In 2015, Parkland Health & Hospital System opened a clinic to meet the growing need for comprehensive and affirming medical care for the transgender community. In five years, the Parkland Transgender Health Clinic has grown to serve more than 500 patients. The clinic currently operates one day a week in three locations. They provide behavioral health care, primary health care, and hormonal treatments.
Achieving Together spoke with Dr. Lara Johnson, Medical Director of Homeless Outreach Medical Services (HOMES) at Parkland Health & Hospital System in Dallas, TX, to learn more about her experience providing care for transgender clients.
What is the benefit of having a separate transgender health clinic rather than integrating transgender care into the larger hospital system?
Before we opened this clinic, we held multiple focus groups with transmale patients and transfemale patients separately. We listened to their experiences and they described their dream clinic. Almost overwhelmingly, the desire from the population that we were serving was to have a separate clinic. Currently, I’m the only provider within our program who is comfortable treating the transgender population. Knowing that there is a time and a place where I will consistently be is important.
What was involved in creating an affirming, community-feel clinic within the context of a larger hospital system?
We had a program manager who was instrumental in helping us do outreach to the community. This included informing the people who needed to know about the clinic without the danger of the clinic becoming a target. We made sure that the staff who were present in the clinic wanted to be there, were willing to be trained in cultural competence, and were the right fit for starting this initiative. Of course, there were also logistical things like making sure that medications were on the formulary at Parkland and that our patients could access those medications, making sure that we had all the right tubes to draw all the right labs in clinic.
How has the clinic evolved since its beginning?
We started in August 2015 with several patients who were kind enough to be our “patients-in-training.” These initial patients were helpful as we gained confidence in running the clinic. Now after being open for four years, we’ve gained a foothold in the community. Patients tell their friends that it’s a good place to get their healthcare. We see two new patients every week and have a two-month waiting list. We are open on Tuesday afternoons.
What has surprised you throughout the development of this clinic?
I’m surprised by what a rewarding and rich clinical experience it’s been. I’ve been working with the homeless population in Dallas for 12 years. My heart is in it. I was anxious when I first started working with the transgender community because I didn’t want to say the wrong thing or do the wrong thing. I’ve become more comfortable over time. I am amazed by the strength of these patients, the adversity they’ve endured, and the grace with which they’ve handled that adversity. It’s the most rewarding clinical experience I’ve ever had. Knowing this is a place where people can come and feel respected, safe, and well-treated is a point of pride for me. People say to us, “This clinic has saved my life.” That’s the best thing you can hear as a clinician.
What do you see as the specific needs for HIV prevention and care in the transgender community?
We recognize that portions of this population are exceedingly vulnerable. It is important to be willing to talk to all of our patients about sexual health. We want to make sure that the patients who are living with HIV are engaged in treatment and are taking their medications and, hopefully, are virally suppressed. We want to offer PrEP when possible for our patients who are high risk. We know that certain segments of the transgender population are disproportionally affected by HIV. We are trying to prevent new cases.
What would you tell clinicians who are interested in providing transgender care?
Humility is always your friend. What I’ve learned is that I will occasionally misstep with pronouns or references that can make someone uncomfortable. But recognizing that and not being afraid to apologize for a misstep is important. That being said, most of our patients are really grateful for our services and understand when things happen. As long as there is that trusting relationship and they know that things weren’t done out of malice, then it’s not as uncomfortable as one might have imagined. Like anything in medicine, we’re all scientists and we should all be striving to continue to learn and grow and develop professionally. This is one of those areas where I feel like we’re behind the times.
Every primary care physician should learn how to manage transgender health. It should be ongoing continuing education and it should be integrated as much as possible into practice. That is a standard of excellence for care. It shouldn’t be something that’s specialty care. It should be integrated into the primary healthcare of an individual.
Sexual health is part of health care and I hope that all providers are comfortable discussing sexual health with their patients. I am concerned about the movement toward allowing medical professionals to discriminate on who they see and how they offer care. I personally don’t believe that medicine is about the provider; I think it’s about the patient. That’s where the focus needs to be. My hope is that providers will remain patient-centered and patient-focused.
What advice would you give to someone starting a transgender health clinic?
- It’s important to have a liaison with the community.It’s helpful to have someone from the community on your staff if possible.
- It’s helpful to have someone from the community on your staff if possible.
- Don’t be afraid to put your feet in the water and get started.
Where do you hope to be three years from now in this work?
- I hope that within three years we have a mobile clinic site that is providing health care in a location that is easier for our clients to access.
- I’m hoping to recruit another provider or two to participate in the healthcare of our transgender population.
- Currently, we have the transgender clinic at the Irving Health Center once a week. I’m hopeful that all of Parkland’s Community Oriented Primary Care (COPC) health centers – there are 12 locations – I’m hoping that each COPC has a weekly transgender clinic.
- I also hope that we have at least a biannual outreach to transgender males – a health day when cervical cancer and breast cancer screening can be offered to a population that might not be comfortable going to a breast center where things can feel overly feminine.
My eventual hope is that some number of years from now the stigma will be gone, the hate will be gone. I remain hopeful that the human race is still on the path toward justice, acceptance, tolerance and fighting for equal rights for every human being.
Resources for transgender health care
Lara M. Johnson, M.D., joined the HOMES Department at Parkland in March, 2008. She graduated from UT Southwestern Medical School in 2002. Following a family medicine residency at John Peter Smith Hospital in Fort Worth, Texas, she completed a fellowship in medical editing and faculty development at Georgetown University. During her fellowship training, Lara first worked in a homeless healthcare center at Unity Health Care, Washington, D.C.’s largest network of community health centers.
Lara has a passion for the underserved. As a child, she visited Parkland Hospital daily for 6 weeks after her mother had brain surgery for a fungal infection. Her father received healthcare from the Dallas VA Hospital after he was diagnosed with HIV in 1988.
Lara is dedicated to serving the vulnerable members of our community, and started Parkland’s first transgender clinic in August 2015. She spoke at the Crystal Charity Ball event in 2016 to help secure funding for a new mobile medical unit. In 2017, Lara was named Parkland’s physician of the year. Her work and advocacy for the homeless have been featured in two KERA radio interviews, two Dallas Morning News stories, and a profile in D Magazine.