405
00:22:46,800 --> 00:22:50,340
is that if people don't feel
safe to enter into this care,

406
00:22:50,340 --> 00:22:51,740
who will be providing this care

407
00:22:51,740 --> 00:22:53,343
in the next generations, right?

408
00:22:57,861 --> 00:23:02,130
So gender affirming care in my viewpoint

409
00:23:02,130 --> 00:23:03,540
is simply good healthcare.

410
00:23:03,540 --> 00:23:07,500
It's evidence-based care
allows for individuals

411
00:23:07,500 --> 00:23:10,920
to better know themselves, their identity,

412
00:23:10,920 --> 00:23:12,930
their medical needs.

413
00:23:12,930 --> 00:23:16,530
And nothing is being done overnight,

414
00:23:16,530 --> 00:23:18,210
which we'll get into.

415
00:23:18,210 --> 00:23:21,390
Clinicians are acting
thoughtfully and deliberately

416
00:23:21,390 --> 00:23:24,633
because these interventions
are lifesaving.

417
00:23:25,860 --> 00:23:29,160
And whenever I tell someone
who doesn't really understand

418
00:23:29,160 --> 00:23:30,690
gender affirming care,

419
00:23:30,690 --> 00:23:33,843
that it's a model that
respects individual choice,

420
00:23:34,980 --> 00:23:37,290
it's guided by science,

421
00:23:37,290 --> 00:23:40,863
it gives you the time that
you deserve to be known.

422
00:23:42,030 --> 00:23:43,777
I'm generally met with a response,

423
00:23:43,777 --> 00:23:46,377
"I wish that my healthcare was like that."

424
00:23:48,570 --> 00:23:53,140
Isn't that what we all want
from our own healthcare

425
00:23:54,000 --> 00:23:56,553
is to be known is, to be cared for,

426
00:23:57,540 --> 00:23:58,940
to be able to be understood?

427
00:24:00,300 --> 00:24:01,500
To be able to have time.

428
00:24:03,210 --> 00:24:05,520
So the fact that the national discussion

429
00:24:05,520 --> 00:24:07,830
around affirming care is so
divorced from the actuality

430
00:24:07,830 --> 00:24:10,560
of what happens on the ground,

431
00:24:10,560 --> 00:24:13,200
you know, affirming care really deeply,

432
00:24:13,200 --> 00:24:18,200
it respects deeply held
principles of freedom and liberty

433
00:24:18,660 --> 00:24:21,753
and acknowledges that you can
pursue your own happiness.

434
00:24:22,650 --> 00:24:24,000
And who wouldn't want that?

435
00:24:25,445 --> 00:24:28,650
And while we see that every
major healthcare organization

436
00:24:28,650 --> 00:24:30,183
supports affirming care,

437
00:24:31,260 --> 00:24:33,280
we see fringe groups resort

438
00:24:34,770 --> 00:24:37,083
to domestic terrorism.

439
00:24:38,010 --> 00:24:40,020
Instead of reasonable debate and dialogue

440
00:24:40,020 --> 00:24:41,760
between scientific and medical experts,

441
00:24:41,760 --> 00:24:45,213
we've seen belief in personal
ideology motivate actions.

442
00:24:46,590 --> 00:24:49,240
And so really what this takes

443
00:24:51,606 --> 00:24:54,820
is meeting this moment

444
00:24:55,740 --> 00:24:57,210
with good education,

445
00:24:57,210 --> 00:24:59,910
with facts and with advocacy,

446
00:24:59,910 --> 00:25:01,740
which is what I hope to get into

447
00:25:01,740 --> 00:25:03,390
in the latter half of
this presentation too.

448
00:25:03,390 --> 00:25:06,303
How we can actually work towards change.

449
00:25:10,770 --> 00:25:13,980
So one thing that we really have seen here

450
00:25:13,980 --> 00:25:16,530
is that Telehealth has been the key

451
00:25:16,530 --> 00:25:18,540
to expanding hard to reach care.

452
00:25:18,540 --> 00:25:21,510
And we've seen this specifically
during the Covid pandemic

453
00:25:21,510 --> 00:25:23,550
with many people that
otherwise trans folks

454
00:25:23,550 --> 00:25:26,580
would have to drive up to two hours

455
00:25:26,580 --> 00:25:30,000
to be able to get good competent care.

456
00:25:30,000 --> 00:25:32,760
And we're all setting
sometimes three or four hours.

457
00:25:32,760 --> 00:25:35,220
Trans folks also disproportionately

458
00:25:35,220 --> 00:25:38,310
make less than cisgender folks.

459
00:25:38,310 --> 00:25:40,860
And so already having to
take a day off of work

460
00:25:40,860 --> 00:25:44,100
and then being able to try
to get hard to reach care.

461
00:25:44,100 --> 00:25:46,110
And we've seen that Telehealth
has really been able

462
00:25:46,110 --> 00:25:48,810
to expand access to that care,

463
00:25:48,810 --> 00:25:51,153
which has been a huge benefit.

464
00:25:53,160 --> 00:25:55,350
At Transhealth specifically
what we've launched

465
00:25:55,350 --> 00:25:57,720
in conjunction with the
Department of Public Health

466
00:25:57,720 --> 00:26:01,170
has been access care program,

467
00:26:01,170 --> 00:26:06,170
basically a line that you can
submit a request at any time.

468
00:26:07,140 --> 00:26:08,790
Right now it's only for
Massachusetts residents

469
00:26:08,790 --> 00:26:11,730
that we hope that it'll be
able to expand and replicate.

470
00:26:11,730 --> 00:26:15,633
And you can ask as a
provider, as a doctor,

471
00:26:16,680 --> 00:26:18,840
any question that you have
around gender affirming care

472
00:26:18,840 --> 00:26:20,430
and have that answered in the moment.

473
00:26:20,430 --> 00:26:23,010
So that we're able to
integrate affirming care

474
00:26:23,010 --> 00:26:25,680
into more conversations.

475
00:26:25,680 --> 00:26:29,760
And we're able to integrate
it into well child visits.

476
00:26:29,760 --> 00:26:31,410
This doesn't mean, I just
wanna be really clear,

477
00:26:31,410 --> 00:26:36,120
it doesn't mean starting
any intervention here,

478
00:26:36,120 --> 00:26:39,150
it's just being able to talk about gender.

479
00:26:39,150 --> 00:26:41,820
Because we know that
awareness of gender identity

480
00:26:41,820 --> 00:26:46,380
comes on about three or four
years old developmentally.

481
00:26:46,380 --> 00:26:51,380
And so being able to integrate
conversations about gender

482
00:26:51,390 --> 00:26:55,800
and being fluid and being
able to just discuss this.

483
00:26:55,800 --> 00:26:58,110
And same with sexuality too.

484
00:26:58,110 --> 00:27:01,170
When we see, you know,
conversations around sexuality,

485
00:27:01,170 --> 00:27:04,320
especially in kids start to
come up around puberty or so

486
00:27:04,320 --> 00:27:08,820
a little earlier too, and
defining one's sexuality,

487
00:27:08,820 --> 00:27:12,750
it becomes instrumental
in being able to just

488
00:27:12,750 --> 00:27:15,753
provide this good care to any person.

489
00:27:20,405 --> 00:27:22,740
And we know from so much research now

490
00:27:22,740 --> 00:27:26,340
that access to gender
affirming care saves lives.

491
00:27:26,340 --> 00:27:31,340
And so I believe that we really
have a responsibility here

492
00:27:32,460 --> 00:27:34,360
to help support individual freedom

493
00:27:35,340 --> 00:27:39,630
and to help people make
their best decisions

494
00:27:39,630 --> 00:27:42,840
with informed consent,
based on clinical outcomes,

495
00:27:42,840 --> 00:27:45,420
based on scientific fact.

496
00:27:45,420 --> 00:27:48,930
And we know that we need more
spaces to be able to talk

497
00:27:48,930 --> 00:27:51,663
and more time to be able
to talk to our providers.

498
00:27:52,530 --> 00:27:56,760
And so it's essential, I think,

499
00:27:56,760 --> 00:28:01,760
to be able to actually start
rethinking how we provide

500
00:28:01,800 --> 00:28:04,590
that care in an affirming model

501
00:28:04,590 --> 00:28:08,973
and integrate that into the
care that we provide every day.

502
00:28:13,642 --> 00:28:18,390
So, safe care, I would say is
really the ground level here,

503
00:28:18,390 --> 00:28:20,853
ensuring that the patient is safe.

504
00:28:21,780 --> 00:28:23,880
And what we're really trying to strive for

505
00:28:24,892 --> 00:28:29,250
is not just culturally competent
or culturally humble care

506
00:28:29,250 --> 00:28:31,420
or ensuring that we have informed consent

507
00:28:32,400 --> 00:28:35,343
or ensuring that everyone's educated,

508
00:28:36,330 --> 00:28:41,243
but actually creative,
authentic explorative spaces

509
00:28:42,630 --> 00:28:43,473
with patients.

510
00:28:44,760 --> 00:28:47,520
How many folks in this
room, by a show of hands,

511
00:28:47,520 --> 00:28:49,200
have felt like you've had a creative,

512
00:28:49,200 --> 00:28:52,623
authentic or explorative
healthcare experience?

513
00:28:57,330 --> 00:28:58,473
Couple. Yep.

514
00:28:59,670 --> 00:29:03,300
How many of you would
want to experience that

515
00:29:03,300 --> 00:29:05,350
at some point in your healthcare journey?

516
00:29:06,570 --> 00:29:08,700
Yeah, maybe not everyone.

517
00:29:08,700 --> 00:29:10,957
Maybe it sounds, "Ooh, this
might be a little too far

518
00:29:10,957 --> 00:29:12,592
"for me."

519
00:29:12,592 --> 00:29:16,480
But being able to provide a space

520
00:29:17,460 --> 00:29:19,870
where you can actually know your patient

521
00:29:21,060 --> 00:29:22,910
and your patient can be better known,

522
00:29:24,060 --> 00:29:25,650
that is what I'm talking about here.

523
00:29:25,650 --> 00:29:28,050
Doesn't mean that your
provider or your doctor

524
00:29:28,050 --> 00:29:30,453
needs to know everything about you, right?

525
00:29:31,500 --> 00:29:33,850
But being able to have the trust

526
00:29:34,950 --> 00:29:37,503
to be able to actually
have a real discussion.

527
00:29:40,860 --> 00:29:45,790
So before I get into some advocacy

528
00:29:46,920 --> 00:29:49,530
and strategies here really,

529
00:29:49,530 --> 00:29:51,030
I wanna provide a example

530
00:29:51,030 --> 00:29:55,650
of what we're doing at Transhealth
in Western Massachusetts

531
00:29:55,650 --> 00:29:57,960
as one example of what this can look like

532
00:29:57,960 --> 00:30:00,660
when specifically geared towards

533
00:30:00,660 --> 00:30:03,360
the trans and gender diverse community.

534
00:30:03,360 --> 00:30:04,410
It does not have to...

535
00:30:04,410 --> 00:30:06,840
I think this model can really be applied

536
00:30:06,840 --> 00:30:08,043
with any population.

537
00:30:08,880 --> 00:30:10,880
But this is one example of how we do it.

538
00:30:13,410 --> 00:30:16,290
So we started by trying to understand

539
00:30:16,290 --> 00:30:18,750
how many trans and gender diverse people

540
00:30:18,750 --> 00:30:20,850
there are in our immediate catchment area.

541
00:30:22,140 --> 00:30:25,290
How likely do people think
trans people are to report

542
00:30:25,290 --> 00:30:29,250
that they're trans to the
government, to the US census?

543
00:30:29,250 --> 00:30:31,950
Not very likely, right?

544
00:30:31,950 --> 00:30:36,633
Especially if you are also
perhaps in the closet too.

545
00:30:38,716 --> 00:30:41,670
But in essence, populations
are hard to count for a reason,

546
00:30:41,670 --> 00:30:43,320
hard to count because
people don't wanna share,

547
00:30:43,320 --> 00:30:44,373
may not feel safe.

548
00:30:45,360 --> 00:30:47,730
And hard to count because there
are maybe systems in place

549
00:30:47,730 --> 00:30:49,200
that don't count.

550
00:30:49,200 --> 00:30:52,710
And if you are not
counted, you won't count.

551
00:30:52,710 --> 00:30:55,890
We still don't know the full
impact of the Covid 19 pandemic

552
00:30:55,890 --> 00:30:58,290
on the LGBTQ community.

553
00:30:58,290 --> 00:31:02,250
Because at the time the CDC
was not gathering SOGI data,

554
00:31:02,250 --> 00:31:04,250
sexual orientation gender identity data.

555
00:31:05,370 --> 00:31:09,540
And so CDC then doesn't know
how to adequately respond

556
00:31:09,540 --> 00:31:13,113
to that population on a
public health response.

557
00:31:14,760 --> 00:31:16,980
And so the best data that we had

558
00:31:16,980 --> 00:31:20,220
was the behavioral risk
factor surveillance survey,

559
00:31:20,220 --> 00:31:23,400
and then also combine that
with the best census data

560
00:31:23,400 --> 00:31:24,720
that we have.

561
00:31:24,720 --> 00:31:27,420
And found out that there were
quite a bit of trans folks

562
00:31:27,420 --> 00:31:29,433
that likely lived in Massachusetts,

563
00:31:30,390 --> 00:31:32,760
Western Mass, which is where we started.

564
00:31:32,760 --> 00:31:35,140
We did start in 2020, we didn't know

565
00:31:36,450 --> 00:31:38,490
when we were first
starting to think about it,

566
00:31:38,490 --> 00:31:40,770
the world was really
gonna flip on it's head

567
00:31:40,770 --> 00:31:43,623
and where we all were in 2020 or so.

568
00:31:44,460 --> 00:31:49,460
But we saw Telehealth
really expand dramatically.

569
00:31:50,820 --> 00:31:55,820
And we also saw year after
year, more and more trans folks

570
00:31:57,960 --> 00:32:01,353
come to Massachusetts
specifically as a safe space.

571
00:32:04,892 --> 00:32:08,103
So that's when we started,
we started on May 4th,

572
00:32:08,940 --> 00:32:12,483
which is Star Wars Day for
all y'all nerds out there.

573
00:32:14,762 --> 00:32:19,762
And what we built was
something that was, I think,

574
00:32:19,830 --> 00:32:21,723
much more than any of us expected.

