In honor of Pride Month, we bring you an episode dedicated to fostering a more inclusive environment for our LGBTQ+ community. Join us as we have a compelling discussion with Dr. Lisa Moreno-Walton and Matías Castro about what it takes to achieve this goal. ​

Show Notes

​

[0:00-4:25] - Intro by Dr. DJ Gaines and Dr. Pooja Jaeel
  • We goes over common LGBTQ term definitions-- included at the bottom of the show notes

[4:34-6:26] -Introduction to Dr. Lisa Moreno-Walton(she/her/hers) and Matias Castro (they/them)
  • Matías clarifies that pronouns aren’t “preferred”- they are pronouns and it is important to be intentionally used

[6:43-8:30] - A Step in Their Shoes
  • Matías says their love of art and to stream “How I’m Feeling Now” by CharlieXCX to help artists with Indegenious/Black/Brown backgrounds.
  • ​Dr.Moreno is a proud New-Yorker and mother, she loves cooking, working out, music, kayaking and gardening

[9:00-9:27] - Need for Change  
  • Pooja mentions the statistic from the 2008 National Transgender Discrimination Survey Report: 19% of transgender or gender nonconforming patients were denied service and 28% of those patients were verbally assaulted. Also, LBGTQ patients are less likely to reach out for service.

[9:55-15:46] - Facts about the LGBTQ Center in Sacramento 
  • Matías gives background about the LGBTQ center in Sacramento and themself:
    • Important for centers to provide services because the government is not a reliable resource for LGBTQ persons. 
    • ​Provides HIV and STD testing/prevention work 
    • ​Place where POC can receive support from other POC
    • They are a health educator, offers rapid testing and gives counseling sessions. Also gives cultural humility training
    • ​Explains how they have the advantage to help people who have never had medical access in the United States, act as a first time medical system navigator to get them some services

[15:48-19:15] - Faults in the Medical System
  • Dr.Moreno discusses her experience working with LGBTQ patients in the Emergency Room and the faults in the medical system dealing with LGBTQ persons: 
  • Patients are uncomfortable because of their bad experience. Sometimes patients turned away just because of their sexual orientation. LGBTQ, racial and other social stressors are more prone to be marginalized, making them less likely to come in, making them sicker even though LGBTQ people are more at risk for medical issues/social traumas. 

[19:30-25:19] - Ways to Address the Issues 
  • Matías and Dr.Moreno  discusses how they try to fix problems in medical system: 
  • ​As a nonprofit, Matías is in charge of all the testing and outreach. There is a lack of funding, but passion is what drives them. 
  • Dr. Moreno tries to address the issues in the Emergency Department. She does HIV/STD testing and domestic screening. Teaches residents to ask patients about their primary care physicians to refer patients to specific doctors good for them. Never sends a patient home unless they have a place to stay, are able to take their prescriptions and have a follow-up appointment. 
  • ​Dr.Moreno discusses how trainees don’t feel equipped to deal with these specific patients, so they utilize Dr.Moreno as a source and use didactic and open training. Also hosts workshops. 
  • Dr.Moreno published a paper discussing discomfort and lack of knowledge that  medical professionals have when dealing with LGBTQ patients, and has created resources and faculty to help.

[26:30-33:10] - The Ideal Environment
  • Matías describes the ideal environment for centers: 
  • ​People want a relaxed, non-judgmental environment with a  human connection with the providers
  • Dr.Moreno discusses the ideal environment for medical centers: 
  • ​Building trust is key 
  • We are the only nation that doesn’t view healthcare as a human right, health care is too much of a for-profit business. So, stresses that every patient deserves to have the highest level of care. ​
  • Pooja tells how the mis-treatment by the hospital lead to the suicide of a transgender patient-- emphasizing psychological harm of hospital maltreatment

[33:14-41:16] - How to Build Rapport 
  • Pooja asks how Dr.Moreno and  Matías built patient rapport. What are some phrases used? 
  • Matías says the easiest way is to introduce their name and pronouns to everyone they meet and allowing people to reply. Normalizing the usage of pronouns is the perfect way to help LGBTQ patients. ​
  • Dr.Moreno says that you always tell what you want to be called, what their role is and what would you like me to call you-- all part of normalizing respect. Also, medical providers need to make clear that they want to take care of the patient and offer the best possible care. Must admit if they lack knowledge in an aspect of health and take input from patients.
  • Pooja asks a follow-up question:  how to not burden patients with having to explain too much?
    • Dr. Moreno says acknowledging that, and asking “do you mind if I look a few things up” or “do you mind if I call an expert?” helps. Specialists should also include people who are experts in professional care.

[41:20-46:00] - Common Mistakes 
  • DJ asks what are things medical professionals do wrong? 
  • Dr. Moreno says that not asking if they don’t know, and not asking what patients would like to be called and they can sometimes “slip” with pronouns so invite other people in your environment to correct you. 
  • Matías sees people making a big deal out of people mis-gendering people, it makes things uncomfortable. Affirms Dr. Moreno’s advice. 


