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Healthcare disparities within the LGBTQ community

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Meet The Disruptor: QSPACES

Queer and trans people have worse health outcomes than the general public. A local couple is trying to change that with a Yelp-like doctors app for LGBTQ Philadelphians

Queer and trans people have worse health outcomes than the general public. A local couple is trying to change that with a Yelp-like doctors app for LGBTQ Philadelphians

When Catherine Hofmann and Nic Anthony moved from North Carolina to West Philadelphia in the summer of 2015, they felt like they had almost everything they needed—a sweet apartment, an upcoming wedding to plan, their spotted dog Tex, and the start of an exciting med school career for Anthony—except for one thing. Since they had just moved here, they didn’t have a wide circle of other queer friends.

“I’ve always loved solving problems,” says Hofmann, a self-taught designer with a background in activism. “So when I see a problem I can solve, I dive right in.”

Hofmann and Anthony thought the answer to their friendship-building problems could be in the form of an App. Hofmann created a survey to gauge interest in a queer social app that she and Anthony sent out to over 300 local queer people.  

The responses were not what the couple were hoping for. Many respondents said, yeah sure, but those apps kind of already exist. But a crucial piece of information emerged from that survey. “The response was overwhelming,” Hofmann says. “The number one thing queer people we knew were concerned about was healthcare.”

In the open comments section of the survey, respondent after respondent posted about needing a therapist or a doctor or a specialist who was also sensitive to the needs of queer and trans patients. They also began to notice that in a Facebook community for exchanging goods and advice amongst queer Philadelphians, the most common thread was a queer or trans person asking for a recommendation for a health provider that was competent and queer-friendly. “Every time I would log on there would be a new post and a lot of people would comment and exchange experiences but then in a week that info was gone or hard to find,” Hofmann says.

Queer and trans people have much higher rates of substance abuse, mental health issues and suicide, as well as much worse overall health outcomes. Often this is because queer and trans patients are more likely to face discrimination from doctors and other healthcare providers, delay necessary medical care because of fear of discrimination. Queer people are also more likely to be uninsured, have gaps in insurance coverage, or experience other barriers to access.

So Hofmann and Anthony pivoted to meet what was an obvious need. In late June, they launched QSPACES, a website designed to assist the Philadelphia queer community find  health providers through a database with the capability to rate and leave feedback on their experiences—essentially the Yelp of queer-competent healthcare.

Through QSPACES, users can search for a potential provider by name, identify providers in a given field or practice, or contribute the names of providers who aren’t yet included in the database. (Hofmann and Anthony purchased a list of 7,500 Pennsylvania providers to kick things off but are depending on us to populate the site with names that are missing). Similar to sites like Healthgrades and ZocDoc, QSPACES allows users to rate providers with a star rating and leave written feedback, but it also breaks down ratings into three categories: overall, quality of care, and LGBTQ competency.

Providers can also add themselves and will eventually be able to pay to have an extended profile offering their services to the queer and trans communities. These ads and brand sponsorships will fund the site, and Hoffman says they plan also to generate revenue through subscriptions. (Hoffman runs QSPACES, while also continuing to do freelance design work.) In the future, using Anthony’s skills, QSPACES hopes to also be able to offer cultural competency training for providers. And the couple plans to expand QSPACES to cities across the country, starting with New York, Washington D.C., and Baltimore.

Hofmann and Anthony at Philly Pride 2017. Photo by Jim Shulman

Queer and trans people have much higher rates of substance abuse, mental health issues and suicide, as well as much worse overall health outcomes. Often this is because queer and trans patients are more likely to face discrimination from doctors and other healthcare providers, delay necessary medical care because of fear of discrimination, and receive substandard care due to a provider being poorly trained or uneducated about LGBTQ bodies and experiences (not to mention the dark past of the medical establishment when it comes to the trans community). Queer people are also more likely to be uninsured, have gaps in insurance coverage, or experience other barriers to access.

As a med student hoping to become a doctor of Emergency and Orthopedic surgery, Anthony was seeing these problems play out first hand. Courses or textbooks would sometimes rely on stereotypes and outdated case studies. Medical schools usually have diversity trainings but it tends to be a quick one-off lecture. Of the top 30 medical schools, the average amount of time spent on training providers to be attuned to the needs of minority patients is usually 3-4 hours or a referral to online resources. “That should be baked in,” Hofmann says, “a doctor never knows who’s gonna walk through the door next.”

And once Hofmann and Anthony started talking casually about their interest in this topic, people started coming out of the woodwork to share doctor horror stories. “I knew something was wrong with me, but my doctor didn’t believe me,” one friend told them. “I felt like because I was queer no one was taking me seriously,” said another.

The project began in earnest in October 2015 when Hofmann made the first sketches and the couple entered Thomas Jefferson University’s JAZ Tank innovation pitch contest. They didn’t win, but the university’s innovation fund decided to invest $10,000 in QSPACES anyway. Hofmann and Anthony used that money to hire Webjunto, a design firm committed to diversity, and then contributed from their own savings to finish the website.

Similar to sites like Healthgrades and ZocDoc, QSPACES allows users to rate providers with a star rating and leave written feedback, but it also breaks down ratings into three categories: overall, quality of care, and LGBTQ competency.

Cameron McConkey, a provider of education, counseling, and HIV prevention services at the John Bell Health Center of Philadelphia FIGHT, says he regularly works with patients who come to his clinic because they are uncomfortable discussing their sexual orientation, gender expression, and/or sexual history and desires with their primary healthcare providers. Until now, his clients learned of LGBTQ-competent doctors through word of mouth, or on social media, limited to their individual networks.

“With QSPACES, individuals would have access to community-generated information relating to the competency and sensitivity of healthcare practices and providers,” McConkey wrote in an email. “By centralizing this information, I have no doubt that QSPACES will increase institutional and individual accountability around LGBTQ+ competency and sensitivity in the Philadelphia healthcare network.”

Indeed, as review sites like Yelp, or even Amazon, have revealed, public customer feedback can make or break a business—something their owners are aware of. Restaurants check and respond to their Yelp reviews, even changing policies and dishes to respond to patron’s needs. On this more serious playing field, QSPACES could have the effect of creating a wholesale change in the way doctors respond to the needs of LGBTQ patients. The site doesn’t promise to suggest the best eye surgeon in the city—that’s outside its purview. But it could, when it’s in full use, point queer patients to the most sensitive fertility specialist for their needs, or the most knowledgeable psychiatrist. And it could provide a blueprint for all medical providers to do better.

“Our first goal is to make a platform for users to make a better informed decision about who they choose as a provider,” Hofmann says. “The side effect is that providers can see what their patients are saying about them and it will push them to provide better care for everyone.”

Header photo: Michelle Chu

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