Dr. Ng Brings Personal Experience to Patient Care

A Knowledgeable Team

At the Center for LGBTQ+ Care, “We know that the success of our patients’ wellness depends on the skills and knowledge of the teams of people who care for them,” he says. That’s why the new fund that Dr. Ng established (see accompanying story) includes training support for all members of the center’s team, not just physicians and nurses, but also medical assistants and scheduling staff. “They can attend conferences and meetings in person to learn skills and gain experience and knowledge that will help them provide even better care for our patients.”

Providing the best care requires an understanding of patients’ unique medical challenges, Dr. Ng says. For example, “Recently, along with one of our trainees, I saw a patient who happened to be transgender and had gender affirmation surgery. This patient was very worried about having cancer, based on a symptom, and the trainee and I performed an exam and spent time talking to them to learn why they were so concerned. We found that the patient had multiple family members who were diagnosed with or had died of cancer.”

The patient wondered whether their gender affirmation surgery had anything to do with the possibility of cancer or the symptom they were having, he says.

“We had to have additional knowledge about their health, their anatomy and their surgery, and about cancer, in general,” Dr. Ng says. “We also had to have the time to communicate about what we found when we did their exam. The appointment went long, but by the end of it, the patient told the trainee that they felt relieved. I found this very gratifying.” He notes that for practitioners with less experience treating LGBTQ+ patients, “it can become more challenging to have these conversations.”

Challenging Bias

Nationally, many LGBTQ+ patients report negative experiences with healthcare. The 2015 U.S. Transgender Survey by the National Center for Transgender Equality showed what a report summary called “startling disparities between transgender people in the survey and the U.S. population when it comes to the most basic elements of life, such as finding a job, having a place to live, accessing medical care, and enjoying the support of family and community.”

“I think that stigma and assumptions that people experience negatively color interactions,” Dr. Ng says. “Implicit bias needs to be actively challenged. Without challenging our biases, we will bring them into every single visit.”

Earlier in his career, Dr. Ng says, he became aware of his own unconscious bias. “I met a patient who was a little over 60 years old whom I called by the name listed on the patient’s registration information. I said, “Hello, Mr. So-and-So, I’m Dr. Ng. It’s nice to meet you. How can I help you?’ and the first thing the patient said was, ‘Well, I’m transgender and I’m here to transition.’ What I realized at that very moment was the first thing I did was misgender that patient because my world view was to address people by what’s presented, as opposed to taking a moment and asking them how they wanted to be addressed. Now, I make no assumptions and ask everyone how they want to be addressed before they come to see me. We also make sure we use the pronouns they want to go by.”

He notes that everyone lives with multiple identities and experiences. “It’s called intersectionality. The idea is that people’s experiences are multifaceted. Some of them may grant us privilege, and some may not and may place us in the way of experiencing discrimination. We take care of patients who are not just LGBTQ+ but who also may be older, younger, wheelchair users, neurodiverse, persons of size, immigrants – there are all these different layers to all of us. At Cleveland Clinic, many people are aware of diversity, and a growing number of us are paying attention to how these identities intersect and interplay.”

To make LGBTQ+ patients feel safe, Dr. Ng says, “we have to make sure that the whole healthcare system is affirming and encouraging. This will take time. More people, especially younger people, have a lived experience of having trans and nonbinary friends, and they are making sure that we are held accountable for being inclusive. But change doesn’t happen overnight. We have to be intentional, and having resources to provide education and funding training is important.” Dr. Ng encourages colleagues to consider making a gift to the fund for the Cleveland Clinic Center for LGBTQ+ Care.

“I think that the opportunity to give and make a difference is huge, and we never know what impact we can make,” he says. “Whatever is offered may be very useful for patients, patient care, training and education. I believe that the funds we raise will give us the tools to change lives and improve health, and whatever people choose to give will make a difference.”