[46:50-50:28] - How to Create a More Inclusive Environment 
  • DJ asks Dr. Moreno what she does to make the workfloor more friendly for LGBTQ
  • Dr. Moreno discusses that she has gotten people to call patients the way they want to be called. She was able to add a second name in the EMR (aka), referring to the name that the patient wants to be called by. Also, encourages people to admit when they don’t know something and reach out to specialists trained in hormonal treatment for transgender patients. She also tries to recruit LGBTQ professionals to join diversity committees to create allies

[51:04-55:02] - Initiatives at The Sacramento LGBTQ Center 
  • Pooja asks what initiatives Matías is involved in
  • Matías says there are lots of health-related initiatives. They are launching a sexual health clinic in South Sacramento. Personal initiative for them, as they,, growing up in South Sac, never got tested for HIV until they were 19. They are also working on a research study with UCSF. Trying to offer HIV/STD testing using social distancing guidelines. 
  • Advises people to help they should really be engaged with the given community to amplify voices

[55:38-60:11] -  How to Advocate for the Community 
  • DJ asks how to go about talking to the people that you’re advocating for, even if you’re not part of the community: 
  • Dr. Moreno uses focus groups and makes relationships/talks with her neighbors to be informed and get different perspectives. She also does multiple education videos, and in the videos she hires actors from the actual community to inform and correct her if she does something wrong. She realizes that she has a position of power and needs to give a message that certain behaviors are not tolerable and improve the environment.

[61:05-63:50] - Take Home Points
  • Matías advises to be intentional about your work, amplify voices and continue to educate yourself. Put effort to help trans and queer communities survive, especially as doctors 
  • Dr. Moreno states you need to acquire knowledge and admit your knowledge deficits and reach out for the appropriate resources. Remember that every human life matters, and to treat everyone the way you want to be treated. If you follow simple human decency. 
    • Dr. Moreno also commends the team for giving them a voice. 


[64:04-64:29] - Outro
LGBTQ Definitions 
Pooja and DJ provide a list of relevant, although non-comprehensive, list of terms related to gender and sexuality. All definitions are directly from pediatricEducation.org - What is the Dutch Protocol for Gender Dysphoria?

  • Gender: “denotes the public (and usually legally recognized) lived role as boy or girl, man or woman. Biological factors combined with social and psychological factors contribute to gender development.”
    • ​Gender is not dichotomous and other terms such as third gender, agender or gender queer reflect this.
    • Assigned gender (birth gender/natal gender): “based on a child’s genitalia upon birth”
    • Gender identity: “individuals’ sense of being male, female, or neither”
    • Gender atypical/variant/non-conforming: “refers to physical features that are not typical of a gender of an individual in society”

  • Cisgender: “gender identity or expression alligns to the gender assigned at birth” 

  • Transgender: “broad spectrum of individuals who transiently or persistently identify as a gender different from their gender at birth”. 

  • Gender dysphoria: “when an individual’s gender identity is incongruent with their assigned gender or sexual body characteristics and this incongruence causes extreme distress”.

  • Sexual orientation: “is the personal quality inclining persons to be romantically or physically attracted to persons of the same sex, opposite sex, both sexes or neither sex.”

  • Gender expression: “the manner in which a person communicates about gender to others through external means such as clothing, appearance, or mannerisms”

  • Transitioning: “…the process where individuals change their social and/or physical characteristics for the purpose of living in their desired gender role.” It includes social and/or general affirming treatment. “
    • Social transitioning: when an individual “…starts to live in the experienced gender role and encompasses clothing, gender role behavior, and the use of a name and pronouns of that gender.” This is a reversible process.

  • Gender affirming treatment: “is the clinical approach that supports the expression of one’s experienced gender of which puberty blockers, hormone treatment, and surgeries may be a part.” This can be a reversible or non-reversible process.”

Credits:
Co-hosts/Producers: Dr. Pooja Jaeel, Dr. DJ Gaines
Executive Producers: Dr. Tammy Lin
Co-Executive Producer: Dr. Pooja Jaeel, Dr. Tiffany I. Leung
Senior Producer: Dr. DJ Gaines
Editor: Joanna Jain
Production Assistants: Sanika Walimbe, Emily Han
Website/Art design: Ann Truong
​Music: Chris Dingman

Special Thanks to Lanz Nalagan, Corporate Giving Director at the Sacramento LGBT Community Center for his thoughts and advice on this episode.

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.The DEI Shift podcast and its guests provide general information and entertainment, but not medical advice. Before making any changes to your medical treatment or execution of your treatment plan, please consult with your doctor or personal medical team. Reference to any specific product or entity does not constitute an endorsement or recommendation by The DEI Shift. The views expressed by guests are their own, and their appearance on the podcast does not imply an endorsement of them or any entity they represent. Views and opinions expressed by The DEI Shift team are those of each individual, and do not necessarily reflect the views or opinions of The DEI Shift team and its guests, employers, sponsors, or organizations we are affiliated with.