Smitty Heavner-Sullivan’s doctor had just attended a conference on the HIV-prevention drug known as PrEP when he showed up for an appointment a few years back.
Knowing her patient was gay, Heavner-Sullivan’s doctor couldn’t wait to tell him about the drug and how he could sign up for it. At the same time, Heavner-Sullivan said the doctor ignored everything else told her about his health, including the fact that he had been married for four years and had little chance of contracting HIV.
“There are other things that are more pressing for my health, and instead of looking at me as an individual, (she) reduced me to my sexuality and tried to treat that instead of treating me,” said Heavner-Sullivan, a nurse at Prisma Health Greenville, speaking on behalf of himself and not Prisma.
Heavner-Sullivan’s experience was just one example of bias surrounding lesbian, gay, bisexual, transgender and queer people in health care that the Medical University of South Carolina is now trying to fix.
MUSC has embarked on a plan to improve health care for LGBTQ+ people, reduce bias in medicine and create a center for transgender health. These efforts come at a time when transgender people around the country have found themselves under attack, including in South Carolina, where legislation has been introduced to criminalize transgender health treatments for minors and ban transgender girls from competing in K-12 sports.
MUSC’s first step came last month when it hired Chase Glenn as its first director of LGBTQ+ Health Services and Enterprise Resources, a first-of-its-kind position in South Carolina. Glenn, a longtime community activist for the state’s queer community, will be in charge of coordinating improvements to care for LGBTQ+ patients and helping design the new transgender health center.
“It’s about the health services that we provide in the community and making sure we’re meeting the needs of the community and getting the positive outcomes that we know the community deserves,” Glenn said.
The statement “First, do no harm,” is one of the most important elements of medicine. Thousands of medical students each year take an oath to abide by it. However, without knowing, many doctors could unintentionally harm their patients, Heavner-Sullivan and South Carolina public health professor Ann Blair Kennedy said.
Both said they don’t believe doctors or other health care professionals go into their work seeking to make LGBTQ+ patients feel uncomfortable or unwelcome; it just happens.
It can be hard for some doctors to acknowledge that biases they’ve held for a long time — assuming a woman plans to have children with a husband or expecting a born-male patient to identify as a man, for example — could be harmful, they said. LGBTQ+ people handle their lives differently than other patients.
“People — and I’m a little bit of an optimist — want to do good things, and they want to be good people,” said Kennedy, a professor at the University of South Carolina School of Medicine Greenville. “And it is very painful and sometimes uncomfortable to then discover that what you have been doing in your everyday actions hurts other people.”
It’s issues like this that Glenn and MUSC hope to address.
“It’s not just about finding your one gay patient and saying, ‘Hey, you should go on PrEP,’” Glenn said. “But what does it look like to have conversations about PrEP with all sorts of different people?”
Heavner-Sullivan said Glenn’s new role made him want to “jump and cheer” to see an institution make such a direct statement of support for LGBTQ+ health care.
“It, I’m hopeful, will send a very clear message to especially that community, but also the whole state that the health care workers of the state of South Carolina care about the citizens of South Carolina, regardless of who they are,” Heavner-Sullivan said.
Making basic changes
One of the most basic changes Glenn will help coordinate is how health care workers ask patients about their gender identity and what pronouns they use.
“The fundamental needs of LGBTQ folks are not necessarily being met” when a physician doesn’t gather that information, Glenn said.
Glenn and his boss, MUSC chief equity officer Willette Burnham-Williams, know it will be a challenge to implement this change. Some doctors, Kennedy said, have expressed fears over whether queer patients will be willing to answer gender- and sexual-identity questions at all and say they are afraid to ask.
“We need to be in the practice of normalizing these conversations so everyone begins to feel more comfortable asking these types of questions,” Glenn said.
Asking these questions can reduce a patient’s suicide risk and increase uptake of smoking cessation advice, Heavner-Sullivan said. More than that, health care workers introducing themselves with their own pronouns can help remove barriers, too, he said.
In one instance, Heavner-Sullivan said telling a patient his own name and pronouns made them feel more comfortable sharing that they had been using black-market hormone therapies.
“Because I walked in and made that introduction, we were able to make a connection very quickly and recognize what was happening,” Heavner-Sullivan said. “Simply by adding, ‘My pronouns are,’ I was able to save probably weeks of a medical evaluation for this patient, hundreds of thousands of dollars and identify their problem. And, likely the problem would have resulted in death some months later.”
Some heterosexual and cisgender patients might be confused, and others might get angry at the question, Kennedy said. Nevertheless, Glenn said this is just another important part of patient education.
“Sometimes we have to navigate some uncomfortable conversations, and the way we do that is with more education,” Glenn said.
Burnham-Williams said MUSC will train frontline workers first, to ensure LGBTQ+ patients feel welcome from the second they walk in the door.