575
00:32:22,800 --> 00:32:26,430
So this is a table that one of our nurses

576
00:32:26,430 --> 00:32:29,700
built in the clinic and just
came in one day and decided,

577
00:32:29,700 --> 00:32:32,580
you know, I think the kids
need a chalk table here

578
00:32:32,580 --> 00:32:35,580
and just decided to do it
and spend his own money.

579
00:32:35,580 --> 00:32:37,173
We obviously reimbursed him,

580
00:32:38,820 --> 00:32:43,350
but he cared that much about
the clinical environment.

581
00:32:43,350 --> 00:32:46,230
People beginning to bring
in so many different flags.

582
00:32:46,230 --> 00:32:47,070
I mean so many flags,

583
00:32:47,070 --> 00:32:50,040
I don't even know what they are anymore.

584
00:32:50,040 --> 00:32:52,110
And if you want a really fun journey,

585
00:32:52,110 --> 00:32:55,230
go on Wikipedia and just
search all the LGBTQ flags.

586
00:32:55,230 --> 00:32:56,553
There are many.

587
00:32:58,643 --> 00:33:00,240
And it began to grow too.

588
00:33:00,240 --> 00:33:03,840
We wanted to make it feel
like a nonclinical space

589
00:33:03,840 --> 00:33:06,363
in some way, we didn't
want it to feel sterile.

590
00:33:07,350 --> 00:33:10,408
So we wanted to ensure that there was,

591
00:33:10,408 --> 00:33:12,750
you know, a space that had cool wallpaper,

592
00:33:12,750 --> 00:33:16,650
spaces that didn't feel
so hospital esque perhaps.

593
00:33:16,650 --> 00:33:20,190
And about 85% of our team identifies

594
00:33:20,190 --> 00:33:22,383
as trans or gender diverse.

595
00:33:23,220 --> 00:33:25,740
So you have a very different
clinical environment

596
00:33:25,740 --> 00:33:28,230
when you can see yourself represented

597
00:33:28,230 --> 00:33:30,540
in those that are caring for you.

598
00:33:30,540 --> 00:33:33,120
And the interventions
that come up like this

599
00:33:33,120 --> 00:33:34,620
misgender jar for example,

600
00:33:34,620 --> 00:33:36,930
and turning that into
a positive affirmation

601
00:33:36,930 --> 00:33:41,250
was just one example of
people just being creative

602
00:33:41,250 --> 00:33:45,213
and just wanting to devote
their own selves to this work.

603
00:33:47,310 --> 00:33:48,810
Different examples of...

604
00:33:48,810 --> 00:33:50,730
I really need to get some
more pictures in here now

605
00:33:50,730 --> 00:33:52,800
because these are old
pictures and there's again,

606
00:33:52,800 --> 00:33:53,763
many more flags.

607
00:33:54,990 --> 00:33:57,930
But then allowed us to
provide psychotherapy,

608
00:33:57,930 --> 00:34:02,490
primary care, psychiatry,
community services

609
00:34:02,490 --> 00:34:05,700
and eventually research
and advocacy and education.

610
00:34:05,700 --> 00:34:10,530
And over two years growing
to 50 staff members total.

611
00:34:10,530 --> 00:34:13,593
And about 2,500 trans or
gender diverse patients.

612
00:34:14,490 --> 00:34:17,610
And that's two years, that's
not a lot of time, right?

613
00:34:17,610 --> 00:34:21,423
There's a demonstrated need
in building this place.

614
00:34:23,520 --> 00:34:27,090
Core to it or essential to it
really is our community room.

615
00:34:27,090 --> 00:34:29,629
And our community room
is a place where there's

616
00:34:29,629 --> 00:34:31,980
a Nintendo Wii, you can
drop in, you can hang out,

617
00:34:31,980 --> 00:34:35,670
there's drama groups, yoga
groups, meditation groups.

618
00:34:35,670 --> 00:34:37,830
There were these kids that put on a play.

619
00:34:37,830 --> 00:34:40,440
And that was just, you know,

620
00:34:40,440 --> 00:34:42,240
I mean that was just a part
of the community programming

621
00:34:42,240 --> 00:34:43,500
that was offered.

622
00:34:43,500 --> 00:34:47,280
It was not just, you know,
your DBT skill group,

623
00:34:47,280 --> 00:34:49,560
though that's really, really important.

624
00:34:49,560 --> 00:34:51,810
But also being able to rethink,

625
00:34:51,810 --> 00:34:54,390
what else can a healthcare
facility offer to

626
00:34:54,390 --> 00:34:57,633
that really becomes a home for people.

627
00:34:59,190 --> 00:35:01,083
One of those is a closet too.

628
00:35:02,520 --> 00:35:06,150
And as many people literally
coming out of the closet

629
00:35:06,150 --> 00:35:09,960
able to get clothes and also
give some of their clothes

630
00:35:09,960 --> 00:35:12,363
away to other trans folks
that were in need too.

631
00:35:13,380 --> 00:35:16,710
You'll see in the back too,
a voter registration sign,

632
00:35:16,710 --> 00:35:18,210
we believe that civic engagement

633
00:35:18,210 --> 00:35:20,220
is a part of whole health too.

634
00:35:20,220 --> 00:35:21,750
That's a program called Vote-ER

635
00:35:21,750 --> 00:35:23,250
that started Mass General's Ed

636
00:35:24,180 --> 00:35:26,310
but really getting
people registered to vote

637
00:35:26,310 --> 00:35:30,390
and engaged and feeling
a part of a community

638
00:35:30,390 --> 00:35:32,943
that otherwise may have
they felt forgotten by.

639
00:35:34,380 --> 00:35:37,050
Anyone know Trixie Cosmetics?

640
00:35:37,050 --> 00:35:39,210
Yeah, some folks.

641
00:35:39,210 --> 00:35:43,260
So then, you know, DMing,
Trixie Cosmetics Instagram

642
00:35:43,260 --> 00:35:45,400
or something and then getting free

643
00:35:46,980 --> 00:35:48,630
cosmetics and different supplies

644
00:35:48,630 --> 00:35:50,880
that then eventually go
into our community closet

645
00:35:50,880 --> 00:35:54,150
and having other members
of different communities

646
00:35:54,150 --> 00:35:58,140
donating hygiene products, cosmetics,

647
00:35:58,140 --> 00:36:00,540
different prosthetics, whatever it is,

648
00:36:00,540 --> 00:36:03,753
to be able to have this
place be built by community.

649
00:36:05,070 --> 00:36:08,550
Having a tree, this tree
now stays up all year round.

650
00:36:08,550 --> 00:36:11,010
We did put it up and it's just there

651
00:36:11,010 --> 00:36:14,010
and it's different ornaments
at different times of the year.

652
00:36:15,390 --> 00:36:17,970
But really what I'm talking about

653
00:36:17,970 --> 00:36:20,790
is what this kid wrote here.

654
00:36:20,790 --> 00:36:24,093
This is what I mean when I talk
about gender affirming care,

655
00:36:26,280 --> 00:36:27,310
being nice

656
00:36:28,320 --> 00:36:29,530
and having fun stuff

657
00:36:31,290 --> 00:36:32,123
and rocking.

658
00:36:33,900 --> 00:36:36,603
And it's not really rocket science here.

659
00:36:37,800 --> 00:36:41,580
I mean if you practice
gender affirming care

660
00:36:41,580 --> 00:36:44,523
in primary care, it's
pretty basic primary care.

661
00:36:45,600 --> 00:36:49,500
If you're practicing it in
psychiatry and mental health,

662
00:36:49,500 --> 00:36:53,100
it doesn't take whole core curriculums.

663
00:36:53,100 --> 00:36:56,070
And at the end it starts with
or at the beginning rather

664
00:36:56,070 --> 00:36:57,320
it starts with compassion

665
00:36:58,620 --> 00:37:00,520
and starts with patient-centered care

666
00:37:01,530 --> 00:37:03,603
and treating people as human beings.

667
00:37:05,130 --> 00:37:09,120
This was written by an inmate

668
00:37:09,120 --> 00:37:12,780
at Gardner State Penitentiary
in Massachusetts.

669
00:37:12,780 --> 00:37:16,170
And he wrote to us and had said

670
00:37:16,170 --> 00:37:20,550
that during this time he
was not an LGBTQ person,

671
00:37:20,550 --> 00:37:22,650
but that learning about us on the news

672
00:37:22,650 --> 00:37:25,920
helped him better understand
his transgender daughter.

673
00:37:25,920 --> 00:37:28,817
And that during this time we had become

674
00:37:28,817 --> 00:37:30,753
a beautiful and caring light.

675
00:37:32,430 --> 00:37:37,430
And then went back to try to
help the LGBTQ affinity group

676
00:37:38,070 --> 00:37:40,170
in the prison to be able
to have more resources

677
00:37:40,170 --> 00:37:42,263
because he cared so
much about his daughter.

678
00:37:43,260 --> 00:37:47,130
So in these ways, healthcare
can become a source of hope

679
00:37:47,130 --> 00:37:48,840
and healing in so many other ways

680
00:37:48,840 --> 00:37:51,333
that are not just defined by insurance,

681
00:37:52,170 --> 00:37:56,910
that are not just defined by
a pharmacy benefit manager,

682
00:37:56,910 --> 00:38:00,153
not just defined by a relative value unit,

683
00:38:01,050 --> 00:38:04,660
but defined by what we
pour into healthcare

684
00:38:05,610 --> 00:38:07,360
and that relationship that we built

685
00:38:08,820 --> 00:38:10,470
and the community that we built.

686
00:38:10,470 --> 00:38:13,410
So you'll see here some
examples do include

687
00:38:13,410 --> 00:38:14,790
our Covid vaccine clinic

688
00:38:14,790 --> 00:38:18,180
that we partnered with the
Department of Public Health Fund.

689
00:38:18,180 --> 00:38:20,103
BIPOC Joy groups.

690
00:38:21,210 --> 00:38:23,340
Support groups, notice
that the support group

691
00:38:23,340 --> 00:38:26,130
for trans and gender diverse parents.

692
00:38:26,130 --> 00:38:29,037
So it's parents who are
trans or gender diverse.

693
00:38:29,037 --> 00:38:32,250
And so really providing some niche groups,

694
00:38:32,250 --> 00:38:34,230
some of them supportive,

695
00:38:34,230 --> 00:38:36,510
some of them a zine workshop.

696
00:38:36,510 --> 00:38:38,110
Who here has seen a zine before?

697
00:38:39,090 --> 00:38:41,943
Yeah, I found my first zine there. Yeah.

698
00:38:43,607 --> 00:38:48,607
And spaces that are creative,
but fitness classes too.

699
00:38:48,960 --> 00:38:52,713
Blackout poetry classes,
body work sessions,

700
00:38:53,760 --> 00:38:56,760
Fall Social Name & Change Clinic.

701
00:38:56,760 --> 00:38:58,290
Farm shares.

702
00:38:58,290 --> 00:39:00,550
Just really trying to expand

703
00:39:01,470 --> 00:39:04,983
what we mean when we talk about
community-based care, right?

704
00:39:06,180 --> 00:39:10,290
And imagining how we can provide that care

705
00:39:10,290 --> 00:39:15,290
outside of the one-to-one
patient to doctor relationship.

706
00:39:18,780 --> 00:39:20,230
So also right now

707
00:39:21,660 --> 00:39:23,373
in healthcare specifically,

708
00:39:24,240 --> 00:39:26,590
it's really hard to hire

709
00:39:27,600 --> 00:39:30,120
in the workforce in general.

710
00:39:30,120 --> 00:39:32,700
There's a lot of, especially with folks

711
00:39:32,700 --> 00:39:36,390
in support staff roles, many spaces,

712
00:39:36,390 --> 00:39:40,530
nursing too, it can be
difficult to hire folks.

713
00:39:40,530 --> 00:39:44,070
And one of the best
predictors of retention

714
00:39:44,070 --> 00:39:46,863
is whether somebody at
work cares about you.

715
00:39:48,180 --> 00:39:50,643
One person at work really cares about you.

716
00:39:51,930 --> 00:39:54,120
And when surveying our
team at Transhealth,

717
00:39:54,120 --> 00:39:57,990
we saw that a hundred percent agree

718
00:39:57,990 --> 00:39:59,890
that someone at work caress about you.

719
00:40:01,020 --> 00:40:05,703
This data is not often seen
in healthcare environments.

720
00:40:07,380 --> 00:40:09,450
And so this creation of a community,

721
00:40:09,450 --> 00:40:12,675
it's not only creating
community for the patient

722
00:40:12,675 --> 00:40:16,383
and for the community,
but for our team too.

723
00:40:17,430 --> 00:40:20,790
A space where everyone's
able to feel safe,

724
00:40:20,790 --> 00:40:23,103
known, affirmed, where
you can be yourself,

725
00:40:24,540 --> 00:40:26,240
where you can be yourself at work.

726
00:40:27,120 --> 00:40:28,740
And when surveying our team, again,

727
00:40:28,740 --> 00:40:30,960
we see a hundred percent of our team

728
00:40:30,960 --> 00:40:32,660
says they can be themself at work.

729
00:40:34,560 --> 00:40:36,810
That's probably not
the most important part

730
00:40:36,810 --> 00:40:40,953
of being a healthcare
provider, clinician, doctor.

731
00:40:41,820 --> 00:40:44,700
But it probably helps when
you can show up at work

732
00:40:44,700 --> 00:40:48,960
and be authentic and
not have to shove parts

733
00:40:48,960 --> 00:40:51,110
of yourself down to be
able to do your job.

734
00:40:53,910 --> 00:40:55,950
When we ask our patients

735
00:40:55,950 --> 00:40:59,490
and patient satisfaction can
be really hit or miss sometimes

736
00:40:59,490 --> 00:41:01,953
in trying to really
understand how patients feel.

737
00:41:03,030 --> 00:41:07,050
But when asking if Transhealth
affirms patient's identities,

738
00:41:07,050 --> 00:41:09,640
we see that about 93% agree

739
00:41:10,530 --> 00:41:12,753
with Transhealth affirming identity.

740
00:41:15,090 --> 00:41:18,393
Around 89% of patients saying
that they can be themselves.

741
00:41:19,320 --> 00:41:22,590
Now remember that 50 to 70% of trans folks

742
00:41:22,590 --> 00:41:23,823
report discrimination.

743
00:41:25,950 --> 00:41:28,350
So this is a very different statistic

744
00:41:28,350 --> 00:41:30,900
going from expecting discrimination

745
00:41:30,900 --> 00:41:33,780
from your healthcare provider

746
00:41:33,780 --> 00:41:36,003
to being able to be yourself.

