Licensed Marriage and Family Therapist, Direct Patient Care
Melle Browning is a Licensed Marriage and Family Therapist (LMFT#115804) and earned his Master’s in Counseling Psychology from Dominican University of California.
Mel has a private practice providing psychotherapy for a range of issues such as anxiety, depression, life transitions, and relationships with a focus on attachment and trauma.
Mel is trained in EMDR and other somatic approaches to trauma informed therapy and has specific training and experience in providing LGBTQIA+ and trans/gender diverse affirming care.
Mel is a queer gender non-conforming trans man and has a passion for social justice and trauma informed work, believing both are key to forming and maintaining healthy communities that thrive.
Mel has experience training hundreds of volunteers, mental health and medical professionals, law enforcement, and student leaders on a range of issues and populations such as trauma informed crisis response, LGBTQIA+ populations and working with gender diverse individuals with an emphasis on improving and providing affirming care.
In this kickoff to PRIDE Month at My DPC Story, Mel Browning, a long-time friend of Maryal and an LMFT himself, Mel discusses his own take on insurance-driven care and how affirming care can greatly affect the health of an individual. Through his discussion of telemedicine, use of affirming language to care for those in the LGBTQIA+ Community and much more, Mel's take on his care as a gender non-conforming queer man is eye-opening and gives a lot of food for thought for those seeking to provide more affirming care.
Resources Mentioned And Recommended By Mel:
- PFLAG - Parents, Families, and Friends of Lesbians and Gays
- User Way (an AI powered accessibility tool for those who visit websites)
- WPATH - World Professtional Association for Transgender Health
- Inclusive Therapists - A Directory of Inclusive Therapists
CONTACT:
707-200-4968
Socials - IG and FB: mellebrowningtherapy
Website: mellebrowningtherapy.com
SHOW TRANSCRIPT*
Melle Browning DESCRIPT
[00:00:00] Direct primary care is an innovative alternative path to insurance driven healthcare. Typically patients pay their doctor a low monthly membership and in return build a lasting relationship with their doctor and have their doctor available at their fingertips.
[00:00:29] Direct patient care means to me that you can make the best possible clinical decisions for your client, for your patient, without your experience and your clinical expertise, making those decisions instead. Right. So I think that it, it means providing the best possible care and directly to, to your patient and to your client, just in terms of pride month.
[00:00:53] It's like interesting right. To I think oftentimes. LGBTQ eye plus [00:01:00] health is highlighted during pride, but you know, we exist all throughout the year. Right. And it's just making it joke with somebody recently. Definitely. I think it's a, it's an opportunity to celebrate. I think oftentimes there's a lot of hardships and challenges and heartache that happens, but, I think.
[00:01:20] There's a time to celebrate and have pride in who you are. But I also think it's important that we recognize how pride came to be, which that started as a riot. And it started as as fighting back back against oppression and that systemic oppression continues to this day. And so it's like, it's a continued journey.
[00:01:41] So I see it as like, yes, there's still those, there are celebrations. And there's also a recognition of the continued systemic oppression that happens in all systems in our society. And so I think that. As a direct primary care doctor, it's important that you [00:02:00] recognize the systemic oppression that exists, right?
[00:02:02] So that someone's health is going to be impacted by, whether they can get housing, whether they can get employment, whether they can access gender affirming care. That's a huge, I mean, research really shows that the health and wellbeing of the person increases dramatically when they have access to gender affirming care and transition related care.
[00:02:21] So I think that being really aware of that and knowing what that means, like it has a direct impact on all aspects of their health, mental health, and physical health and wellbeing and note, knowing the challenges that come with. The marginalization that you know, has happened for folks within the community.
[00:02:40] So being aware of all of that and then doing your best to provide affirming care means that you're going to be having such a huge impact on their health and wellbeing and it's needed. So I really hope that more of you out there will be interested in, shifting practices to make care accessible to folks.
[00:03:00] [00:03:00] I'm Melle Browning of Melle branding therapy. And this is my DPC story. Welcome to the podcast, Melle. Thanks for having me. This is wonderful. So just for the listeners to know I've known Mel for over 20 years, I think we calculated 25 before recording. And it's just incredible one to think about that. I've known someone for that long and to that it's been that number of years.