First of its kind
At other South Carolina health care institutions, including Grand Strand Medical Center, Lexington Medical Center, Prisma Health and Tidelands Health, a position as specific as Glenn’s doesn’t exist. Most have diversity boards or diversity officers who handled a range of issues, including LGBTQ+ patients.
“We have not (given) this particular community of our patients and their families the equal kind of care and service that they deserve,” MUSC’s Burnham-Williams said.
While a broad approach to patient diversity is important, Kennedy, the public health professor, said specific roles like Glenn’s can help ensure that LGBTQ+ people do not end up forgotten.
Unlike race, the attributes that define LGBTQ+ patients cannot necessarily be seen. Traditional approaches to diversity in health care, Kennedy said, often focus on the two binaries of Black or White and male or female.
“Those are the two things that people automatically want to address, so there is a possibility of having some communities left out of conversations,” Kennedy said. “For example, size and weight diversity. … There is always the risk that there might be groups that are not at the table.”
Prisma Health, one of the largest health care providers in the state, said it “has leaders, physicians, and a Pride Alliance Business Resource Group actively identifying gaps in care for this population and ensuring that any barriers are addressed.” The system also offers a list of physicians that specialize in care for LGBTQ+ people, including gender-affirming hormone replacement therapy and surgery.
Grand Strand Health, in the Myrtle Beach area, has an equity compliance coordinator who “oversees access to services for patients and their companions, inclusive of LGBTQ+ individuals.”
“Our commitment to a diverse, equitable and inclusive organization is not passive; it is active,” Grand Strand Health CEO Mark Sims said in a statement. “This commitment means an engaged and inclusive culture for our patients, for our colleagues and for our communities.”
Tidelands Health, another Myrtle Beach area health system, has a diversity and inclusion officer, with support from an advisory council, but no specific role overseeing LGBTQ+ health.
Kennedy said there is a benefit to having one overarching diversity officer, namely when it comes to coordinating progress. If health care organizations do have separate positions, she said it’s extremely important that they are working together.
“If you are not part of this community, it’s not in the forefront of your mind, and you don’t necessarily even understand that it’s a problem,” she said.
Glenn’s hiring comes as states around the country, including South Carolina, have sought to pass laws to bar and even criminalize doctors who provide gender-affirming treatment to transgender minors.
South Carolina bill H. 4047 would make it a felony for doctors to provide transgender health treatments to minors, such as hormone-replacement therapy. Prescribing puberty blockers, which delay many bodily changes associated with person’s assigned sex at birth but are widely known in the medical community to be safe, would also be banned. The bill has stalled without a hearing so far.
A separate effort by some state lawmakers to ban trans girls from school sports also fell flat twice this year.
“Trans folks right now are really being targeted in lots of different arenas,” Glenn said. “We’re seeing that they are maybe are the easiest target right now, specifically in the LGBTQ community. When there’s fear of discrimination within health care, we know that people will delay taking care or maybe not seek care at all. This is literally an issue of life and death for LGBTQ folks.
“We need to really do our work to increase awareness and understanding and bring us to a space where LGBTQ folks know that they’re going to be accepted and welcomed,” he added.
Burnham-Williams acknowledged that moving forward with some of MUSC’s priorities, particularly concerning transgender health care, will be difficult and might face opposition. But she still believes that “greater than 80%” of people will support them.
Despite being a state-supported institution, MUSC doesn’t have to reflect the “standard historical South Carolina conservative ways of doing things,” she said.
Burnham-Williams said she’s received many emails in support of what they are doing for LGBTQ+ people in the state.
Regardless of what laws the state passes, Burnham-Williams said MUSC will be pushing forward.
“We will always be pushing for the best kinds of advocacy that we can for the LGBTQ community,” she said. “We know that sometimes that may get us in trouble, and we’re ready to face that trouble and to focus on doing what we said we’re going to do, which is take care of the LGBTQ community in the way that it deserves to be cared for. We’re not going to be examples of historical kinds of stereotypes and exclusion.”
Taking a risk
Burnham-Williams is sure MUSC will make mistakes as it works to improvement health care.
But “it’ll never be done well until we’re willing to take the risk,” she said.
A major part of Glenn’s role is to help prevent mistakes and, when they do happen, help MUSC learn from them.
“Now we will have someone who has lived the experience,” Burnham-Williams said. “What I love about Chase is he’s going to keep us honest and on point.“
But hiring Glenn isn’t the be-all-end-all, Heavner-Sullivan said.
“We cannot rest just because there is an officer for LGBTQ health. It’s not done,” he said.
Glenn said he also recognizes that as a white man, his experience as a queer person isn’t all encompassing. So he said he’ll be spending time on outreach and connecting with other communities to make sure voices from the whole spectrum of LGBTQ+ people, including nonwhite people, are heard at MUSC.
“Whenever possible, you should be using an intersectional lens in this work, so we don’t just get stuck in my one perspective as the trans, white man,” Glenn said. “Just because I’m in this position, I’m not the only voice from the community that needs to be heard.”