747
00:41:40,860 --> 00:41:44,887
As one patient said, "I
like never being dead named

748
00:41:44,887 --> 00:41:47,587
"or having staff who aren't
familiar with me get confused

749
00:41:47,587 --> 00:41:49,147
"on how to address me.

750
00:41:49,147 --> 00:41:52,837
"It's especially nice to not
have to explain my existence

751
00:41:52,837 --> 00:41:56,077
"or wonder if the person
across from me is an ally.

752
00:41:56,077 --> 00:41:57,967
"There's a difference
in being in an office

753
00:41:57,967 --> 00:41:59,967
"that's working to make you feel welcome

754
00:42:04,079 --> 00:42:08,437
"and being in one where you
never even have to consider it.

755
00:42:08,437 --> 00:42:10,027
"There are some things that are intangible

756
00:42:10,027 --> 00:42:12,787
"and are beyond being
able to adequately explain

757
00:42:12,787 --> 00:42:14,947
"to those, not of that experience.

758
00:42:14,947 --> 00:42:16,987
"Other practices were okay mostly

759
00:42:16,987 --> 00:42:18,877
"they checked all the boxes.

760
00:42:18,877 --> 00:42:22,020
"But at Transhealth, I'm
not a box to be checked."

761
00:42:22,020 --> 00:42:24,220
I promise I didn't pay
anyone to write that.

762
00:42:25,440 --> 00:42:26,313
It was online.

763
00:42:29,820 --> 00:42:31,807
I promise I didn't pay
anyone for this either.

764
00:42:31,807 --> 00:42:33,517
"The care of Transhealth has been better

765
00:42:33,517 --> 00:42:34,867
"than my wildest dreams

766
00:42:34,867 --> 00:42:37,237
"and it's a big reason
why I stayed in the area

767
00:42:37,237 --> 00:42:38,917
"as long as I did.

768
00:42:38,917 --> 00:42:40,537
"I doubt I'll have a more
knowledgeable, kinder,

769
00:42:40,537 --> 00:42:42,213
"more responsive care team again.

770
00:42:43,147 --> 00:42:45,907
"Thank you so much for what
you've done, continue to do.

771
00:42:45,907 --> 00:42:47,617
"And I honestly feel bad
for all the cis people

772
00:42:47,617 --> 00:42:50,730
"who can't go to Transhealth
for their healthcare."

773
00:42:50,730 --> 00:42:53,850
I promise you everyone is
welcome at Transhealth.

774
00:42:53,850 --> 00:42:56,100
It just so happens that we have
a lot of trans people there.

775
00:42:56,100 --> 00:42:57,390
I wonder why.

776
00:42:57,390 --> 00:42:59,790
But we do not discriminate
and we'll see anyone.

777
00:43:01,170 --> 00:43:05,200
But imagine being a patient
and staying in a location

778
00:43:07,200 --> 00:43:09,510
because of your care provider.

779
00:43:09,510 --> 00:43:12,273
Even in an of area of Telehealth too.

780
00:43:13,530 --> 00:43:16,650
Or not being a box to be checked, right?

781
00:43:16,650 --> 00:43:18,120
Or having your patients feel like

782
00:43:18,120 --> 00:43:20,700
they don't have to be a box to be checked,

783
00:43:20,700 --> 00:43:23,133
whether your patients
wanna stay because of you.

784
00:43:26,670 --> 00:43:28,707
So we focus on clinical care

785
00:43:28,707 --> 00:43:30,720
and we also focus on
our other pillars too.

786
00:43:30,720 --> 00:43:33,723
Education, research and advocacy.

787
00:43:35,070 --> 00:43:39,123
And that's supported in our
foundation, is community.

788
00:43:40,530 --> 00:43:42,000
So at the end of the day,

789
00:43:42,000 --> 00:43:44,160
we are nothing without our community.

790
00:43:44,160 --> 00:43:47,220
And while all of these are
separate departments there,

791
00:43:47,220 --> 00:43:49,470
it really relies on understanding

792
00:43:49,470 --> 00:43:51,693
and listening to the community.

793
00:43:55,260 --> 00:43:56,640
These are just some examples

794
00:43:56,640 --> 00:43:58,653
of some of the headlines that came out.

795
00:44:00,990 --> 00:44:03,213
We did not advertise since day one.

796
00:44:04,440 --> 00:44:07,590
And people were like, "Well,
like are people gonna come?"

797
00:44:07,590 --> 00:44:11,130
And we, you know, waited by
the phone literally on day one

798
00:44:11,130 --> 00:44:13,263
and within a week we were flooded.

799
00:44:14,370 --> 00:44:16,270
This was the impact in the first year.

800
00:44:17,850 --> 00:44:20,500
A heat map showing different
concentrations of folks.

801
00:44:23,130 --> 00:44:26,193
And this was the impact after year two.

802
00:44:29,580 --> 00:44:33,450
Now, just to clarify,
there's a difference between

803
00:44:33,450 --> 00:44:37,890
gender dysphoria and
leading with a diagnosis

804
00:44:37,890 --> 00:44:41,190
versus gender diversity in
someone's identity, right?

805
00:44:41,190 --> 00:44:43,530
Outside of a diagnosis.

806
00:44:43,530 --> 00:44:48,090
So many of these people
identify as gender diverse.

807
00:44:48,090 --> 00:44:52,110
It doesn't mean that this is
based on any diagnosis at all.

808
00:44:52,110 --> 00:44:55,443
It's people who felt safe and
comfortable and cared for.

809
00:44:58,410 --> 00:45:00,000
So I wanna talk a little...

810
00:45:00,000 --> 00:45:02,877
I think it's nice to
hear about Transhealth

811
00:45:02,877 --> 00:45:05,580
and that's like really cool
Dallas, but like what do I do?

812
00:45:05,580 --> 00:45:10,580
And so I want to focus a little
bit more on what you can do.

813
00:45:10,950 --> 00:45:12,720
And this is gonna be a little outside

814
00:45:12,720 --> 00:45:15,240
of maybe the traditional
medical school lecture

815
00:45:15,240 --> 00:45:17,550
that's focused on here's
how you care for a patient.

816
00:45:17,550 --> 00:45:20,070
I think that everyone's
probably gonna learn

817
00:45:20,070 --> 00:45:22,530
how to care for trans patients.

818
00:45:22,530 --> 00:45:24,990
I think it's much more about the impact

819
00:45:24,990 --> 00:45:26,430
that we want to have,

820
00:45:26,430 --> 00:45:29,193
and especially in this moment right now,

821
00:45:30,120 --> 00:45:32,970
as brilliant, brilliant humans.

822
00:45:32,970 --> 00:45:37,970
How do we stand up for
evidence-based scientific healthcare?

823
00:45:42,690 --> 00:45:44,700
So some just general misconceptions,

824
00:45:44,700 --> 00:45:46,980
I just wanna point out too.

825
00:45:46,980 --> 00:45:48,960
I think everyone probably
understands these,

826
00:45:48,960 --> 00:45:53,960
but puberty is irreversible, right?

827
00:45:54,810 --> 00:45:58,293
And the choice to do nothing
is really a permanent one.

828
00:46:01,910 --> 00:46:05,640
So when blockers, GnRH agonists

829
00:46:08,070 --> 00:46:13,070
are provided to a kid, for example,

830
00:46:13,590 --> 00:46:17,700
that is at the age of
puberty specifically.

831
00:46:17,700 --> 00:46:21,480
And blockers are used very
often in precocious puberty,

832
00:46:21,480 --> 00:46:23,193
in cisgender populations.

833
00:46:24,540 --> 00:46:27,420
This is with lots of discussion,

834
00:46:27,420 --> 00:46:31,620
lots of discussion with
both guardians or parents

835
00:46:31,620 --> 00:46:35,040
or whomever has legal
custody of the children

836
00:46:35,040 --> 00:46:40,040
and a pediatrician and a
mental health provider.

837
00:46:41,190 --> 00:46:43,740
And that there's lots of
discussion that's involved.

838
00:46:43,740 --> 00:46:46,040
It's not something that's
happening overnight.

839
00:46:48,702 --> 00:46:51,810
And the decision to not do anything,

840
00:46:51,810 --> 00:46:54,240
to not pause for a
moment and have more time

841
00:46:54,240 --> 00:46:56,100
to be able to make an informed decision

842
00:46:56,100 --> 00:46:58,660
with the whole family
present and the entire team

843
00:47:01,623 --> 00:47:03,123
is more of a permanent one.

844
00:47:04,260 --> 00:47:06,270
It's also not a conveyor belt too.

845
00:47:06,270 --> 00:47:08,970
So we're just not feeding
people into a system.

846
00:47:08,970 --> 00:47:12,690
This is an assessment with a large team,

847
00:47:12,690 --> 00:47:14,520
including multiple
mental health providers,

848
00:47:14,520 --> 00:47:17,460
pediatric care and parents at every stage.

849
00:47:17,460 --> 00:47:19,710
And so assessment and treatment planning

850
00:47:19,710 --> 00:47:22,110
is really according to
expert standards of care.

851
00:47:23,360 --> 00:47:26,700
And we also know that no two
transitions are exactly alike.

852
00:47:26,700 --> 00:47:31,680
Transition is very individualized,
aged appropriate process

853
00:47:31,680 --> 00:47:36,300
that is a long-term partnership
between the provider,

854
00:47:36,300 --> 00:47:39,393
patients, patient's parents or guardians.

855
00:47:40,830 --> 00:47:43,860
And one commonality that we see

856
00:47:43,860 --> 00:47:47,100
is that the rate of
regret is incredibly low,

857
00:47:47,100 --> 00:47:50,223
lower than regret with knee replacements.

858
00:47:52,680 --> 00:47:55,080
We see more gender affirming surgeries

859
00:47:55,080 --> 00:47:57,510
happening in cisgender populations

860
00:47:57,510 --> 00:48:00,330
than transgender populations, for example.

861
00:48:00,330 --> 00:48:02,790
So a lot of the disinformation out there,

862
00:48:02,790 --> 00:48:06,903
it starts with being able to
really dispel misconceptions.

863
00:48:08,460 --> 00:48:12,040
Another piece of disinformation
that is out there too

864
00:48:14,103 --> 00:48:18,510
is around the amount of transgender people

865
00:48:18,510 --> 00:48:19,410
in the United States.

866
00:48:19,410 --> 00:48:23,700
And this belief that transgender
people or LGBTQ people

867
00:48:23,700 --> 00:48:28,700
are increasing over time
because of exposure to media,

868
00:48:29,130 --> 00:48:32,130
social media or exposure

869
00:48:32,130 --> 00:48:37,130
to other LGBTQ people
who are grooming folks.

870
00:48:41,484 --> 00:48:43,410
And there's no evidence
for it, first of all.

871
00:48:43,410 --> 00:48:46,470
But what we do know instead is that,

872
00:48:46,470 --> 00:48:47,980
if we look at left-handedness

873
00:48:49,170 --> 00:48:53,880
and starting at around
when we get to the forties

874
00:48:53,880 --> 00:48:56,910
and fifties or so, when we
start to see left-handedness

875
00:48:56,910 --> 00:49:00,270
not be pathologized and
people who are left-handed

876
00:49:00,270 --> 00:49:02,790
not be victimized and they're
being more social acceptance

877
00:49:02,790 --> 00:49:06,390
for left-handedness, we see more people

878
00:49:06,390 --> 00:49:08,610
that are able to be left-handed.

879
00:49:08,610 --> 00:49:12,270
When you have more social
acceptance of a population,

880
00:49:12,270 --> 00:49:17,100
you see more people able to
express their own identity.

881
00:49:17,100 --> 00:49:18,090
And so it makes sense.

882
00:49:18,090 --> 00:49:20,370
You know, we were talking
to some medical students

883
00:49:20,370 --> 00:49:22,890
earlier today and we
were talking about how

884
00:49:22,890 --> 00:49:27,360
it was 1972 that the DSM

885
00:49:27,360 --> 00:49:30,960
had homosexuality as a diagnosis.

886
00:49:30,960 --> 00:49:33,750
And we forget how much
progress has been made

887
00:49:33,750 --> 00:49:35,073
since the seventies.

888
00:49:36,090 --> 00:49:39,600
And so while it may not
always feel like an affirming,

889
00:49:39,600 --> 00:49:43,560
a more caring culture
right now in this moment,

890
00:49:43,560 --> 00:49:45,510
it's only natural that we'd see over time,

891
00:49:45,510 --> 00:49:50,130
more and more kids that feel safe enough

892
00:49:50,130 --> 00:49:52,600
to be able to talk about who they are

893
00:49:53,882 --> 00:49:56,643
and to be able to come
out to parents or others.

894
00:49:58,890 --> 00:50:00,720
And what we know is that in general,

895
00:50:00,720 --> 00:50:04,500
I know there was a ton of
doom and gloom earlier, right?

896
00:50:04,500 --> 00:50:07,290
But what's really important to remember

897
00:50:07,290 --> 00:50:09,870
is that eight in 10 Americans,

898
00:50:09,870 --> 00:50:12,180
this lecture is largely gonna
focus on the United States.

899
00:50:12,180 --> 00:50:14,310
'cause that's where I'm
pulling my data from right now.

900
00:50:14,310 --> 00:50:17,073
But eight in 10 Americans
support non-discrimination.

901
00:50:18,180 --> 00:50:20,850
That's a large number of
people in this country

902
00:50:20,850 --> 00:50:22,450
compared to where we used to be.

903
00:50:23,490 --> 00:50:26,670
We see that Republican
politicians from Florida to Idaho

904
00:50:26,670 --> 00:50:28,710
are attempting to turn trans rights

905
00:50:28,710 --> 00:50:30,240
into a divisive national issue.

906
00:50:30,240 --> 00:50:32,910
But in my experience as a trans woman

907
00:50:32,910 --> 00:50:35,040
who's lived across the country,

908
00:50:35,040 --> 00:50:37,680
these positions seem really out touch.

909
00:50:37,680 --> 00:50:40,680
The conversations I've had
with conservative neighbors

910
00:50:40,680 --> 00:50:45,060
in Arizona or centrist friends in Virginia

911
00:50:45,060 --> 00:50:49,200
are different to the ones
that I now have living,

912
00:50:49,200 --> 00:50:51,400
say in liberal
Massachusetts, North Hampton.

