From the Clinic – LGBTQ+ Healthcare

Today we're talking with the wonderful Dr. Tassy Hayden at Southampton Healthcare in St. Louis, MO. Dr. Hayden has been practicing primary care for seven years post-residency, she has a passion for LGBTQ health, and is also an HIV Specialist. As a customer of PredictionHealth, she has really impacted our team in the way she takes care of each of her patients. We wanted her to share some thoughts with all of you.

Dr. Hayden, what do you love most about medical practice?
Being in the room with patients. I get into a flow state where I’m able to make diagnostic connections and propose solutions with ease and confidence. I love using my skills to help people feel better.

And what is particularly unique about Southampton Healthcare?
Southampton Healthcare is a wonderful place. We offer general primary care to adolescents and adults, but we have a special focus on people living with HIV and LGBTQ+ individuals. We are colorful, vocal, passionate, and really good at our job.

What has changed the most about medical practice since you started?
Ever-increasing red tape and bureaucracy means more time spent grappling with insurance companies for providers and staff. In Missouri, our Marketplace health plans have been decimated by our government and the “free market,” and the plans that remain tend to have high deductibles and restrict some patients from seeing the specialists with whom I prefer to work.

What are the biggest challenges in your medical practice?
The demands of documentation, intricacies of the EMR, and panel management. I’m not just caring for patients while I’m in the office – I’m on call 24/7.

How has your clinical documentation changed over the course of your practice?
In medical school and residency, when I was seeing fewer patients and had more time to document, I was much more comprehensive, often explaining my plan, including two or three next steps, for anyone who would read the note. Before I opted for a scribe with PredictionHealth, my notes had been stripped down to the bare bones needed to avoid litigation and ensure proper billing and payment. I wasn’t accounting for the detailed conversations I had with patients or the joint decision-making employed in nearly every visit. PredictionHealth allows me to recall easily what we’ve talked about so we don’t cover the same ground every visit. More detailed notes have also been helping my office staff get pre-certification for procedures and referrals much more easily.

How has the coronavirus pandemic affected your practice?
It’s been tough for our practice, but we haven’t closed and we haven’t had to let any employees or providers go. We leaned hard into telemedicine to keep everyone safe, and this continues to be a part of every day practice. We have changed check in, waiting room, and cleaning policies to protect our patients, since many patients needed to have in-person visits (eg for lab monitoring of CD4+ counts and HIV viral loads) even during the heights of COVID surges.

You have dedicated a large part of your practice to LGBTQ+ patients. What is the most important thing you would tell a young physician who is just getting out of residency and wants to make that a focus of their practice?
Don’t be intimidated. It’s not hard medicine, either prevention or treatment. I would recommend picking up a copy of the Fenway Guide to LGBT Care and maybe doing a CME lecture or two on transgender affirming care and pre-exposure prophylaxis for HIV. The biggest thing is to change your mindset. You might have been taught rather rigid ways to approach taking a history and performing the physical exam, but removing troublesome assumptions and approaching every patient with an open mind and heart, focusing on risk reduction and trauma-informed care will help you succeed. People are people and deserve quality care that’s right for them. Making room for non-gendered language (“partner” or “spouse”, introducing yourself with your pronouns) with all patients will likely help you learn more about your patients and yourself. 

What do you tell patients who mistrust the medical system?
Medicine as a whole has a fraught relationship with many and we have much work to do to earn the trust of the LGBTQ+ community as well as BIPOC patients and the un- and under-insured. Many practicing providers are working to dismantle the centuries of white supremacy and heteronormativity that have and continue to hurt so many. I see and appreciate their efforts every day. I work hard to hear their concerns, acknowledge them as valid, and brainstorm ways to find the best care we can. Compassionate help is out there, and a good place to start looking is small, quirky practices like ours. 

Where can the US healthcare system improve (I know there are lots of areas!) when it comes to equality of care for LGBTQ+ patients?
A great start would be for the Senate to pass the Equality Act to make discrimination based on gender identity or sexual orientation illegal. With that, we can start building a system of equity and put energy and finances into infrastructure for employment, housing stability, and safety for LGBTQ+ people. Universal insurance coverage of evidence-based, life-saving treatment including gender affirming surgery and hormones as well as PrEP needs to be the norm. On an individual provider/practice level, more of us need to be comfortable prescribing these treatments. It’s not hard medicine. It’s also not hard to avoid assumptions of heterosexual and cisgender states that make many members of the LGBTQ+ community uncomfortable. (See American Family Physician articles about PrEP and GAHT.)

Has anything from your personal journey really impacted your professional career/practice?
So much has made me who I am. I’ve struggled with mental health issues since my teenage years, including both restriction- and bingeing-predominant disordered eating as well as generalized anxiety disorder and major depressive disorder. I’ve had two bariatric surgeries. I am an obese, bisexual woman from a lower-middle class family. I’ve known some degree of struggle despite my relative privilege, and that makes me aware that everyone is going through something and we all deserve to be met with genuine interest and compassion. It also informs my view that many of the stated goals of medicine are not appropriate for all patients and a risk reduction approach is much more widely applicable than aiming for “normal”.

What is your favorite book and why?
Oh, this is so hard! I am always reading, and I enjoy a bit of everything. That being said, I’ve read several books twice, but only one three times: Little Women by Louisa May Alcott. It’s amazing how books resonate differently at different ages. I first read it when I was ten, and the stories of playfulness among a group of sisters were the best part. When I was 22, I enjoyed the stories of the adult sisters stepping out on their own, working hard toward independence and fulfillment. Most recently, at 35, I enjoyed the interpersonal dynamics of Laurie looking for a chosen family, Jo grappling with the restrictions of gender roles, and Marmee working to make the world a better place not only through her own actions but through the lessons she passes on to her children. Also, did you know that Louisa May Alcott supported her family with her writing and also served as a nurse during the Civil War? 

Who are some people that you really admire and that have impacted you personally or professionally?
Julia Child, Meghan Markle, Lizzo, my mom, and several of my patients who have dealt with health issues gracefully despite their young age. I’m proud of people who swerved in their life because of their passions, their health, their loved ones. I’m proud of people who are proud of themselves and champion their differences from the assumed cultural norm, whether those encompass their gender, their race, their body shape, their financial status, or their disabilities. They remind me that I can stand proud of who I am as well as who I’m aiming to become and that taking care of myself needs to be a priority.

This has been so wonderful to hear from you. Please share with us just a couple more fun facts about you or your practice.
My favorite types of visit are: 1) Starting a trans patient on gender affirming hormones and 2) initiating sexual preventive health practices, eg PrEP and contraception. The light in patients’ eyes when they realize that they can have control over their lives in these very personal but important ways is a can’t-miss visual.