[00:03:24] So it is, it is such an honor to have you kick off our month of pride at my DPC story. And as you heard in Mel's credentials and bio, he is an LMF T who does accept cash pay for patients. And so knowing that he absolutely understands the pressures when it comes to insurance versus non-insurance driven care.
[00:03:51] And also he is a queer gender non-conforming trans male. And so he appreciates. Affirming care from a very different perspective [00:04:00] than somebody who is not necessarily part of algae, part of the LGBTQ community nor providing care yet to the LGBTQ community as a clinician. So Mel, I'm gonna toss the mic over to you, and if you can share about your practice specifically and.
[00:04:21] We'll go from there. All right. Thank you for having me. So I I am the practice owner of Mel brownie therapy and that's a private practice in Petaluma, California, and that's in Sonoma county in California. And I, my focus is on a couple of things, so I focused on trauma. So working with folks that have experienced trauma, which so many folks have as well as, depression, anxiety, life, transitions, relationship, parenting issues.
[00:04:48] So, kind of a whole host of things, but another area of focus is gender diverse folks and providing gender affirming care, as well as affirming care to anyone in [00:05:00] the LGBTQ plus community. So that's a huge area of focus for me. Now in your practice, you do accept one insurance and you also accept cash pay.
[00:05:11] And so for folks who are DPC physicians or direct specialty physicians, this is always something that is very interesting, because especially now that we're having more specialists join the direct patient care movement, how do you work with both an insurance as well as cash pay patients? And what are the challenges with both for you?
[00:05:35] Yeah, well, I think, I think it's something that a lot of therapists struggle with in terms of whether I'm going to accept insurance or not. And if I am like, How many, insurance companies. And I've really limited that just because of some of the issues with, the low pay and the amount of time that you're spending and whether or not that's going to be sustainable for a practice.
[00:05:55] And, if I can't sustain my practice, I can't provide care for, my clients. So that's been [00:06:00] something that I've considered. And then just in terms of the amount of pressures from insurance of like, what type of care I can provide and what type of care they cover and what they don't cover and trying to dictate care, that's, that's all things that I think a lot of therapists struggle with.
[00:06:15]And for me making the decision to not accept all kinds of all insurance under the sun, and, but also trying to make some things. Accessible for folks. So I think it's a, it's a back and forth kind of decision making process for a lot of therapists. But for folks that wonder why therapists don't accept a lot of insurances it's oftentimes because of the experiences that we've had with insurance and times of providing care and also trying to make our practice sustainable.
[00:06:42] So I think oftentimes that that's part of the issue. And then just in terms of a lot of things, not being covered by the insurance, but a client actually needs that. And that's what they're coming in for. That's what, that's the care that they need. So, providing an opportunity for folks to be able to, to access the care that they need.
[00:06:59] When [00:07:00] you talk about access to care, it's quite, it's, it's quite a good thing for some people who are able to pay cash for services. I mean, we've seen. Online services like that are helping Talkspace Regaine those platforms find a lot more traffic because of one limiting care in person, but two, because people can pay out of their pocket for care and they're not relying on their insurance to be able to access care for mental health.
[00:07:35] So that said with regards to COVID, how has your practice changed because of the pandemic? Yeah, well, it all went to tele-health. So, I still maintain an office and we'll probably be adding more in person in the future. It's, it's hard knowing with the pandemic where things are headed, but hoping that in-person will come back.
[00:07:58] I know that that some therapists have been [00:08:00] doing in person with, a lot of protections and things like that. And for me, just the risk still didn't make sense. If it was possible to provide care for folks via telehealth. So yeah, changing that that's, that's been actually. In some ways. I think it's been really beneficial because folks that sometimes would make it, it would be really hard for them to seek care in person and make that step.
[00:08:20] They're like, oh, I can actually be in my home in the comfort of my home and actually attend appointments. So I think that in some ways it's been really beneficial for folks accessing care, to be able to make it more like they don't have to have a car. Like they don't have to, so it's like, yes, they need to have some type of like phone connection or wifi and find a way to do that and usually have some type of electronic device, but oftentimes folks do have that or they have access to utilize someone's to do that.
[00:08:48] And so I find that in some ways it's been easier for some folks to finally actually reach out and connect with care. So, but it also has been a great challenge because folks are really struggling with mental health [00:09:00] because of the pandemic on top of other things that everyone's dealing with right now, but that has been a collective trauma.