913
00:50:52,913 --> 00:50:54,810
They're not different, rather.

914
00:50:54,810 --> 00:50:57,900
And the vast majority of
Americans believe in general,

915
00:50:57,900 --> 00:51:01,230
in values and liberty and don't
believe it's their business

916
00:51:01,230 --> 00:51:03,663
to be regulating the
identity of other people.

917
00:51:04,500 --> 00:51:07,770
And so these attacks on
trans kids and trans people

918
00:51:07,770 --> 00:51:10,410
might create headlines,

919
00:51:10,410 --> 00:51:13,140
but what we really see in general

920
00:51:13,140 --> 00:51:14,670
is that voters' priorities,

921
00:51:14,670 --> 00:51:15,990
and we're coming up on another election

922
00:51:15,990 --> 00:51:17,340
whether we like it or not,

923
00:51:17,340 --> 00:51:21,573
voters' priorities are the
economy and healthcare.

924
00:51:22,859 --> 00:51:24,870
And we see that time and time again.

925
00:51:24,870 --> 00:51:26,730
And when you look at priorities,

926
00:51:26,730 --> 00:51:30,930
even in Republican or Democrat
or independent polling,

927
00:51:30,930 --> 00:51:35,523
trans people, trans kids do
not make the top 20 of that.

928
00:51:36,870 --> 00:51:39,243
It's just a non kitchen table issue.

929
00:51:41,803 --> 00:51:45,840
So when you narrow that
question down to attitudes,

930
00:51:45,840 --> 00:51:47,580
you do find that eight in 10 Americans

931
00:51:47,580 --> 00:51:49,410
support non-discrimination protections

932
00:51:49,410 --> 00:51:51,270
for LGBTQ individuals,

933
00:51:51,270 --> 00:51:55,260
including 65% of members
of the Republican party.

934
00:51:55,260 --> 00:51:57,780
2021 poll found that
two thirds of Americans

935
00:51:57,780 --> 00:52:00,840
opposed bills limiting transgender rights.

936
00:52:00,840 --> 00:52:03,060
And this follows big picture trends

937
00:52:03,060 --> 00:52:04,920
like decades long evolution

938
00:52:04,920 --> 00:52:09,180
that led to the legalization
of same-sex marriage in 2014.

939
00:52:09,180 --> 00:52:11,250
Where the trend among the
next generation of voters,

940
00:52:11,250 --> 00:52:14,700
where 5% of youth now
identify as gender diverse,

941
00:52:14,700 --> 00:52:19,173
three times the rate than
the greater population.

942
00:52:21,090 --> 00:52:25,140
We see that this is a
manufactured marginal issue.

943
00:52:25,140 --> 00:52:27,420
And we've seen dozens
of states passing laws

944
00:52:27,420 --> 00:52:30,690
restricting kids from
participating in sports,

945
00:52:30,690 --> 00:52:32,670
limiting access to care,

946
00:52:32,670 --> 00:52:35,460
mentioning LGBTQ history in schools.

947
00:52:35,460 --> 00:52:37,740
But we've seen the four recent elections

948
00:52:37,740 --> 00:52:40,860
in American history
rejecting that extremism

949
00:52:40,860 --> 00:52:42,183
at the ballot box.

950
00:52:43,020 --> 00:52:46,830
And we saw that in 2008 midterms

951
00:52:46,830 --> 00:52:48,870
when these issues were elevated,

952
00:52:48,870 --> 00:52:50,020
those who elevated them

953
00:52:51,382 --> 00:52:53,193
did not necessarily succeed.

954
00:52:54,300 --> 00:52:56,890
And we've seen the 2022 midterms

955
00:52:58,830 --> 00:53:01,500
where people who were denying elections

956
00:53:01,500 --> 00:53:06,500
and anti-abortion extremism
also got crushed too.

957
00:53:08,010 --> 00:53:11,400
So extreme policies are really good

958
00:53:11,400 --> 00:53:13,620
for winning primaries,

959
00:53:13,620 --> 00:53:16,890
but they're really great for
losing the general election.

960
00:53:16,890 --> 00:53:20,940
And each time, the conventional
wisdom in the media,

961
00:53:20,940 --> 00:53:22,290
even on the left,

962
00:53:22,290 --> 00:53:24,870
was that you might be
steamrolled by bullies.

963
00:53:24,870 --> 00:53:27,573
We see four clear wins later
that that's not the case.

964
00:53:28,980 --> 00:53:31,180
And so I think we're seeing

965
00:53:32,160 --> 00:53:35,610
a continued trend in general support

966
00:53:35,610 --> 00:53:38,890
for people to be able to
identify how they identify

967
00:53:39,780 --> 00:53:42,903
without intervention by the government.

968
00:53:43,920 --> 00:53:47,130
So at the core of our democratic values

969
00:53:47,130 --> 00:53:48,843
relies the promise of liberty,

970
00:53:49,770 --> 00:53:53,160
freedom and the pursuit of happiness.

971
00:53:53,160 --> 00:53:55,710
And I believe that this
pledge really should extend

972
00:53:55,710 --> 00:53:59,985
to all citizens and non-citizens too,

973
00:53:59,985 --> 00:54:03,330
including transgender individuals.

974
00:54:03,330 --> 00:54:07,200
And the ability for trans
individuals to be able to direct

975
00:54:07,200 --> 00:54:09,840
their own care, it's
not just a health issue,

976
00:54:09,840 --> 00:54:13,350
but a testament to foundational rights.

977
00:54:13,350 --> 00:54:16,200
It speaks to the essence
of parental rights

978
00:54:16,200 --> 00:54:17,700
when you're talking about youth

979
00:54:17,700 --> 00:54:20,250
and also the sanctity of the family unit

980
00:54:20,250 --> 00:54:23,403
and should be free from
government intervention.

981
00:54:24,720 --> 00:54:28,830
We pride ourselves on these values.

982
00:54:28,830 --> 00:54:33,000
And so when discussing affirming care,

983
00:54:33,000 --> 00:54:35,790
I mean, what we know
from the Covid pandemic

984
00:54:35,790 --> 00:54:38,310
and talking about vaccinations in general

985
00:54:38,310 --> 00:54:40,260
and trying to get people vaccinated

986
00:54:40,260 --> 00:54:43,023
is it's not science that's
gonna convince people.

987
00:54:44,190 --> 00:54:46,350
You can talk about the science
of a vaccine all you want,

988
00:54:46,350 --> 00:54:48,783
but it's illustrating shared values.

989
00:54:49,680 --> 00:54:53,580
It's talking about the
care that you might have

990
00:54:53,580 --> 00:54:56,460
for maybe an elderly
relative, for example,

991
00:54:56,460 --> 00:54:58,510
and why it's important to get vaccinated.

992
00:55:00,214 --> 00:55:04,997
And same here, really
identifying the shared values,

993
00:55:05,850 --> 00:55:07,770
identifying the audience
that you're talking to

994
00:55:07,770 --> 00:55:11,130
and saying what are those shared values

995
00:55:11,130 --> 00:55:12,060
that we hold together?

996
00:55:12,060 --> 00:55:14,553
And how do we have a
conversation together?

997
00:55:16,470 --> 00:55:19,680
How do we emphasize our shared experience?

998
00:55:19,680 --> 00:55:23,130
How do we illustrate the
concrete scientific harms

999
00:55:23,130 --> 00:55:26,500
that lead to increased suicide attempts

1000
00:55:27,990 --> 00:55:30,660
amongst trans kids, if we
continue to see trans kids

1001
00:55:30,660 --> 00:55:31,593
being vilified.

1002
00:55:32,520 --> 00:55:34,780
And instead cut through the disinformation

1003
00:55:36,420 --> 00:55:39,300
and talk about the truth of
what's actually happening,

1004
00:55:39,300 --> 00:55:41,943
while not reinforcing
those negative beliefs.

1005
00:55:44,490 --> 00:55:49,490
Everyone in this room
is extremely privileged

1006
00:55:49,539 --> 00:55:53,883
to be able to be a doctor.

1007
00:55:54,780 --> 00:55:56,460
You'll be a doctor,

1008
00:55:56,460 --> 00:55:58,840
you'll have a moral authority

1009
00:56:00,030 --> 00:56:02,073
and you'll have a duty to do no harm.

1010
00:56:05,218 --> 00:56:08,620
And so your voice is
incredibly powerful in this

1011
00:56:09,630 --> 00:56:11,640
from a fact-based perspective,

1012
00:56:11,640 --> 00:56:15,180
but also by talking about shared values

1013
00:56:15,180 --> 00:56:17,950
and how to prevent additional
harm against trans kids

1014
00:56:18,900 --> 00:56:20,283
or trans people in general.

1015
00:56:21,420 --> 00:56:24,640
Every major healthcare organization

1016
00:56:25,770 --> 00:56:29,433
says it's the duty of that
profession to advocate.

1017
00:56:30,900 --> 00:56:34,350
And so, your healthcare organization,

1018
00:56:34,350 --> 00:56:38,130
the AMA, is saying
advocate for that patient,

1019
00:56:38,130 --> 00:56:40,140
not just right there at the bedside,

1020
00:56:40,140 --> 00:56:42,753
but at the State House
and on Capitol Hill.

1021
00:56:43,920 --> 00:56:48,040
And this is why I'm talking
to you today about advocacy

1022
00:56:49,170 --> 00:56:51,333
because your voice is critical here.

1023
00:56:54,330 --> 00:56:59,330
What we can also do is begin
to, on a clinical level,

1024
00:57:01,410 --> 00:57:04,440
adopt universal precautions.

1025
00:57:04,440 --> 00:57:07,980
So just as you might clean your hands

1026
00:57:07,980 --> 00:57:10,530
before entering into a patient's room,

1027
00:57:10,530 --> 00:57:12,450
just as you might have
a standard assessment

1028
00:57:12,450 --> 00:57:15,420
when you're walking in
to greet the patient,

1029
00:57:15,420 --> 00:57:18,393
being able to incorporate in
your universal precautions,

1030
00:57:19,320 --> 00:57:20,553
introducing yourself,

1031
00:57:22,590 --> 00:57:24,303
introducing your own pronouns,

1032
00:57:25,260 --> 00:57:29,100
and then asking the patient for their name

1033
00:57:29,100 --> 00:57:30,000
and their pronouns.

1034
00:57:30,000 --> 00:57:31,800
Not their preferred name

1035
00:57:31,800 --> 00:57:33,660
because our names are our names, right?

1036
00:57:33,660 --> 00:57:35,070
It's just our names.

1037
00:57:35,070 --> 00:57:37,370
Not preferred pronouns,
but just our pronouns.

1038
00:57:38,670 --> 00:57:41,410
And I was telling some
medical students earlier today

1039
00:57:43,603 --> 00:57:47,010
that when I was a nurse on a psych floor,

1040
00:57:47,010 --> 00:57:50,200
the sheer act of me asking
a patient's pronouns

1041
00:57:51,390 --> 00:57:53,580
led the patient to disclose
that they were trans

1042
00:57:53,580 --> 00:57:58,580
after 40 years of repressing
their trans identity

1043
00:57:59,700 --> 00:58:04,540
because they lost access to
hormones early on in their life

1044
00:58:05,550 --> 00:58:09,060
and then were kicked out of their home,

1045
00:58:09,060 --> 00:58:11,190
had no access to economic resources,

1046
00:58:11,190 --> 00:58:14,670
had to live on the street
and had to detransition

1047
00:58:14,670 --> 00:58:17,580
forcibly really on the streets to survive

1048
00:58:17,580 --> 00:58:19,950
as a male instead of a female,

1049
00:58:19,950 --> 00:58:22,500
so that they were not
assaulted on the streets.

1050
00:58:22,500 --> 00:58:24,660
And it wasn't until I asked that patient

1051
00:58:24,660 --> 00:58:26,970
who everyone presumed was male,

1052
00:58:26,970 --> 00:58:28,690
what her pronouns were

1053
00:58:30,570 --> 00:58:33,850
that she was able to disclose

1054
00:58:35,250 --> 00:58:37,613
for the first time and
felt safe enough doing it.

1055
00:58:39,780 --> 00:58:42,390
That then kicked off a lot of scans

1056
00:58:42,390 --> 00:58:44,400
that found that she had terminal cancer

1057
00:58:44,400 --> 00:58:46,233
about six months left to live,

1058
00:58:47,880 --> 00:58:51,450
and she was gonna be
released from the psych unit,

1059
00:58:51,450 --> 00:58:54,390
in patient psych to the street

1060
00:58:54,390 --> 00:58:58,563
until we identified that she
had about six months left.

1061
00:58:59,400 --> 00:59:02,610
We advocated for her to get
access to hormone therapy,

1062
00:59:02,610 --> 00:59:06,120
estrogen, but due to the
clotting, it was unclear.

1063
00:59:06,120 --> 00:59:07,620
And so an ethics consult was called.

1064
00:59:07,620 --> 00:59:09,390
And finally she was able to get access

1065
00:59:09,390 --> 00:59:11,370
to the estrogen therapy

1066
00:59:11,370 --> 00:59:14,010
while she also moved to hospice care.

1067
00:59:14,010 --> 00:59:15,940
And she was able to die

1068
00:59:17,220 --> 00:59:18,820
the woman that she knew she was.

1069
00:59:20,370 --> 00:59:24,810
And she didn't deserve me
asking for her pronouns

1070
00:59:24,810 --> 00:59:26,010
for that to be the time.

1071
00:59:30,300 --> 00:59:33,480
She deserved to be able
to be known as herself

1072
00:59:33,480 --> 00:59:34,743
40 years before.

1073
00:59:36,720 --> 00:59:39,120
So asking for pronouns is
incredible intervention.

1074
00:59:39,120 --> 00:59:41,940
Yes. And it should be just a
part of the basic assessment,

1075
00:59:41,940 --> 00:59:43,980
but that should not be the ceiling,

1076
00:59:43,980 --> 00:59:47,223
that is the bare minimum
that we can do as healers.

1077
00:59:50,520 --> 00:59:54,183
It's not just about how we
engage with our patients,

1078
00:59:55,066 --> 00:59:58,410
but how we engage with others
that we may disagree with

1079
00:59:58,410 --> 01:00:00,450
and how we have conversations with those

1080
01:00:00,450 --> 01:00:02,100
we may disagree with.

1081
01:00:02,100 --> 01:00:04,950
And engage in value-based
discussions that might be hard.

