What does PRIDE month mean to you? An interview with Travis Reece-Nguyen, MD, MPH, FAAP

By Becky Wong, MD

Dr. Travis Reece-Nguyen is a pediatric anesthesiologist at the Lucile Packard Children’s Hospital (LPCH) at Stanford. He is the LGBTQ+ Health Leader for the Stanford Anesthesiology Department, Medical Director of the Gender Recognition and Affirmative Care through Education (GRACE) Team at LPCH, and Chair of the Diversity, Equity and Inclusion (DEI) Committee in the Society of Pediatric Anesthesia.

What does PRIDE month mean to you?

PRIDE month holds deep significance for me as a gay man, a husband, and as a father. Growing up in rural Texas in a non-accepting family environment, I desperately needed a sense of community and acceptance, but it was not until I left Texas that I found acceptance within the LGBTQ+ community and our allies. For many folks like me, PRIDE represents inclusivity as it creates a sense of community where I continue to find support and solidarity. PRIDE is a time when I can fully embrace my identity and celebrate the diverse LGBTQ+ community to which I belong. As a gay father, PRIDE month also allows me to celebrate not only my own journey but also the achievements of LGBTQ+ parents and families who have fought for recognition, acceptance, and the right to love and raise their children with pride. This month reminds me that I am part of something greater: a vibrant and resilient community that embraces love, acceptance, and equality.

What are the health inequities among the LGBTQ+ community?

Historically, the LGBTQ+ community has faced significant challenges in accessing appropriate and respectful healthcare. Discrimination, prejudice, and lack of knowledge among healthcare providers have resulted in inadequate care, health disparities, and disparities in health outcomes for LGBTQ+ individuals. Barriers in LGBTQ+ healthcare can include refusal of care based on sexual orientation or gender identity (aka medical discrimination which was recently made legal in Florida), limited cultural competence, inadequate training on LGBTQ+ health issues, and the absence of inclusive policies and practices. These barriers not only contribute to physical and mental health disparities but also impact the overall well-being and quality of life for LGBTQ+ individuals. Healthcare organizations and providers are increasingly recognizing the importance of providing affirming, inclusive, and competent care to LGBTQ+ patients. Steps are being taken to address these issues such as implementing LGBTQ+-inclusive policies, enhancing provider education and training, and creating safe and welcoming healthcare environments.

By breaking down barriers in LGBTQ+ healthcare, we can improve health outcomes, promote well-being, and foster a more inclusive society. It is essential that healthcare providers and systems recognize the unique needs and experiences of LGBTQ+ individuals, providing them with the care they deserve. Through education, policy changes, and ongoing advocacy, we can create a healthcare system that is inclusive, equitable, and affirming for all members of the LGBTQ+ community.

Can you give us examples of ways to provide the best care for patients of the LGBTQ+ community?

Certainly! Providing the best care for patients of the LGBTQ+ community can simply mean creating a welcoming and inclusive perioperative environment. One of the best ways to improve LGBTQ+ healthcare is by increasing your own cultural competence by educating yourself about the specific healthcare needs and experiences of LGBTQ+ individuals. This includes understanding the spectrum of gender identity, sexuality, and the unique health disparities faced by the community. Those in positions of power should provide training to their faculty and trainees which should cover LGBTQ+-specific health issues, cultural competency, and inclusive language. Another simple way to create an inclusive perioperative setting for gender diverse patients is to respect gender identity by using a patient’s correct pronouns and chosen name. If you do not know their pronouns, you can simply ask, which helps you avoid making assumptions about gender identity. It is also completely acceptable to never use pronouns during a patient encounter and only use the patient’s name instead. It is important to ask

As patient advocates outside of the OR, we can also seek to make our perioperative/clinic spaces a welcoming place by displaying LGBTQ+-friendly signage/literature and ensuring access to all-gender, single stall restrooms. You could also update intake forms to include options for gender identity and chosen names, but when updating forms make sure to use gender-neutral language and avoid assumptions about family structures or relationship statuses. Lastly, at the organizational level, you can advocate to include non-discrimination policies that explicitly protect individuals based on sexual orientation and gender identity. This can also help ensure that your LGBTQ+ patients and employees feel safe and respected in your healthcare facility and within your department.

Although I’ve listed a few basic individual, departmental, and organizational actions that you can take, the most important aspects of providing care for LGBTQ+ patients all center on physical and psychological safety. Every anesthesiologist can do our part through self-education and advocacy to help provide an affirming and positive experience for LGBTQ+ patients throughout their perioperative hospital stay.

What are some common misconceptions?

There is a long-standing misconception that started nearly 60 years ago that being LGBTQ+ was a choice and a mental illness. This claim has repeatedly been disproven by major medical and psychological organizations over the last several decades because sexual orientation and gender identity are not choices. They are an inherent aspect of a person’s identity, and any attempts to “convert” someone’s sexual orientation or gender identity are harmful and not supported by reputable medical organizations. Unfortunately, we are now seeing the same tropes and arguments that were used to discriminate against the LGB community in the 1980s starting to resurface against the transgender and gender-diverse community today through anti-trans legislation and political rhetoric.

Another very common misconception in healthcare is that all LGBTQ+ individuals are at high risk for HIV/AIDS. While HIV/AIDS does have a disproportionate impact on certain populations, particularly racial and ethnic minorities and gay, bisexual, and other men who have sex with men, not all LGBTQ+ individuals are at high risk. Risk factors depend on various factors such as sexual behavior, substance use, and access to healthcare. Please avoid the discriminatory trap of assuming all gay men are high risk for HIV. As anesthesiologists we occasionally encounter HIV+ individuals in the OR setting which presents us with the opportunity to be an upstander by speaking up if we hear anti-LGBTQ+ discriminatory statements from others.

Perhaps the most important misconception to debunk is that the LGBTQ+ community is not a uniform, monolith community. The LGBTQ+ community is beautifully diverse and encompasses people with different backgrounds, experiences, and healthcare needs. It is important to approach each individual with sensitivity and avoid making assumptions based on stereotypes.

It’s crucial to continuously educate ourselves and challenge these misconceptions to provide the best possible care to our patients in the LGBTQ+ community.

Can you tell us about the GRACE Team that you are leading at Stanford?

The clinical needs of transgender and gender-diverse patients have outpaced healthcare training which has opened gaps on how to define best practices. Medical and nursing school curricula continue to overlook this growing population, leading to a healthcare workforce that is unprepared to adequately and safely care for this vulnerable population. Additionally, gender-affirming care is largely excluded from research and medical education funding, further exacerbating the widespread lack of provider knowledge about gender diverse identities and health needs.

Our Gender Recognition and Affirmative Care through Education (GRACE) Team at Stanford Children’s Hospital is a multidisciplinary team that provides gender-affirming care education to hospital employees, leads quality improvement initiatives, serves as content experts in hospital leadership, and promotes research efforts aimed at improving the healthcare experiences of all transgender and gender-diverse patients. We provide essential education to medical, nursing, ancillary, and support staff across the hospital system and have educated nearly 1,000 employees over the past year alone. Increasing providers’ knowledge of gender-affirming care vastly improves patient experiences and outcomes while promoting a more informed, compassionate, and culturally-competent workforce.

As the Medical Director of the GRACE team, I’ve been lucky enough to speak on the importance of perioperative gender-affirming care all over the country and I encourage anyone interested in learning more about our GRACE team or how to improve gender-affirming care in their own departments to reach out to me!