[00:09:05] That's been ongoing and chronic for a long period of time. And that has a big impact on people's mental health. So, so seeing that in folks as well is, yeah, it's a, it's an extra challenge to have a global pandemic happening on top of other mental health concerns. With regards to telemedicine as the way that you are able to deliver care for clients.
[00:09:25] Can you touch on the effectiveness of telehealth versus in-person visits and where the differences lie, or if there are any differences in terms of quality of care between the two, between the two modes? Yeah. Well, I mean, the research has actually been pretty clear that it's been as effective as in-person care.
[00:09:46] I know that a lot of folks have a lot of different opinions and I do think that certain things can be more beneficial in person. Right. So if someone's feeling really isolated, Being in person can provide a lot if it's a child, [00:10:00] that play therapy is going to be a lot of the work. Again, there's ways to do that with tele-health, but it might not be quite the same as in-person.
[00:10:07] So there's certain things that I think can be challenging with tele tele-health but on the whole research shows that it does effective and I've, I've actually found that to be the case. I was kind of skeptical. Even though I knew that what the research was because I do EMDR, which is a trauma focused therapy, and I was like, there's no way I can translate this to, cause I had not done that I hadn't done before.
[00:10:30]And it's actually been really effective for folks. So, it's, that's been a learning thing for me during this process. So yeah, I appreciate your sharing that because. I think that yes, for physicians, but also for patients, this idea of like, oh, it's not, it's not the same as visiting the doctor.
[00:10:50] And then when we throw in examples of, you don't necessarily need to come into the doctor to talk about your lab results. It's very different when a patient comes in for a physical [00:11:00] finding versus going over lab results on a piece of paper.
[00:11:04] So I feel that using in-person visits to support tele-health is so important and we're telehealth can be used. It's quite effective. And I am glad that you shared what you did. And I know just from my patient's experience with telehealth, before I went on maternity leave, they had not really thought about how effective it could be.
[00:11:27] And I'm glad that indirect primary care, especially tele-health is not something that is deemed. Approved or not. If, if insurance is not taken and trans can't tell us what to do. And so, yeah. So thank you for that. Yeah. There's a lot of challenges right now in terms of trying to get parody for tele-health and insurance and different states.
[00:11:46] And I mean, there's just, there's a lot going on there, but yeah, I mean, I've had some folks that were kind of, they were like, oh, well, I'm going to do this right now because that's the only thing available, but I really want to go back to in person when you have that available. And now they're telling me, they're like, actually I [00:12:00] really want to keep it.
[00:12:01]I, I've been asking to make sure that I'm going to continue offering tele-health because for them not having to drive because sometimes with traffic sometimes it's, it's a good chunk of time that folks don't have to worry about. And they're like , this has been working for me really well.
[00:12:14] So, I do have some folks that want in person when that's available, but on the whole, a lot of folks are like, actually I'm probably going to continue with tele-health after this. So yeah, it's, it's been, something that is sometimes a challenge is if folks don't have the privacy.
[00:12:28] Yeah. Aspect. And, for the LGBTQ plus community, when I'm been dealing with folks that have moved back home, like if they're college age student, students that have been moved, moving home, maybe they're not out, at home, or maybe it's not an affirming environment. That's been an extra challenge with, I think the pandemic, but but on the whole, still having access to care, even if they've, had to move back home or they, or they can't travel, being able to still access therapy has been really in if somebody is struggling with a challenge specifically, like if they're not, if they have not [00:13:00] come out yet to those around them, how have you seen creative ways to overcome that challenge in your clients? I mean, I think it depends. I think sometimes they're, they're really valid reasons that folks are not out, right, because it's either not safe or, they like, they they're going through a lot and that's not the time for them to try to come out to non affirming, family members.
[00:13:24] And so, getting, I think in those instances, just my pushes to connect with, for folks that are affirming, because, the research is clear that when folks are in a non affirming environment, the risk of suicide and other mental health concerns increased dramatically. So getting them connected to community is really important, whatever that looks like.
[00:13:45] That's a zoom social hangout with the local LGBTQ organization. Great. If that's therapy with an individual therapist, if that's connecting with other folks in any type of queer group or trans or gender diverse [00:14:00] groups, that's gonna. The benefit to their mental health, especially if they're not surrounded by an affirming home environment.