1082
01:00:06,420 --> 01:00:09,990
How we work to change
institutional policy,

1083
01:00:09,990 --> 01:00:11,940
to recognize our own power

1084
01:00:11,940 --> 01:00:15,540
and to show up authentically at work

1085
01:00:15,540 --> 01:00:18,190
to be able to have a place
where you can be yourself.

1086
01:00:19,350 --> 01:00:21,000
And that requires the whole team,

1087
01:00:22,440 --> 01:00:24,590
that requires the
institution's commitment.

1088
01:00:26,700 --> 01:00:28,680
What we can also do,

1089
01:00:28,680 --> 01:00:32,040
we're concerned about
larger policy issues,

1090
01:00:32,040 --> 01:00:35,970
is work with state equality
organizations in other states.

1091
01:00:35,970 --> 01:00:38,340
We, again, carry so much power.

1092
01:00:38,340 --> 01:00:41,283
So writing op-eds, writing editorials,

1093
01:00:42,150 --> 01:00:45,330
working in the legislative process,

1094
01:00:45,330 --> 01:00:47,640
information sharing, we at Transhealth

1095
01:00:47,640 --> 01:00:50,460
created a pediatric
affirming care coalition

1096
01:00:50,460 --> 01:00:53,340
that now has 500 pediatric providers

1097
01:00:53,340 --> 01:00:55,500
across the country in every state.

1098
01:00:55,500 --> 01:00:57,420
That information share about what do we do

1099
01:00:57,420 --> 01:00:58,670
in this moment right now.

1100
01:00:59,970 --> 01:01:04,140
It's so valuable to be able
to even just engage there.

1101
01:01:04,140 --> 01:01:06,393
An engagement with the AMA.

1102
01:01:09,614 --> 01:01:11,200
So I do believe

1103
01:01:12,180 --> 01:01:15,530
at Transhealth, this is just
one model of what we can do

1104
01:01:15,530 --> 01:01:17,523
in healthcare altogether.

1105
01:01:18,690 --> 01:01:22,980
But we can shift healthcare
from a treatment centric model

1106
01:01:22,980 --> 01:01:25,500
to one focused on prevention,

1107
01:01:25,500 --> 01:01:27,270
one focused on affirmation,

1108
01:01:27,270 --> 01:01:28,653
one focused on community.

1109
01:01:30,870 --> 01:01:34,140
We can directly counter
what the nation's top doctor

1110
01:01:34,140 --> 01:01:37,470
just declared an epidemic,
the loneliness epidemic.

1111
01:01:37,470 --> 01:01:39,640
And that starts with building community

1112
01:01:40,770 --> 01:01:44,703
and preventing deaths
of despair and suicide.

1113
01:01:48,971 --> 01:01:51,360
We know that places like Transhealth

1114
01:01:51,360 --> 01:01:53,470
have shown very high patient engagement

1115
01:01:54,510 --> 01:01:57,180
and I bet have saved a ton of lives

1116
01:01:57,180 --> 01:01:59,220
that otherwise might be lost to suicide.

1117
01:01:59,220 --> 01:02:02,823
And we can do that for any
of our patient populations.

1118
01:02:04,500 --> 01:02:06,840
One way we've done that
is we've extended the time

1119
01:02:06,840 --> 01:02:07,860
we spend with our patients.

1120
01:02:07,860 --> 01:02:10,500
We have hour long initial
visits or 30 minute visits,

1121
01:02:10,500 --> 01:02:14,100
which can be somewhat unheard
of in primary care these days.

1122
01:02:14,100 --> 01:02:15,730
But we want to create a space

1123
01:02:15,730 --> 01:02:17,613
where that patient feels known,

1124
01:02:18,480 --> 01:02:19,617
where that patient patient feels seen,

1125
01:02:19,617 --> 01:02:21,033
and that takes time.

1126
01:02:22,320 --> 01:02:26,280
We also really have tried to
prioritize real world concerns

1127
01:02:26,280 --> 01:02:29,200
over whatever insurance
says is what we should be

1128
01:02:30,480 --> 01:02:32,100
really the priority of our assessment.

1129
01:02:32,100 --> 01:02:34,290
So now we're gonna listen
to what the patients say

1130
01:02:34,290 --> 01:02:35,123
that they need.

1131
01:02:35,123 --> 01:02:36,750
And that's been community surveys,

1132
01:02:36,750 --> 01:02:38,730
that's been then responding
with community classes

1133
01:02:38,730 --> 01:02:41,160
as you saw there, community closet,

1134
01:02:41,160 --> 01:02:43,680
many other things that
are outside of the scope

1135
01:02:43,680 --> 01:02:44,853
of the initial visit.

1136
01:02:46,200 --> 01:02:49,230
We also have tried to really
focus on staff wellbeing,

1137
01:02:49,230 --> 01:02:51,120
addressing systemic staff burnout,

1138
01:02:51,120 --> 01:02:53,400
dissatisfaction by trying to
create a more compassionate,

1139
01:02:53,400 --> 01:02:55,500
affirming work environment.

1140
01:02:55,500 --> 01:02:58,410
We know that the physician suicide rate

1141
01:02:58,410 --> 01:03:00,840
exceeds that of active military members

1142
01:03:00,840 --> 01:03:02,253
returning from Afghanistan.

1143
01:03:04,440 --> 01:03:05,433
That's terrible.

1144
01:03:07,110 --> 01:03:10,530
And so by creating a more affirming place

1145
01:03:10,530 --> 01:03:12,627
where your colleagues care about you

1146
01:03:12,627 --> 01:03:16,380
and you can be known as
someone who's a part of a team,

1147
01:03:16,380 --> 01:03:17,760
that's what we're trying to strive for.

1148
01:03:17,760 --> 01:03:20,160
So that this is wellness for everyone here

1149
01:03:20,160 --> 01:03:22,920
and not a system that
just burns people out

1150
01:03:22,920 --> 01:03:24,070
and churns 'em through.

1151
01:03:25,040 --> 01:03:27,180
And then in focusing on
community engagement,

1152
01:03:27,180 --> 01:03:28,920
patients becoming active
community members,

1153
01:03:28,920 --> 01:03:32,490
fostering social connections
that mitigate loneliness.

1154
01:03:32,490 --> 01:03:33,690
And that's all been possible.

1155
01:03:33,690 --> 01:03:35,160
You're like, "Dallas,
how is this possible?"

1156
01:03:35,160 --> 01:03:36,791
Well, through revenue diversification

1157
01:03:36,791 --> 01:03:39,960
and not just relying on primary care RVU's

1158
01:03:39,960 --> 01:03:41,130
to provide all this money,

1159
01:03:41,130 --> 01:03:44,520
but thinking about creative
financial ways to augment

1160
01:03:44,520 --> 01:03:47,400
the time that then
patients are able to spend

1161
01:03:47,400 --> 01:03:48,450
with their providers.

1162
01:03:50,460 --> 01:03:52,950
I believe, I'm sure y'all have heard

1163
01:03:52,950 --> 01:03:54,450
about value-based healthcare

1164
01:03:54,450 --> 01:03:55,950
and have talked about
value-based healthcare.

1165
01:03:55,950 --> 01:03:59,130
I believe that this is
value-based healthcare.

1166
01:03:59,130 --> 01:04:02,880
I believe that when we
focus our shift towards

1167
01:04:02,880 --> 01:04:05,643
intervening at the right
time at the right place,

1168
01:04:06,750 --> 01:04:09,300
we're able to actually
care for that patient

1169
01:04:09,300 --> 01:04:10,200
when they need it.

1170
01:04:11,340 --> 01:04:14,463
We don't commit to overuse
of care or underuse of care.

1171
01:04:15,390 --> 01:04:18,060
And so it's not the patient
who's been discriminated against

1172
01:04:18,060 --> 01:04:21,330
that waits and waits and
their problem gets worse

1173
01:04:21,330 --> 01:04:23,430
and they don't go to urgent care.

1174
01:04:23,430 --> 01:04:25,170
And then they finally
show up at emergency care

1175
01:04:25,170 --> 01:04:28,710
when the problem could have
been handled in primary care.

1176
01:04:28,710 --> 01:04:30,840
But instead that that patient trusts

1177
01:04:30,840 --> 01:04:33,280
their primary care physician

1178
01:04:34,380 --> 01:04:36,540
and that that patient
can show up right there.

1179
01:04:36,540 --> 01:04:39,273
And that costs the
system a lot less money.

1180
01:04:40,470 --> 01:04:45,300
And it also costs the body a lot less too,

1181
01:04:45,300 --> 01:04:47,000
and likely prevents against death.

1182
01:04:48,390 --> 01:04:49,830
And that starts with trust,

1183
01:04:49,830 --> 01:04:52,130
rebuilding trust in our
healthcare environment

1184
01:04:53,690 --> 01:04:56,520
and the relationships we
have with our patients.

1185
01:04:56,520 --> 01:04:58,380
And I believe really wholeheartedly

1186
01:04:58,380 --> 01:05:02,060
that we need a way to tackle
the loneliness epidemic

1187
01:05:02,060 --> 01:05:03,033
in this country.

1188
01:05:04,860 --> 01:05:07,590
And we need a way to be
able to foster community.

1189
01:05:07,590 --> 01:05:10,658
And we need a way to
be able to help us all

1190
01:05:10,658 --> 01:05:13,173
have a space where we can
come back to each other.

1191
01:05:14,580 --> 01:05:17,400
And I don't know of any other vehicle

1192
01:05:17,400 --> 01:05:19,350
that can do that as well as healthcare.

1193
01:05:20,250 --> 01:05:21,603
It's not the tech industry.

1194
01:05:25,650 --> 01:05:27,720
So think of your own care.

1195
01:05:27,720 --> 01:05:30,240
Think of the last time that you went

1196
01:05:30,240 --> 01:05:31,440
and received healthcare.

1197
01:05:34,080 --> 01:05:39,080
How well did your
physician, your provider,

1198
01:05:39,093 --> 01:05:42,540
your clinician know your dreams?

1199
01:05:42,540 --> 01:05:44,333
And what would you want them to know?

1200
01:05:48,270 --> 01:05:50,370
Could they have known you better?

1201
01:05:50,370 --> 01:05:52,270
What could that care have looked like?

1202
01:05:57,476 --> 01:06:00,003
And what is one action that
you can commit to today

1203
01:06:00,003 --> 01:06:02,673
that you can walk out of here with,

1204
01:06:03,630 --> 01:06:05,073
be able to change your camp.

1205
01:06:06,120 --> 01:06:08,070
I'd encourage you to maybe
write that down on your phone

1206
01:06:08,070 --> 01:06:10,170
or on a piece of paper or somewhere.

1207
01:06:10,170 --> 01:06:12,780
But something that you
will take out of this room

1208
01:06:12,780 --> 01:06:15,270
with you today, carry with you,

1209
01:06:15,270 --> 01:06:18,053
that will change the way that
you practice moving forward.

1210
01:06:20,250 --> 01:06:22,260
Thank you very much for your time,

1211
01:06:22,260 --> 01:06:24,310
and I'd be happy to answer any questions.

1212
01:06:42,180 --> 01:06:46,500
Thank you very, very much
Dallas for that talk.

1213
01:06:46,500 --> 01:06:51,500
And we have microphones across both sides,

1214
01:06:51,840 --> 01:06:53,943
so we're open for questions.

1215
01:06:57,770 --> 01:06:58,603
And I don't know if Bruce is here.

1216
01:06:58,603 --> 01:07:00,180
I don't know how will I get questions

1217
01:07:00,180 --> 01:07:03,000
from our online provider?

1218
01:07:03,000 --> 01:07:04,080
[Bruce] I'm here Dr. Tandoh.

1219
01:07:04,080 --> 01:07:06,060
All right questions from the online,

1220
01:07:06,060 --> 01:07:08,310
people that are online.

1221
01:07:08,310 --> 01:07:10,073
[Bruce] I don't have any so far.

1222
01:07:10,073 --> 01:07:10,906
Okay.

1223
01:07:20,850 --> 01:07:23,070
So Dallas, let me start off,

1224
01:07:23,070 --> 01:07:28,070
as a provider, as a
trauma surgeon, you know,

1225
01:07:28,200 --> 01:07:30,000
the last questions that you put out,

1226
01:07:30,000 --> 01:07:34,290
like what do my primary
care know my dreams?

1227
01:07:34,290 --> 01:07:35,847
And I was like, "No."

1228
01:07:38,370 --> 01:07:39,990
But I mean, the thing is, you know,

1229
01:07:39,990 --> 01:07:41,287
being realistic, I was like,

1230
01:07:41,287 --> 01:07:44,467
"I don't think they have time to even ask

1231
01:07:44,467 --> 01:07:46,457
"about knowing my dreams." You know?

1232
01:07:46,457 --> 01:07:47,290
Yeah.

1233
01:07:47,290 --> 01:07:49,650
So is the system that we have created

1234
01:07:49,650 --> 01:07:52,200
and how do we go about
changing that system?

1235
01:07:52,200 --> 01:07:55,230
Because I'll be honest, they
barely know the medicines

1236
01:07:55,230 --> 01:07:56,430
that I'm supposed to be taking,

1237
01:07:56,430 --> 01:07:58,305
and then the one I don't
take I don't tell 'em

1238
01:07:58,305 --> 01:07:59,910
that I'm not taking, you know.

1239
01:08:00,877 --> 01:08:04,080
So, you know, so even to
get to that point, you know,

1240
01:08:04,080 --> 01:08:06,030
it becomes pretty difficult.

1241
01:08:06,030 --> 01:08:07,320
-Yeah.
-Yeah.

1242
01:08:07,320 --> 01:08:08,153
Yeah.

1243
01:08:09,630 --> 01:08:10,770
I mean, I think it starts really

1244
01:08:10,770 --> 01:08:12,690
with the philosophical shift

1245
01:08:12,690 --> 01:08:14,230
and starting with

1246
01:08:16,063 --> 01:08:17,650
thinking about

1247
01:08:21,480 --> 01:08:23,730
you know, how healthcare
can become a space

1248
01:08:23,730 --> 01:08:26,220
where people are able to
discuss their identity

1249
01:08:26,220 --> 01:08:27,802
in some way, right?

1250
01:08:27,802 --> 01:08:28,890
I mean who they are in some way, right?

1251
01:08:28,890 --> 01:08:31,230
And at Transhealth,
it's like second nature

1252
01:08:31,230 --> 01:08:33,000
to be talking about your identity

1253
01:08:33,000 --> 01:08:38,000
and your sexual relationships
and who you are,

1254
01:08:38,280 --> 01:08:39,630
who you want to be.

