In this MD Newsline exclusive interview with family medicine physician Dr. Alexis Smith, we discuss primary care and LGBTQ+ healthcare challenges and disparities in the wake of the COVID-19 pandemic.
What are the biggest challenges that primary care physicians are tasked with in the wake of COVID-19?
Dr. Alexis Smith:
“I think the biggest challenges for me have been that I’ve had to do many visits over the phone. Particularly, visits with teenagers over the phone can be very tricky because you have to make sure that the teenager is away from their parent and able to talk to you in private. In some cases, especially in the safety net setting, that’s not possible, so the children end up not telling you what’s really going on.
So I’ve really been trying hard to have teenagers come to well-child visits. I try to get a sense if they seem to be struggling with anything to have them come in and separate them from their parent in a way that I can clearly see that they’re separated from their parent and that I can talk to them alone. So that has been very challenging during the COVID-19 pandemic.
The other thing is people losing their insurances, switching healthcare systems, and if they need mental health support, that causes a lot of delay in getting that support. If the support is over the phone, again, when people are in closed quarters, they may not necessarily be able to confide in their therapist, which can be very challenging.
I have been trying my best to see these patients face-to-face with what my system allows me to do, especially now that LA is not in a huge surge right now. I’m trying to see my patients face-to-face as much as possible. But it has been very challenging, and I know that during the COVID-19 pandemic, LGBTQ+ people are often living with their families and not accessing the same safe spaces that they could before.
And so many of them feel like they cannot be the gender that they prefer to be at home, they cannot express that [identity], or sometimes they feel that they cannot reveal their sexual identity at home, and that’s been very challenging to address, and heartbreaking for me, also.”
Do you think LGBTQ+ health disparities have worsened during the COVID-19 pandemic?
Dr. Alexis Smith:
“The Trevor Project’s activity has doubled during the pandemic at times. Social isolation is hurting every young person today, including straight youth. But having factors compounded like being LGBTQ+, being a racial minority, or having socioeconomic stress on top of social isolation can be very hard and very challenging for these patients.
Additionally, accessing care for transgender patients has been more challenging, especially during surges, when a lot of the specialty clinics don’t have as much availability as they normally have. So it’s been a big challenge for this population.”