[00:14:08] So, it's like connecting folks which has been really great to see the local organizations pivot to providing online which is to say again, there's going to be a benefit to in-person, right. But if that's not available the different creative ways that you can connect it to communities is really important.
[00:14:25] When you mentioned affirming care, I want to, especially because we're starting off the month of pride at my DPC story, I want to talk about definitions of particular LGBTQ plus terms as well as when they are considered affirming versus non affirming usage of those terms.
[00:14:50] If that makes sense. Right. I mean, usually again, like I think something to really Have in mind in terms of affirming and not affirming care is like not [00:15:00] assuming like you're going to actually be able to get along way by just not assuming what things mean.
[00:15:06]And so, the word lesbian or the term lesbian is going to possibly be different depending on the person. But folks usually use lesbian to describe someone who is a woman and who is also attracted to. A woman or someone that's feminine. Or same, same sex, right? Folks will sometimes say that as well, or same gender gay usually again, like again has been utilized in a lot of different ways.
[00:15:34] Right. So, but usually means I'm a man who's attracted to the same gender. Right. So another man or male. So, and then bisexual again, that's been it depends on who you talk to. Some folks, it means that you're attracted to both men and women, other folks, and, and some folks argue that that's very binary.
[00:15:54] Other folks argued that you can identify as, and I use a identify, right? You [00:16:00] can say that you are bisexual and that does not mean that you are saying that you just are attracted to a binary. So that could be you're attracted to your gender. Folks of your agenda, same gender and folks that are not your same gender.
[00:16:17] And it could be like others. Right? So Penn sexual usually means all kind of all genders. And so again, like folks can have a lot of different terms and what that means to them and within that. Right? Like, so I think that just knowing that the way that folks use a label can, can depend on the person and the definition can, can be slightly different depending on the person.
[00:16:44] So really it's like who that individual is and what does that mean to them? Right. And, and, and the terms that they use in terms of queer, that is a word that I love. I love queering things up. And I, [00:17:00] I consider that things that like don't fit inside. Like certain boxes, like I kind of consider as queer and that's, that's my view of it.
[00:17:08] But, it has a history of being used as a slur, against the gay community. So, I'm not going to necessarily use that word if the person that, the patient or the client that I am working with is not using that term. So, if that person doesn't use queer, I'm not going to use queer for them.
[00:17:24] I use grit for myself. I love the word queer. I think that it's really all in kind of inclusive and and open to all of the ways that I don't fit into a lot of the, notions of, of what people think like I certain box or label is. So it works well for me in terms of. Too, that folks oftentimes don't know what they mean.
[00:17:46] So cisgender and transgender. So cisgender, that is not a derogatory term. Some people think that it is it's like, well, no, it's just that we have transgender. So we're like, okay, well what's, it's not just like, you're [00:18:00] normal. And then you're trans like, right. It's like, we want to like have words that describe people who are trans and folks that are not, not trans.
[00:18:08] So it's like that, that there is a word for it. So, and it's a cisgender. So cisgender just means that the gender you were assigned at birth, you identify as that gender, right. It matches. And that's a huge part of the population is cisgender. So transgender. The definition that is often used, there is a little caveat that I put with it.
[00:18:31] So, so transgender usually means that someone was assigned a gender at birth and they do not. Well, that's not the gender that they have. So they, so let's say they were assigned female at birth. And now they are clear that that's not their gender and their gender actually is male or non-binary or gender fluid or other what's important to note is that [00:19:00] folks that are born intersects, right.
[00:19:02] So they're oftentimes put in a category also, and they might not identify with. The category that they were put in, but that doesn't necessarily mean that they're transgender. So, that's sometimes a little confusing for folks, but I think it's clear. It's important to say that because there are, I think sometimes a lot of folks that are intersex are lumped into the trans community and they're like, wait, like, those are actually two separate things.
[00:19:27]And I might also identify as trans. But that's, I might be trans, but that's different. So then intersects. So, and then in terms of other terms, right, there's just all, there's all sorts of gender identities. So folks can identify as a gender or gender fluid or by gender,
[00:19:50] so there there's a lot, or non-binary, and to be queer non-binary means like it's not male or female. But that doesn't mean that [00:20:00] it's like. Right in the middle. It's not like, oh, there's a spectrum. And like on one side is female and the other side is male and I'm in the middle. That's not what I'm binary is.