1255
01:08:39,630 --> 01:08:44,040
And it's really very much
a part of the conversation

1256
01:08:44,040 --> 01:08:46,110
with a provider.

1257
01:08:46,110 --> 01:08:49,020
And I think that's because
at the starting point,

1258
01:08:49,020 --> 01:08:52,136
you know, the provider is really starting,

1259
01:08:52,136 --> 01:08:55,680
I'll take with our amazing
physicians for example,

1260
01:08:55,680 --> 01:09:00,450
is starting with questions
that are very open-ended

1261
01:09:00,450 --> 01:09:03,300
and very much, they are
not leading questions,

1262
01:09:03,300 --> 01:09:06,688
but you know, what should I know here?

1263
01:09:06,688 --> 01:09:09,120
What are your values?

1264
01:09:09,120 --> 01:09:11,370
What are your goals for care?

1265
01:09:11,370 --> 01:09:12,320
And starting there.

1266
01:09:13,945 --> 01:09:16,020
And working with the family there too.

1267
01:09:16,020 --> 01:09:17,777
And that requires having enough time.

1268
01:09:17,777 --> 01:09:19,230
-Right?
-Right, right, right.

1269
01:09:19,230 --> 01:09:21,840
So I mean, one, it's
a philosophical switch

1270
01:09:21,840 --> 01:09:25,860
and two, it's a time allocation too.

1271
01:09:25,860 --> 01:09:27,450
And then three, it's like the patient

1272
01:09:27,450 --> 01:09:29,790
actually knowing that that's
what they're signing up for

1273
01:09:29,790 --> 01:09:30,623
in a way too.

1274
01:09:30,623 --> 01:09:33,240
Because I can imagine you
going into your primary care

1275
01:09:33,240 --> 01:09:35,670
next week and they're like,
"So tell me about who you are."

1276
01:09:35,670 --> 01:09:37,061
And you're like, "What?"

1277
01:09:37,061 --> 01:09:38,303
(both laugh)

1278
01:09:38,303 --> 01:09:39,780
Like, "No, no.'

1279
01:09:39,780 --> 01:09:41,160
So it requires a shift.

1280
01:09:41,160 --> 01:09:42,030
-Right.
-Right?

1281
01:09:42,030 --> 01:09:44,000
And people to understand
what they're signing up for

1282
01:09:44,000 --> 01:09:45,180
in a way too.

1283
01:09:45,180 --> 01:09:47,790
And not everyone will want that,

1284
01:09:47,790 --> 01:09:49,860
but we have created a space

1285
01:09:49,860 --> 01:09:53,190
where people are able to discuss that.

1286
01:09:53,190 --> 01:09:55,860
And like how many times do you
get to discuss your identity

1287
01:09:55,860 --> 01:09:57,150
in a healthcare context?

1288
01:09:57,150 --> 01:09:58,503
-Right.
-Yeah.

1289
01:10:02,010 --> 01:10:03,603
That's great. Questions?

1290
01:10:05,100 --> 01:10:06,903
Yep. Dr. Gibson?

1291
01:10:08,101 --> 01:10:10,737
Hold on till you got the microphone.

1292
01:10:14,517 --> 01:10:16,740
[Dr. Gibson] Thank you
very much. Excellent.

1293
01:10:16,740 --> 01:10:18,790
Can you talk a little bit more about

1294
01:10:21,570 --> 01:10:23,310
getting additional funding?

1295
01:10:23,310 --> 01:10:26,880
It sounds like not just
what the insurance will pay

1296
01:10:26,880 --> 01:10:30,883
for the visit to help
support the Transhealth,

1297
01:10:31,770 --> 01:10:33,990
community structure that you've developed,

1298
01:10:33,990 --> 01:10:36,840
the patients, the longer
visits, all of that.

1299
01:10:36,840 --> 01:10:39,660
Can you talk a little bit more about that?

1300
01:10:39,660 --> 01:10:41,220
So part of that has been,

1301
01:10:41,220 --> 01:10:43,470
so I mentioned those different
pillars, for example,

1302
01:10:43,470 --> 01:10:45,120
part of that's been through advocacy work,

1303
01:10:45,120 --> 01:10:47,370
which is why the advocacy
work is so important.

1304
01:10:47,370 --> 01:10:50,433
And having testimony on the
hill is so important too.

1305
01:10:51,300 --> 01:10:54,690
And part of that was say
protecting reimbursement models,

1306
01:10:54,690 --> 01:10:58,800
having pay parity for Telehealth
visits in Massachusetts

1307
01:10:58,800 --> 01:11:00,870
to make sure that there was not,

1308
01:11:00,870 --> 01:11:02,370
I think there were proposals for insurers

1309
01:11:02,370 --> 01:11:06,210
to lower it down to like 70% per in-person

1310
01:11:06,210 --> 01:11:07,580
in Telehealth, for example.

1311
01:11:07,580 --> 01:11:10,410
So trying to first protect
payment parity, right?

1312
01:11:10,410 --> 01:11:13,080
And what we've already seen is some gains

1313
01:11:13,080 --> 01:11:18,080
also working advocacy to
increase payment rates too.

1314
01:11:19,470 --> 01:11:21,000
Starting with places like,

1315
01:11:21,000 --> 01:11:23,613
at least in Massachusetts
Mass Health, for example,

1316
01:11:24,900 --> 01:11:26,700
our Medicaid program.

1317
01:11:26,700 --> 01:11:30,660
And then from there it's also been

1318
01:11:30,660 --> 01:11:34,530
trying to work with government partners

1319
01:11:34,530 --> 01:11:38,640
and trying to bring in
additional sources of funding

1320
01:11:38,640 --> 01:11:39,840
through government itself

1321
01:11:39,840 --> 01:11:41,740
and through some of our advocacy work.

1322
01:11:42,930 --> 01:11:45,780
It's also been through
pharmacy programs too.

1323
01:11:45,780 --> 01:11:48,930
So we've seen specifically

1324
01:11:48,930 --> 01:11:51,750
through drug pricing program

1325
01:11:51,750 --> 01:11:53,880
called 340B, that that has been helpful.

1326
01:11:53,880 --> 01:11:57,123
It's not something ever to rely on fully,

1327
01:11:58,290 --> 01:12:01,140
especially because there's
been some challenges to it.

1328
01:12:01,140 --> 01:12:02,740
There's also just, I think

1329
01:12:04,410 --> 01:12:07,050
considering other service lines too,

1330
01:12:07,050 --> 01:12:09,660
I mean at least for the trans
and gender diverse community,

1331
01:12:09,660 --> 01:12:12,810
that can include things like,
and we don't do this yet,

1332
01:12:12,810 --> 01:12:16,830
but working towards surgical
programs for example,

1333
01:12:16,830 --> 01:12:18,490
or working towards

1334
01:12:19,710 --> 01:12:21,960
like dermatology as well.

1335
01:12:21,960 --> 01:12:23,580
Maybe that's laser hair removal,

1336
01:12:23,580 --> 01:12:27,120
maybe that's electrolysis too.

1337
01:12:27,120 --> 01:12:30,210
And then also, you know,
I think for the long term,

1338
01:12:30,210 --> 01:12:33,150
it's also thinking about all
those lives that are saved

1339
01:12:33,150 --> 01:12:36,990
and how we incorporate that
into our quality models.

1340
01:12:36,990 --> 01:12:41,407
And we incentivize that
and say, "Let's capture

1341
01:12:41,407 --> 01:12:45,847
"how many lives are saved with
a community care based model

1342
01:12:45,847 --> 01:12:48,397
"and how that actually translates

1343
01:12:48,397 --> 01:12:49,620
"to better patient outcomes."

1344
01:12:49,620 --> 01:12:52,023
And then, you know,
reimbursement the rates too.

1345
01:12:54,000 --> 01:12:56,310
But it's really been through
that revenue diversification.

1346
01:12:56,310 --> 01:12:59,613
And then also impact donors too.

1347
01:13:00,450 --> 01:13:01,283
Yeah.

1348
01:13:03,810 --> 01:13:05,460
I have one person there.

1349
01:13:05,460 --> 01:13:07,363
And then Dr. Imbasciani.

1350
01:13:09,017 --> 01:13:10,470
[Audience Member] Hello. Oh, hi.

1351
01:13:10,470 --> 01:13:13,353
Well first of all,
absolutely wonderful talk.

1352
01:13:13,353 --> 01:13:16,290
I really loved it and I
feel like I learned a lot,

1353
01:13:16,290 --> 01:13:17,760
so thank you so much for your time.

1354
01:13:17,760 --> 01:13:18,593
Thank you.

1355
01:13:19,440 --> 01:13:22,680
[Audience Member] Also, I
just kind of wanna make sure

1356
01:13:22,680 --> 01:13:26,580
that I understand because
you kind of mentioned

1357
01:13:26,580 --> 01:13:29,520
like this is just good healthcare,

1358
01:13:29,520 --> 01:13:31,590
you know, like this model is just

1359
01:13:31,590 --> 01:13:35,512
what good healthcare looks
like or should look like.

1360
01:13:35,512 --> 01:13:38,193
And I think maybe I'm a little confused.

1361
01:13:39,660 --> 01:13:42,180
Do you mean that this is a good model

1362
01:13:42,180 --> 01:13:45,540
for primary care in general?

1363
01:13:45,540 --> 01:13:47,940
Because I think I'm
having a little trouble

1364
01:13:47,940 --> 01:13:51,000
visualizing how this model would work for,

1365
01:13:51,000 --> 01:13:54,540
you know, different, you
know, surgical subspecialties

1366
01:13:54,540 --> 01:13:56,820
or just other subspecialties.

1367
01:13:56,820 --> 01:13:58,770
Like, I don't know if I
really wanna talk about

1368
01:13:58,770 --> 01:14:00,420
like my sexual relationships with the guy

1369
01:14:00,420 --> 01:14:02,460
that's replacing my knee.

1370
01:14:02,460 --> 01:14:03,293
Yes.

1371
01:14:03,293 --> 01:14:04,126
[Audience Member] And that kind of thing.

1372
01:14:04,126 --> 01:14:07,260
So just, I think this model is wonderful,

1373
01:14:07,260 --> 01:14:09,390
but I guess I'm just a little confused

1374
01:14:09,390 --> 01:14:11,460
as to what you mean when you say

1375
01:14:11,460 --> 01:14:13,320
that this is what good
healthcare looks like

1376
01:14:13,320 --> 01:14:16,260
and how that's applicable
to other specialties.

1377
01:14:16,260 --> 01:14:17,093
Yeah. Yeah.

1378
01:14:17,093 --> 01:14:18,990
Thank you. That's a great, great question.

1379
01:14:18,990 --> 01:14:22,983
I would say primary care,
mental healthcare generally.

1380
01:14:24,660 --> 01:14:29,280
I think that you could
see elements of this

1381
01:14:29,280 --> 01:14:31,830
in inpatient care though too.

1382
01:14:31,830 --> 01:14:33,580
You know, good person-centered care

1383
01:14:36,284 --> 01:14:39,100
that provides space for people to be able

1384
01:14:40,052 --> 01:14:41,880
to talk about who they are.

1385
01:14:41,880 --> 01:14:43,500
And it was probably not the person

1386
01:14:43,500 --> 01:14:45,300
who's replacing your knee.

1387
01:14:45,300 --> 01:14:47,850
But one example I was talking
to the medical students

1388
01:14:47,850 --> 01:14:49,323
about earlier today too, was,

1389
01:14:50,370 --> 01:14:53,400
and this is specific to the LGBTQ context,

1390
01:14:53,400 --> 01:14:56,310
I was wearing a Pride
flag on an inpatient unit,

1391
01:14:56,310 --> 01:14:57,900
for example and there was this,

1392
01:14:57,900 --> 01:15:00,360
a team of folks that was rounding,

1393
01:15:00,360 --> 01:15:03,600
that was trying to get some
good collateral on this patient,

1394
01:15:03,600 --> 01:15:06,963
and this patient was
talking about her boyfriend.

1395
01:15:07,800 --> 01:15:11,430
And it wasn't until
after the team had left

1396
01:15:11,430 --> 01:15:13,950
and they weren't able to get
any type of collateral at all.

1397
01:15:13,950 --> 01:15:15,960
And you know, she wasn't really giving

1398
01:15:15,960 --> 01:15:17,820
the boyfriend's number or anything

1399
01:15:17,820 --> 01:15:18,990
and they just weren't able to find out

1400
01:15:18,990 --> 01:15:21,930
if she could be discharged
to a safe place.

1401
01:15:21,930 --> 01:15:23,737
Then I came back in and she was like,

1402
01:15:23,737 --> 01:15:27,367
"Hey, so I don't actually have boyfriend,

1403
01:15:27,367 --> 01:15:28,320
"I have a girlfriend."

1404
01:15:28,320 --> 01:15:32,100
And that opened up a space
where she could actually

1405
01:15:32,100 --> 01:15:36,450
disclose more about what
her actual connections were

1406
01:15:36,450 --> 01:15:39,420
in life that didn't involve her sexuality,

1407
01:15:39,420 --> 01:15:42,540
but it did involve her sexuality in a way,

1408
01:15:42,540 --> 01:15:44,940
but really just involved a space

1409
01:15:44,940 --> 01:15:47,550
where she could experience trust

1410
01:15:47,550 --> 01:15:50,250
and she could disclose something

1411
01:15:50,250 --> 01:15:52,380
that then allowed us to us to, you know,

1412
01:15:52,380 --> 01:15:54,570
get some collateral and find
out she could be discharged

1413
01:15:54,570 --> 01:15:56,073
to a safe space, essentially.

1414
01:15:57,780 --> 01:16:00,633
But, so it doesn't,

1415
01:16:01,576 --> 01:16:06,540
in that way it's not necessarily
talking about sexuality

1416
01:16:06,540 --> 01:16:08,430
or gender in that space,

1417
01:16:08,430 --> 01:16:12,090
but being able to experience
trust perhaps on an inpatient.

1418
01:16:12,090 --> 01:16:14,130
Again, not applying to every specialty,

1419
01:16:14,130 --> 01:16:16,120
but I might say that or suggest

1420
01:16:17,850 --> 01:16:21,360
that probably every specialty
could have more spaces

1421
01:16:21,360 --> 01:16:24,453
where you could have some more
conversation or more trust.

