Addressing health disparities in the LGBTQ+ community and other marginalized patients
Family medicine doctor, Meggie Woods, MD, sees patients at an Oakland, California homeless clinic and a large community hospital. These patients often have complex medical needs, compounded by social conditions and gaps in healthcare.
“I'm the Lead Clinician and run the HIV, substance use, and gender affirming care programs,” said Dr. Woods, whose pronouns are they/them. “I see patients who've never had preventive screening such as Pap smears, never had mammograms, never really wanted to see a doctor because it didn't seem like a safe place to go — so they didn't get any medical care,” they explained.
Some of Dr. Woods’ patients need access to HIV pre-exposure prophylaxis, or PrEP — medicine to prevent getting HIV. “If you're not feeling safe talking to your provider about your sexual health, then they may not know that you should be offered PrEP.”
Another gap in care includes lack of access to gender-affirming care, including hormones and surgery. “That has been a huge part of what patients have wanted and not been able to access previously. Being able to provide hormones and referrals for gender-affirming surgery has been lifesaving for my patients,” Dr. Woods noted.
Their patients have numerous cardiovascular complications. “I’m often diagnosing congestive heart failure, atrial fibrillation, and mitral valve insufficiency,” Dr. Woods described. “We had a [new] patient and heard a heart murmur on the exam. We did a point-of-care ultrasound and identified mitral valve insufficiency. He was very short of breath but didn’t know he had it [a mitral valve problem].”
3M™ Littmann® CORE Digital Stethoscope benefits for hearing loss and difficult scenarios
When treating patients with such complex conditions, it’s valuable to have leading-edge diagnostic tools.
Dr. Woods learned about Eko Health’s stethoscope technology about four years ago. “My partner was born with profound hearing loss and has worn hearing aids most of his life. He was applying to medical school and was concerned about his ability to hear using a stethoscope,” they explained.
“I got him a 3M™ Littmann® CORE Digital Stethoscope to see if that would be helpful.”
Before he applied to medical school, Woods’ partner had been an engineering manager at a large Bay Area tech company. Now, as a fourth-year medical student at the University of California, San Francisco (UCSF), he plans to apply to otolaryngology to help other people who have hearing loss. He streams sounds from his digital stethoscope directly to his new cochlear implants. The digital stethoscope enables him to auscultate heart and lung sounds the same way his hearing classmates do. The Eko App further supports clinicians who have hearing loss. They can connect the stethoscope with Bluetooth-enabled hearing aids and cochlear implants.
Just a couple of years ago, Dr. Woods’ partner bought them a 3M™ Littmann® CORE Digital Stethoscope as a Christmas gift. Before then, Dr. Woods could usually hear body sounds with an analog stethoscope, but there were a couple of difficult scenarios.
“There are situations where it's difficult to hear body sounds due to body habitus, or body wall thickness. That has always been challenging for me,” they described. Background noises also made it difficult. The Littmann® CORE’s amplification and active noise cancellation features are assets. “I can hear sounds that are softer — sounds that before, I wouldn’t have paid as much attention to,” they said.
There was also an unexpected bonus. “I get a lot of comments about my metallic rainbow stethoscope. People really enjoy that, so that's been fun,” they noted. “It's little things like that that help LGBTQ patients feel comfortable and feel like they're safe with their provider.”
The importance of pronouns and names
“Often in medical charts, I'll see patients being misgendered or referred to by their deadname (name given at birth) instead of the name that they go by,” Dr. Woods described. “Those are just very simple ways of honoring and respecting a patient. They indicate that you are a safe place and safe person for them to be who they are.”
“Conversely, if you go to a doctor and they use the wrong pronouns, and they use the wrong name, it immediately puts you on edge. It immediately makes people feel unsafe. I think it's important to be able to have the awareness to ask what people's pronouns are.”
It’s important to have staff at all levels who are trained to understand how to ask about pronouns and why it's important to use someone's lived name. Dr. Woods holds regular training with their staff on topics like that.
Dr. Woods’ personal revelation about their pronouns came about during residency. “I came out as queer in college and felt genderqueer. I didn't talk a lot about my gender identity for a decade or so. It wasn't something that I felt comfortable talking about except among other queer trans folks,” they said.
“In residency, I shadowed an expert in gender-affirming health, Dr. Madeline Deutsch, at the Dimensions Youth Clinic. One of her first questions to me was, ‘What are your pronouns?’ No one had ever asked me that before. I told her I didn't really know, but I went home and thought about it.”
As part of their work, Dr. Woods precepts medical students from UCSF. “The students I work with have been wonderful and curious and eager to learn,” Woods described. “They have all expressed interest in learning about transgender healthcare. They've all been interested in understanding the complex medical conditions that happen commonly to people experiencing homelessness. They want to learn it all.”
Learn how the 3M™ Littmann® CORE Digital Stethoscope makes it easier to hear body sounds and support clinicians with hearing loss.
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