CINCINNATI — For many of us, going to the doctor can be intimidating enough. For people like Zach Reinstatler, the experience can be much more so.
As a person who is transgender, Reinstatler said, "I've experienced discrimination, absolutely."
But it's also the medical transition treatments they've received at the University of Cincinnati Medical Center that they said "saved (their) life."
"When I started coming here for treatment, I was in a much darker place," they told WCPO.
'From the moment they walk in the door'
Reinstatler credits the life-saving work, in part, to one of their doctors, Dr. Sarah Pickle with the UC College of Medicine: In addition to treating patients like Reinstatler, she's working to correct what she characterized as a lack of training among MDs when it comes to LGBTQIA+ issues in medicine.
"Med schools now, the average for LGBTQ curriculum is about four hours," she told WCPO, which is why she's working with residents like Dr. Andrea Jaramillo to broaden that education, post-medical school.
"Follow the same principles that we follow with any population — respect, love, compassion," Jaramillo said.
Pickle also worked to create other signals of affirmation among UC Health's culture and processes, such as revising patient paperwork to ask patients for their preferred pronouns or gender identity.
Affirmation, she said, "starts from the moment they walk in the door. It's what they see."
It also takes understanding: Pickle is also working to develop a virtual reality learning module — scheduled to launch in March 2022 — to help doctors and clinicians better understand the experiences of transgender people. Once launched, the training will be available to any clinician in Ohio.
"How do we create a culture of caring?" she said. "It has to start with training."
Learning to talk about LGBTQ health
Pickle's work marks a stark contrast from just three or four decades ago, when public discussions about LGBTQIA+ healthcare revolved primarily around HIV and AIDS, creating a culture of fear and shame, as it was often called "a gay man's disease."
It's a misconception that Cincinnati Black Pride founder Tim'm West said still persists today.
"It's not only not fair; it's really inaccurate," he said.
According to the Centers for Disease Control and Prevention, nearly a quarter of HIV diagnoses in 2018 were in people who identified as heterosexuals, and roughly another 7% of cases were related to intravenous drug use.
West's journey with the disease began in the late 1990s. He said that's when he got his first glimpse about the medical field's difficulty talking about LGBTQ health issues.
"I trusted someone who said he was negative," he said. "I was in a relationship with that person. That ended, left with something as a reminder of it."
When he was first diagnosed, he said, the message he was given was grim.
"At the time, they didn't have the language, so the doctor told me I had full-blown AIDS," he recalled. "It was pretty scary."
It prompted him to seek out a new doctor. He found a clinician who was both black and gay, whom he identified with. He said the compassionate, connected care impacted his attitude and, therefore, his health. He was more inclined to follow medical instructions.
In 2021, his viral levels are undetectable.
Affirmation as health care
Dr. Shanna Styker, with Equitas Health in Walnut Hills, said LGBTQIA+ communities "have been disproportionately impacted by poor access to health care because of discrimination," and that bad experiences with providers can cause people to delay or avoid care. That can lead to worse health outcomes.
Julia Applegate heads up the Equitas Health Institute, which oversees research and education for the organization across the state of Ohio. She said a comprehensive approach to healthcare is critical to people in LGBTQIA+ communities.
"The coordination of care is so important because the amount of homophobia and transphobia in our bigger society is so strong," she said.
As a lesbian, she said she had to wonder if her appearance ever prevented her physician from talking with her about certain things.
"All through my prime fertility years, I was never asked if I wanted to be a parent," she said. "Not once."
She said medicine still has a long way to go, but she said LGBTQIA+ patients will have a better experience now than even 10 years ago due to strides in affirming care, like the kind Pickle is working to instill at UCMC.
"Medical transition has saved my life," Reinstatler said. "Dr. Pickle has been a huge part of that. She's affirming. She's understanding."