1422
01:16:25,470 --> 01:16:27,630
But let me ask, a trauma surgeon though,

1423
01:16:27,630 --> 01:16:29,310
just listening to you
and your last question,

1424
01:16:29,310 --> 01:16:30,990
is, what I would take out of this.

1425
01:16:30,990 --> 01:16:34,020
And what I'm taking away is
even as a trauma surgeon,

1426
01:16:34,020 --> 01:16:35,220
emergency general surgery, right?

1427
01:16:35,220 --> 01:16:36,480
When I walk into the emergency room,

1428
01:16:36,480 --> 01:16:38,528
I usually have the patient's name,

1429
01:16:38,528 --> 01:16:40,650
but what I'm gonna start doing

1430
01:16:40,650 --> 01:16:43,680
is instead of just going in saying Mr, so,

1431
01:16:43,680 --> 01:16:45,997
or just say, introduce myself and say,

1432
01:16:45,997 --> 01:16:47,880
"How do you want me to introduce,

1433
01:16:47,880 --> 01:16:51,483
"how do you want me to address you?"

1434
01:16:51,483 --> 01:16:53,136
You know, I mean that's one of the thing

1435
01:16:53,136 --> 01:16:55,110
I'm taking away, you know?

1436
01:16:55,110 --> 01:16:56,238
Yeah.

1437
01:16:56,238 --> 01:16:57,720
So it doesn't have to be like primary care

1438
01:16:57,720 --> 01:16:59,670
or I mean, it could be in anything you do,

1439
01:16:59,670 --> 01:17:02,670
-like that you were saying.
-Yeah.

1440
01:17:02,670 --> 01:17:04,830
And part of this too is just
checking assumptions, right?

1441
01:17:04,830 --> 01:17:08,490
So there was a really terrible
incident that happened

1442
01:17:08,490 --> 01:17:10,410
at a Massachusetts based hospital

1443
01:17:10,410 --> 01:17:14,140
where there was a man
who was admitted to an ED

1444
01:17:15,750 --> 01:17:18,960
and the team, he had
said that he had taken

1445
01:17:18,960 --> 01:17:22,140
a positive pregnancy
test earlier in the day

1446
01:17:22,140 --> 01:17:25,560
and the team just, it did not
fit in their conceptualization

1447
01:17:25,560 --> 01:17:30,560
of this person and did
not work this man up

1448
01:17:31,920 --> 01:17:34,083
for the possibility of a pregnancy.

1449
01:17:36,475 --> 01:17:40,476
And later in the day, the
fetus experienced fetal demise

1450
01:17:40,476 --> 01:17:45,476
and that was just a lost
chance at an assessment

1451
01:17:45,750 --> 01:17:47,880
in an emergent situation

1452
01:17:47,880 --> 01:17:50,850
that just required some
checking assumptions

1453
01:17:50,850 --> 01:17:51,990
at the door a little bit.

1454
01:17:51,990 --> 01:17:54,660
So it doesn't mean that
maybe we're taking 30 minutes

1455
01:17:54,660 --> 01:17:55,920
or an hour with someone, right?

1456
01:17:55,920 --> 01:17:58,080
There are emergent and
critical situations,

1457
01:17:58,080 --> 01:18:00,270
but just watching our assumptions

1458
01:18:00,270 --> 01:18:04,358
and incorporating that into
our universal precautions

1459
01:18:04,358 --> 01:18:05,191
that we do.

1460
01:18:06,030 --> 01:18:07,680
Right. Dr, Imbasciani?

1461
01:18:07,680 --> 01:18:08,790
[Dr. Imbasciani] Yeah. Hi Dallas,

1462
01:18:08,790 --> 01:18:09,990
if you don't mind, is this on?

1463
01:18:09,990 --> 01:18:11,199
Yes.

1464
01:18:11,199 --> 01:18:12,032
[Dr. Imbasciani] Yeah, great.

1465
01:18:12,032 --> 01:18:14,070
Wonderful talk. Thank you very much.

1466
01:18:14,070 --> 01:18:17,220
I'm not sure, I'm sensitive to pronouns,

1467
01:18:17,220 --> 01:18:21,300
but I'm not sure it's not
enough in certain circumstances.

1468
01:18:21,300 --> 01:18:24,270
I'm wondering if you have advice to,

1469
01:18:24,270 --> 01:18:26,650
I'm a urologic surgeon, but to others

1470
01:18:27,544 --> 01:18:32,544
who are screening adults
for generally based cancers.

1471
01:18:33,150 --> 01:18:36,573
So breast, uterine, cervix or prostate,

1472
01:18:38,670 --> 01:18:41,160
you're respectful for the pronouns,

1473
01:18:41,160 --> 01:18:46,160
but certain trans patients
may have a sensitivity

1474
01:18:46,320 --> 01:18:49,320
to the discussion around organs

1475
01:18:49,320 --> 01:18:51,900
that conceptually have been left behind.

1476
01:18:51,900 --> 01:18:53,087
Yeah.

1477
01:18:53,087 --> 01:18:54,660
[Dr. Imbasciani] Am I saying that okay?

1478
01:18:54,660 --> 01:18:56,397
-Yeah.
-Conceptually left behind.

1479
01:18:56,397 --> 01:18:57,724
Yes, yes. I understand.

1480
01:18:57,724 --> 01:18:59,160
[Dr. Imbasciani] Yeah.
So do you have advice

1481
01:19:00,628 --> 01:19:02,880
for how to engage in that conversation?

1482
01:19:02,880 --> 01:19:05,790
Yeah, it's a great question.

1483
01:19:05,790 --> 01:19:08,640
I would suggest whether it's...

1484
01:19:08,640 --> 01:19:10,440
And this question was actually asked

1485
01:19:10,440 --> 01:19:12,903
somewhat in a tangential way earlier too,

1486
01:19:14,265 --> 01:19:17,760
when we talk about the patient

1487
01:19:17,760 --> 01:19:20,190
or we talk about the patient's body,

1488
01:19:20,190 --> 01:19:23,310
I would really recommend always deferring

1489
01:19:23,310 --> 01:19:27,960
to the language that
that patient is using.

1490
01:19:27,960 --> 01:19:31,140
And in speaking about it in that way,

1491
01:19:31,140 --> 01:19:33,333
speaking about the
patient in that way too,

1492
01:19:34,830 --> 01:19:37,470
but also operating with
informed consent too.

1493
01:19:37,470 --> 01:19:40,053
So if there's a need to say chart,

1494
01:19:41,730 --> 01:19:44,280
you know, a certain organ for example,

1495
01:19:44,280 --> 01:19:46,290
or use a certain name,
informing the patient

1496
01:19:46,290 --> 01:19:49,440
of why you need to put this
in the chart in a certain way

1497
01:19:49,440 --> 01:19:52,830
because the chart is the
patient's property, right?

1498
01:19:52,830 --> 01:19:55,350
And the patient will be
able to view their chart.

1499
01:19:55,350 --> 01:19:57,810
And so I think there's
kind of two conversations

1500
01:19:57,810 --> 01:19:58,980
that are happening.

1501
01:19:58,980 --> 01:20:01,380
There's how we chart and
how we refer to the patient

1502
01:20:01,380 --> 01:20:03,539
in the chart and then how
we refer to that patient

1503
01:20:03,539 --> 01:20:05,070
in person.

1504
01:20:05,070 --> 01:20:08,880
And then what I would say
is asking that patient,

1505
01:20:08,880 --> 01:20:13,880
what do you call, you know,
this organ for example.

1506
01:20:14,250 --> 01:20:15,930
Some people may use the term,

1507
01:20:15,930 --> 01:20:20,760
for example, front hole for example.

1508
01:20:20,760 --> 01:20:24,360
And some people may use
another term altogether.

1509
01:20:24,360 --> 01:20:27,330
And so trying to be respectful
to the term that they use

1510
01:20:27,330 --> 01:20:30,450
and then also inform the patient of, well,

1511
01:20:30,450 --> 01:20:33,810
and when I transmit this
information to someone else

1512
01:20:33,810 --> 01:20:35,310
for the purpose of charting, for example,

1513
01:20:35,310 --> 01:20:38,430
this is why I need to
be able to use a term

1514
01:20:38,430 --> 01:20:39,450
that others will understand.

1515
01:20:39,450 --> 01:20:41,190
So just operating with informed consent

1516
01:20:41,190 --> 01:20:45,080
and inform consent and
asking what name you can,

1517
01:20:45,080 --> 01:20:46,533
so what words you'd use.

1518
01:20:47,790 --> 01:20:50,340
Not to obscure by any means,

1519
01:20:50,340 --> 01:20:51,810
but just to be really sensitive

1520
01:20:51,810 --> 01:20:55,230
to the patient's experience.

1521
01:20:55,230 --> 01:20:56,520
Does that make sense?

1522
01:20:56,520 --> 01:20:57,353
Yeah.

1523
01:20:58,830 --> 01:21:01,770
And on that question too,
when we just think about EMRs,

1524
01:21:01,770 --> 01:21:03,333
some people have asked also,

1525
01:21:04,590 --> 01:21:06,630
you know, how do you refer to the patient

1526
01:21:06,630 --> 01:21:08,550
when you're starting
your note, for example.

1527
01:21:08,550 --> 01:21:13,383
So a 30 year old transgender man, right?

1528
01:21:14,940 --> 01:21:17,250
I would really recommend especially say

1529
01:21:17,250 --> 01:21:19,830
if you're using Epic for example,
using the three asterisk,

1530
01:21:19,830 --> 01:21:23,310
but creating a blank space
there and asking the patient

1531
01:21:23,310 --> 01:21:27,300
how they refer to themselves
and putting that again

1532
01:21:27,300 --> 01:21:29,250
in the patient's own property,

1533
01:21:29,250 --> 01:21:31,350
which is their medical record.

1534
01:21:31,350 --> 01:21:35,820
Because otherwise some
folks may, I see this a lot.

1535
01:21:35,820 --> 01:21:40,350
You see trans people getting charted

1536
01:21:40,350 --> 01:21:42,180
as the transgender person

1537
01:21:42,180 --> 01:21:45,270
and then cisgender people not, right?

1538
01:21:45,270 --> 01:21:48,270
And it kind of others,
trans folks in that way,

1539
01:21:48,270 --> 01:21:50,490
but also has the very real consequences

1540
01:21:50,490 --> 01:21:51,510
of outing that person,

1541
01:21:51,510 --> 01:21:53,970
depending on where that chart goes to.

1542
01:21:53,970 --> 01:21:56,940
Especially if you're involved
in say, care everywhere

1543
01:21:56,940 --> 01:21:57,900
for example.

1544
01:21:57,900 --> 01:22:00,270
And that you didn't
really have the consent

1545
01:22:00,270 --> 01:22:02,280
to out that patient, right?

1546
01:22:02,280 --> 01:22:03,930
Now, there might be really good reasons

1547
01:22:03,930 --> 01:22:05,340
to put that in the note.

1548
01:22:05,340 --> 01:22:09,030
But again, it starts with the
philosophy of informed consent

1549
01:22:09,030 --> 01:22:12,240
and say, "Let's talk about
why this is important."

1550
01:22:12,240 --> 01:22:14,490
I don't really know of
a reason why it's vital

1551
01:22:14,490 --> 01:22:18,720
to talk about someone's
gender identity in the note,

1552
01:22:18,720 --> 01:22:20,910
especially if the patient
doesn't want that.

1553
01:22:20,910 --> 01:22:23,460
It might be vital to talk about
certain organ systems though

1554
01:22:23,460 --> 01:22:24,780
and have an organ inventory,

1555
01:22:24,780 --> 01:22:28,443
but that is different than
someone's gender identity.

1556
01:22:30,900 --> 01:22:32,310
Right.

1557
01:22:32,310 --> 01:22:34,195
We have one question over there

1558
01:22:34,195 --> 01:22:36,450
and then one up there.

1559
01:22:36,450 --> 01:22:39,150
[Audience Member] Yeah, thanks
for the really nice talk.

1560
01:22:39,150 --> 01:22:42,450
I think on the discussion
of outing people,

1561
01:22:42,450 --> 01:22:44,280
this is something I've been
like thinking a bit about

1562
01:22:44,280 --> 01:22:46,050
and kind of curious about.

1563
01:22:46,050 --> 01:22:49,110
As I once had a non-binary
friend express to me

1564
01:22:49,110 --> 01:22:51,330
that they really didn't
like when people asked

1565
01:22:51,330 --> 01:22:53,160
for their pronouns, because they said

1566
01:22:53,160 --> 01:22:55,440
they kind of had to make
that split second decision

1567
01:22:55,440 --> 01:22:59,310
of, "Is this person safe to
come out to or do I lie?"

1568
01:22:59,310 --> 01:23:03,690
And I'm wondering if you have
any sort of practical advice

1569
01:23:03,690 --> 01:23:06,900
for interacting with patients in a way

1570
01:23:06,900 --> 01:23:11,640
that creates that space
for them to self-identify

1571
01:23:11,640 --> 01:23:14,310
if they feel safe and
comfortable doing it, so.

1572
01:23:14,310 --> 01:23:17,647
But also not like putting
them on the spot and saying,

1573
01:23:17,647 --> 01:23:19,147
"You need to either come out to me

1574
01:23:19,147 --> 01:23:20,640
"or lie about who you are."

1575
01:23:20,640 --> 01:23:21,473
Correct. Yeah.

1576
01:23:21,473 --> 01:23:22,380
[Audience Member] And
so I'm just wondering

1577
01:23:22,380 --> 01:23:24,480
if you have any like tips for that.

1578
01:23:24,480 --> 01:23:25,530
Totally. Yeah.

1579
01:23:25,530 --> 01:23:28,203
That's a great, great nuanced question.

1580
01:23:33,268 --> 01:23:36,810
So I think I would start
first by acknowledging

1581
01:23:36,810 --> 01:23:38,910
the data that we just saw,

1582
01:23:38,910 --> 01:23:41,340
which is that healthcare
is not a safe place

1583
01:23:41,340 --> 01:23:43,287
for trans or gender diverse people, right?

1584
01:23:43,287 --> 01:23:45,060
And so it's so understandable

1585
01:23:45,060 --> 01:23:47,280
if you're trans or gender first,

1586
01:23:47,280 --> 01:23:49,140
that you're not gonna want to disclose

1587
01:23:49,140 --> 01:23:50,823
in one way or another, right?

