#pgy-3

[justinesattendingadventures]

I just started a patient on HRT for the first time ever in our residency clinic!!

After ~2.5 years of residency, 1.5 years of building a LGBTQIA+ curriculum, 4 months of advocacy seminars, and a whole lot of barriers, we have finally gotten the okay to start initiating hormone therapy for the purpose of gender affirming care.

This patient is one of two who I had already started the evaluation and informed consent process. We had actually already decided on a plan to start estrogen, but this week the administration approved our official informed consent form so she came in, signed it with my colleague, and got to start estrogen tonight!!

This is a huge milestone for our clinic, residency, and community but also for me, my colleague (who has been a huge champion for all of this change), and of course my patient. I'm honestly a little bummed that I wasn't the one in clinic today to have the visit after doing all the evaluation and informed consent, but the excitement and progress is definitely worth it and I'm thankful for that.

[dontf-ckwiththepancreas]

Sometimes, I wish Epic had an emoji feature just so that I could throw a much-deserved 🙄 or 😒 into a note every now and then.

[heartbeatsandrainstorms]

Curse my rejection sensitivity/anxiety/need for approval/perfectionism all to hell and back. 

I have spent hours stupidly staring at my computer screen in unable-to-do-things mode because I’m too damn afraid that when making this presentation I’ll do it wrong. 

[mdrambles]

The only good thing about telemedicine...

Considering I have ++telephone anxiety:

...this telemedicine thing in a relatively rural area (I’m on my community pediatrics rotation right now, but holding my breath because I might be redeployed at any moment) has been a bit... sucky. We do have online video-enabled telemedicine available, but our connection is spotty on the best of days, so we figured the most reliable thing would be to run clinic over the phone. I have... not been having fun.

But, like a shining oasis in an endless sea of “WHYYYYYYY???”, I got to call a family about their little toddler bean with a skin lesion for which we have been implementing surveillance measures for this likely benign skin lesion. When I called, I could hear the little guy chattering away in the background. Finally, he said, “Mommy, who are you talking to?”, to which his mother responded, “I’m talking to the doctor, honey.”

He gasped in the dramatic way that only toddlers can do with such innocent sincerity, then wailed, “But Mommy, I have an appointment! I’m supposed to see the doctor!”

“I know, honey, but because of the virus outside making people sick, we can’t go to our appointment. That’s why Mommy’s on the phone with the doct--”

“NOOOOOOOOOOOOO!!!”

Throughout this exchange I had to mute myself because I was laughing so hard.

Thank you, my little friend, for making me feel so much better after a few weeks of... well, yuck. I appreciate you!! <3

To all my colleagues providing healthcare in whatever way you can, thank you for everything that you’re doing. We’ve got this.

To everyone who is stocking shelves, keeping the transport lines moving, feeding people, cleaning the hospitals and the clinics and everywhere else, taking care of the kiddos either at home or in the various childcare centres that are still running, thank you. To everyone donating PPE and supporting others in this difficult time, thank you.

And to everyone who is staying home and appropriately distancing to flatten the curve, THANK YOU!

[captainmdphd-blog]

Thanks to a low census and over-scheduling, I was able to leave work ridiculously early. After a wonderful, two-hour nap I’ve spent my day lounging in my recliner in my underwear, eating popsicles, and watching Netflix.

[justinesattendingadventures]

Hi friends! It's been a while... Or is two years more than a while?

Anyway, I've continued to not only survive residency but also grow as a person and physician. Over the past two years, I have found my niche in family medicine moreso than just my OMT and behavioral health focus (which are both still going strong by the way). I have become one of the only providers of gender affirming care in my area and a fierce advocate for the LGBTQIA+ community.

Because of this, I have started to further my learning through a year-long LGBTQIA+ health fellowship seminar series. This program has requested I post a reflection on a blog after each seminar, and since I already have a blog, I figured why not post here and spread the knowledge to the medblr community.

Anyway, I just wanted to make an intro post explaining the posts to come so it's less weird when I start posting very specific/niche blog posts. As I stated before, I am a fierce advocate for the LGBTQIA+ community and I will literally just be posting my homework, so any anti-LGBTQIA+ comments will be deleted and the user will be blocked. I don't have time to debate strangers on the internet as to why human beings should be allowed to exist.

[justinesattendingadventures]

Which intervention level (individual, interpersonal, organizational, systemic) resonates most with you? Describe an action step you intend to take to advance sexual and gender minority (SGM) health equity at this intervention level.

I have always been most fulfilled by making changes at the interpersonal level. Individual changes are probably the easiest to complete but don't have that same sense of fulfillment and organizational/systemic changes are often a bit too daunting and I become easily overwhelmed with so many changes needed.

I have already made some significant interpersonal interventions since co-creating a LGBTQIA+ family medicine curriculum. The one intervention that really left an impact was just openly discussing the community and their needs with a co-resident who was very hesitant about caring for this community and listening to the bad experiences she had had with a member of the community in the past. She felt heard and was then open to taking in more information and learned that several of her colleagues also belong to the community. I watched her become more engaged through further lectures and start to relate the SGM health issues to issues she has faced as a racial minority. She then graduated and went on to provide care for minorities of all types in Missouri, somewhere that desperately needs open minded people like the amazing doctor that I watched her become.

My next interpersonal action step is to teach our new interns about LGBTQIA+ competent care. They are all so excited to learn how to best treat all of their patients. Unfortunately, it is up in the air as to whether our residency will allow me to continue giving regular formal lectures on this topic as there has been a lot of push back from a few opposing individuals. Regardless, me and my colleague who developed the curriculum are seen as experts in this field of medicine, especially gender affirming care, and the interns have already started bringing all of their questions about that to us. While I have quite a ways to go before I consider myself an expert, I do have a lot of knowledge and resources at my disposal and I look forward to teaching them how to best treat all of their patients regardless of my ability to have formal lectures.

[heartbeatsandrainstorms]

We're starting to talk about post-residency plans and assignments.

Shit's starting to get/feel real.

Also put my money where my mouth was last year around this time-- people were saying there were places they were hard nope-ing (as much as they could anyway) in terms of location and then looked askance at me when I said that I would probably volunteer for some of those spots-- because I told the person in charge of assignments that I'd be open to those locations.