1588
01:23:52,800 --> 01:23:55,830
And then you also have to think
about the power of privilege

1589
01:23:55,830 --> 01:23:57,480
that we as healers have,

1590
01:23:57,480 --> 01:24:01,440
where we're getting paid
to be in the setting,

1591
01:24:01,440 --> 01:24:04,170
probably a good amount
more than maybe most people

1592
01:24:04,170 --> 01:24:05,310
that we see.

1593
01:24:05,310 --> 01:24:10,310
Whereas that person is paying
to be there and also not safe,

1594
01:24:12,240 --> 01:24:15,140
like not feeling like they're
in control of the situation.

1595
01:24:15,976 --> 01:24:18,330
Like, you know, provider,
like a physician may feel

1596
01:24:18,330 --> 01:24:22,200
that they're really in control
of that encounter, right?

1597
01:24:22,200 --> 01:24:24,330
So there's a power differential

1598
01:24:24,330 --> 01:24:26,550
that's really occurring there, right?

1599
01:24:26,550 --> 01:24:29,910
And so to try to level that field a bit,

1600
01:24:29,910 --> 01:24:34,590
what I generally do is with
every clinical encounter,

1601
01:24:34,590 --> 01:24:37,050
I would say, you know, my name's Dallas,

1602
01:24:37,050 --> 01:24:40,470
my pronouns are she and
hers, what are yours?

1603
01:24:40,470 --> 01:24:41,610
Or what's your name?

1604
01:24:41,610 --> 01:24:44,340
And I just kind of leave
it there a lot of the times

1605
01:24:44,340 --> 01:24:46,980
I would just introduce
myself with name and pronouns

1606
01:24:46,980 --> 01:24:48,003
every single time.

1607
01:24:49,500 --> 01:24:51,810
A lot of times I say, "What's
your name and pronouns?'

1608
01:24:51,810 --> 01:24:55,050
And there's never one time
where someone got mad at me

1609
01:24:55,050 --> 01:24:57,030
for asking for their pronouns.

1610
01:24:57,030 --> 01:24:59,730
Like never, people sometimes were confused

1611
01:24:59,730 --> 01:25:01,440
about what I was asking,

1612
01:25:01,440 --> 01:25:06,440
but more often than not, it
was a chance to be known,

1613
01:25:06,870 --> 01:25:10,320
or even for some, as
I told that one story,

1614
01:25:10,320 --> 01:25:12,596
a chance to save someone's,

1615
01:25:12,596 --> 01:25:14,010
for someone to be able to die,

1616
01:25:14,010 --> 01:25:16,953
at least in the way that they wanted to.

1617
01:25:18,570 --> 01:25:21,810
So I would just say starting
with that universal precaution

1618
01:25:21,810 --> 01:25:24,670
of leveling the playing field a little

1619
01:25:26,611 --> 01:25:28,860
and introducing yourself and your pronouns

1620
01:25:28,860 --> 01:25:30,450
and then asking what are yours

1621
01:25:30,450 --> 01:25:32,400
or what's your name, pronouns

1622
01:25:32,400 --> 01:25:35,670
and just not pressing it if
someone doesn't wanna give it,

1623
01:25:35,670 --> 01:25:37,170
and that's totally fine too.

1624
01:25:37,170 --> 01:25:39,780
And then if someone doesn't
give their name and pronouns

1625
01:25:39,780 --> 01:25:41,719
at all, or you don't know,

1626
01:25:41,719 --> 01:25:44,310
then really err on the side
of gender neutral pronouns,

1627
01:25:44,310 --> 01:25:46,320
they/them until you know.

1628
01:25:46,320 --> 01:25:49,680
And just practice speaking in that way.

1629
01:25:49,680 --> 01:25:50,940
And I'll say, as a trans person,

1630
01:25:50,940 --> 01:25:52,140
I found it really hard to speak

1631
01:25:52,140 --> 01:25:54,936
in gender neutral pronouns when I started

1632
01:25:54,936 --> 01:25:57,270
and I just kept like
practicing the muscle,

1633
01:25:57,270 --> 01:26:00,600
like in my head and it became pretty easy.

1634
01:26:00,600 --> 01:26:01,893
So it's, you know,

1635
01:26:03,060 --> 01:26:05,610
really acknowledging the privilege

1636
01:26:05,610 --> 01:26:07,127
when you're walking in the room

1637
01:26:07,127 --> 01:26:09,540
and then just not making
those assumptions.

1638
01:26:09,540 --> 01:26:10,620
Is that helpful?

1639
01:26:10,620 --> 01:26:12,000
[Audience Member] Yeah.
Thank you very much.

1640
01:26:12,000 --> 01:26:13,743
We'll take one more question.

1641
01:26:14,700 --> 01:26:16,773
Up there, Krista?

1642
01:26:29,393 --> 01:26:30,226
[Audience Member] Hi.

1643
01:26:30,226 --> 01:26:31,360
So I was just really curious

1644
01:26:32,460 --> 01:26:35,460
a little bit more on the
structural side of things

1645
01:26:35,460 --> 01:26:38,070
and how you envision Transhealth.

1646
01:26:38,070 --> 01:26:43,070
I'm really curious in
creating Transhealth,

1647
01:26:43,740 --> 01:26:45,900
what immediately came to your mind

1648
01:26:45,900 --> 01:26:48,930
in terms of the type of healthcare team

1649
01:26:48,930 --> 01:26:50,610
you wanted to create to provide

1650
01:26:50,610 --> 01:26:52,500
that gender affirming type of care?

1651
01:26:52,500 --> 01:26:54,030
So I guess my question is,

1652
01:26:54,030 --> 01:26:57,780
what specific medical specialties,
healthcare professionals,

1653
01:26:57,780 --> 01:26:59,550
and even non-healthcare professionals

1654
01:26:59,550 --> 01:27:03,180
did you think were essential
in creating that core team

1655
01:27:03,180 --> 01:27:06,000
to provide the gender affirming care

1656
01:27:06,000 --> 01:27:08,490
that you envisioned Transhealth providing?

1657
01:27:08,490 --> 01:27:11,250
And given an unlimited,
not really unlimited,

1658
01:27:11,250 --> 01:27:13,020
but an ideal amount of funding,

1659
01:27:13,020 --> 01:27:16,020
how do you see yourself
like expanding that team

1660
01:27:16,020 --> 01:27:20,790
to provide even better
gender affirming care?

1661
01:27:20,790 --> 01:27:23,130
If you know of an unlimited
source of funding,

1662
01:27:23,130 --> 01:27:24,273
please send them my way.

1663
01:27:24,273 --> 01:27:26,606
(all laugh)

1664
01:27:28,200 --> 01:27:31,560
We wanted to start with a what
was a minimum viable clinic.

1665
01:27:31,560 --> 01:27:33,990
And it was like, what is
the bare bones that we have?

1666
01:27:33,990 --> 01:27:35,640
So it was not the ideal, but it was like,

1667
01:27:35,640 --> 01:27:38,070
what do we need to get things going?

1668
01:27:38,070 --> 01:27:41,130
And so we started really
with a pediatrician,

1669
01:27:41,130 --> 01:27:45,603
a family provider who
then happened to be an MP.

1670
01:27:47,070 --> 01:27:49,050
We really wanted a doc on the team.

1671
01:27:49,050 --> 01:27:52,000
And then we were a little more
agnostic on the family side.

1672
01:27:52,980 --> 01:27:56,550
And then another family
provider, a therapist,

1673
01:27:56,550 --> 01:27:58,953
and a psychiatric provider too.

1674
01:28:01,903 --> 01:28:03,690
A nurse case manager,

1675
01:28:03,690 --> 01:28:05,613
an ambulatory nurse as well,

1676
01:28:07,552 --> 01:28:08,730
and a person at the front desk.

1677
01:28:08,730 --> 01:28:10,260
And that was where we started.

1678
01:28:10,260 --> 01:28:12,667
And that is like not ideal
at all, but we were like,

1679
01:28:12,667 --> 01:28:15,990
"Let's just see if this
experiment runs first."

1680
01:28:15,990 --> 01:28:17,880
And like, "Let's see if people show up."

1681
01:28:17,880 --> 01:28:18,990
Because we didn't wanna build this

1682
01:28:18,990 --> 01:28:19,987
and like no one show up and it's like,

1683
01:28:19,987 --> 01:28:21,630
"Well this was a big flop, let's go home."

1684
01:28:21,630 --> 01:28:23,787
Like, "We thought there
was need and it's not."

1685
01:28:23,787 --> 01:28:27,420
And then it just like, the
need was clearly there.

1686
01:28:27,420 --> 01:28:30,510
So we went from that
small team to 50 people.

1687
01:28:30,510 --> 01:28:33,698
And when you build an
organization out of nothing,

1688
01:28:33,698 --> 01:28:35,280
you know, you have to build the handbooks

1689
01:28:35,280 --> 01:28:38,880
and HR practices and have lawyers

1690
01:28:38,880 --> 01:28:42,960
and like all these things
I did not know at all

1691
01:28:42,960 --> 01:28:45,273
as a new clinician too.

1692
01:28:46,717 --> 01:28:51,030
And then you also, you know,
really rely on the wisdom

1693
01:28:51,030 --> 01:28:53,760
of a lot of other people too
and bringing that wisdom in.

1694
01:28:53,760 --> 01:28:54,840
And there were just a lot of people

1695
01:28:54,840 --> 01:28:59,340
who came out of different
spaces to help us out.

1696
01:28:59,340 --> 01:29:00,960
And then with those pillars too,

1697
01:29:00,960 --> 01:29:02,670
we really wanted to bring in people

1698
01:29:02,670 --> 01:29:05,910
who were skilled in advocacy and research

1699
01:29:05,910 --> 01:29:08,190
and education too.

1700
01:29:08,190 --> 01:29:10,290
So it grew pretty quickly.

1701
01:29:10,290 --> 01:29:13,440
Where I see it going is I really believe

1702
01:29:13,440 --> 01:29:15,600
that a place like Transhealth

1703
01:29:15,600 --> 01:29:19,320
could mimic something like
the Planned Parenthood model

1704
01:29:19,320 --> 01:29:20,670
in some extent.

1705
01:29:20,670 --> 01:29:23,130
And you see Planned
Parenthood organizations

1706
01:29:23,130 --> 01:29:25,350
in many different states,

1707
01:29:25,350 --> 01:29:27,180
and there's not many
healthcare organizations

1708
01:29:27,180 --> 01:29:30,270
that have advocacy so
core to their mission

1709
01:29:30,270 --> 01:29:32,100
as Planned Parenthood.

1710
01:29:32,100 --> 01:29:34,950
And I just believe that's
a part of good healthcare,

1711
01:29:34,950 --> 01:29:37,380
personally, that's my own
philosophical conviction.

1712
01:29:37,380 --> 01:29:40,740
So you could imagine a growth
model in a similar way.

1713
01:29:40,740 --> 01:29:43,500
Theirs relies a lot on impact donors.

1714
01:29:43,500 --> 01:29:46,621
So it would also have to
include probably donations,

1715
01:29:46,621 --> 01:29:48,990
but then a lot of other of these

1716
01:29:48,990 --> 01:29:52,560
kind of financial
diversification models too.

1717
01:29:52,560 --> 01:29:54,120
But ideally, it's also,

1718
01:29:54,120 --> 01:29:56,730
I mean, it's grown now to
community health workers,

1719
01:29:56,730 --> 01:30:01,230
community engagement specialists,
communications people,

1720
01:30:01,230 --> 01:30:04,530
educators, many more
primary care providers,

1721
01:30:04,530 --> 01:30:06,000
psychiatric providers,

1722
01:30:06,000 --> 01:30:08,370
many, many therapists
or therapists ratios,

1723
01:30:08,370 --> 01:30:10,980
three therapists to one
psychiatric provider

1724
01:30:10,980 --> 01:30:14,295
so that we have open
spots for therapy too.

1725
01:30:14,295 --> 01:30:15,930
'Cause it can be so difficult to get that.

1726
01:30:15,930 --> 01:30:19,440
And you know, I would say
that that ideal model is that.

1727
01:30:19,440 --> 01:30:21,480
But then also subspecialties too,

1728
01:30:21,480 --> 01:30:24,120
and thinking about surgeries
and thinking about germ

1729
01:30:24,120 --> 01:30:25,590
and thinking about other spaces

1730
01:30:25,590 --> 01:30:28,893
that can be person-centered
and it can respond to the need.

1731
01:30:30,012 --> 01:30:31,529
Yeah.

1732
01:30:31,529 --> 01:30:33,879
It's only been two years
though, so gimme a little time.

1733
01:30:33,879 --> 01:30:35,430
(Dr. Tandoh laughs)

1734
01:30:35,430 --> 01:30:38,730
Well, I wanna say thank
you again very much Dallas

1735
01:30:38,730 --> 01:30:43,200
for being here and just for talking to us

1736
01:30:43,200 --> 01:30:45,360
about gender affirming
care being the model

1737
01:30:45,360 --> 01:30:47,790
for just general healthcare.

1738
01:30:47,790 --> 01:30:50,610
So I would like us to please show a round

1739
01:30:50,610 --> 01:30:52,413
of appreciation for Dallas again.

1740
01:31:06,360 --> 01:31:07,970
I would also like to say a big thank you

1741
01:31:07,970 --> 01:31:11,070
to Dr. Vito Imbasciani
and Mr. George DiSalvo

1742
01:31:11,070 --> 01:31:15,150
for endowing this lectureship
and all your support

1743
01:31:15,150 --> 01:31:17,188
around education here for us

1744
01:31:17,188 --> 01:31:21,660
producing competent,
cultural, humble positions.

1745
01:31:21,660 --> 01:31:24,240
And I wanna say very much thank you

1746
01:31:24,240 --> 01:31:28,080
to the Imbasciani Lecture
Selection Committee.

1747
01:31:28,080 --> 01:31:30,540
Thank you very much, Pam,
for all the work you put

1748
01:31:30,540 --> 01:31:34,080
into this and how you bring
us great speakers every year.

1749
01:31:34,080 --> 01:31:35,981
And last but not least, thank you

1750
01:31:35,981 --> 01:31:40,560
to my office staff,
especially Emily and Krista,

1751
01:31:40,560 --> 01:31:42,420
for really making this all run.

1752
01:31:42,420 --> 01:31:45,365
And Tiffany, who I'm sure is on Zoom

1753
01:31:45,365 --> 01:31:47,160
for making this all come together.

1754
01:31:47,160 --> 01:31:49,983
So again, thank you all
and have a good night.