[00:20:09] Right. So it's not like, oh, that means that you're androgynous for some people, but it's its own separate gender identity. So I think that that sometimes gets confusing for folks because we like to put people on like in little boxes and we like to put them on a spectrum and in terms of a binary and that's not exactly how humans exist.
[00:20:32]So it's important to really know those terms in, to, in terms of like what it means in terms of non-binary folks, trans folks as gender folks. And that's just kind of, that's, those are a few, right? That's not a whole long exhaustive list of terms to be aware of. There's a lot of great.
[00:20:51] Educational sites, to, P flag is a great resource as well in terms of definitions. But a lot of LGBTQ organizations will have like [00:21:00] definitions on their website and then in terms of gender nonconforming. So I consider myself a gender nonconforming trans man. I say that because I don't conform to the ideas of like what, what society says like a man is supposed to be, or, how a male is supposed to present.
[00:21:20] One simple example is I like to wear eyeliner. I think guys look cool wearing eyeliner. And I think all guys should be able to wear eyeliner without an issue. But that doesn't mean that I'm not a dude. Right. So non-conforming in my, in the way I. View it right. Is just that, that I don't conform to a lot of the ways that society, like big takes that particular gender should act or present or go about the world as in terms of how we conceptualize gender identity.
[00:21:54] Like something to think about is a lot of times I'll hear folks say, oh, well, they were born as a [00:22:00] man. And now they're a girl. And like that is really non affirming way of describing someone's experience. So in terms of what is often said, and again, this is always evolving, but it's often said someone was assigned by gender at birth, right.
[00:22:16] And then they, this is their gender identity. So let's say I was assigned female birth that's me. And now my gender identity is male or trans male. So, someone might be assigned male at birth and they, their gender identity is non-binary or female or gender fluid and so on and so forth. So to be clear, the reason why that's important is that we're not saying that person was something else.
[00:22:46] And then they changed into something else. It's like they were born who they are and they are presenting their authentic selves now, but they were assigned something else at birth. Right. It's like folks looked at them when you [00:23:00] shall be this and, stamped it on a form. Right. So, and this is just being clear that that's not the case for the folks are burned who they are.
[00:23:09] And then they authentically are now presenting who they are to the world. I think that's so important. And I appreciate you sharing that foundation for us to build on. As we hear the next three guests. This month, because I feel that my education in medical school, as well as residency was next to zero, when it comes to being a person practicing, affirming care.
[00:23:36] So I think that is also reimport. That is also really important for the listeners to hear, because they're going to be hearing those terms used in the next three weeks as well. Now, my next question to you is what does your intake form look like when you have a new client addressing affirming care? Well, it's different now that it's like all [00:24:00] online.
[00:24:01] Um, So some of it what's, which is like an ongoing issue is some of it is dictated and non changeable from the electronic health record system that you're using. And there's a lot of us that are pushing for certain ones to change, to be more affirming. And then also sometimes because someone might be, Submitting it to their insurance afterwards for out of network reimbursement or things like that.
[00:24:25] Like it has to have a legal name on it that might be different or like certain things need to be on there. Which is really difficult for folks. Cause they're, needing to fill out things and put things in there that like Kimberly bring up a lot of stuff for folks. So it's challenging, but What's important for me is that folks are able to put their gender identity, their pronouns and things like that.
[00:24:49]And the, the name that they use and that's things that they can enter into the intake and system. So for me, that's part of affirming care is like the forms you [00:25:00] use. Like what, how, how was it stated? And I, I don't know how many times I've been in an office that you have to like check male or female, or you have to like, where there's no place to put pronouns, and I know that they're going to just start mis-gendering me.
[00:25:13] And and so sometimes I'm like written it at the top, like, and, sometimes that helps sometimes it doesn't, but some of the things that folks can consider when, when they're trying to make their practice more affirming is like, Do you have a place to list pronouns? Are you asking what folks pronouns are the name that they go by right.
[00:25:34] Versus versus whatever else, other name that you need to have, what are your forms have in terms of, I think a lot of times I'm handed a form that says like, when was your last menstrual period? Right. And I'm like, so if in my chart it says that I am a trans man and I've had a hysterectomy, why do I have to be considered, constantly asked that question.
[00:25:57] Right? So I think certain things like that can [00:26:00] improve the, the patient experience and can improve their ability to trust you, to feel comfortable. And therefore the more that they're comfortable, the more that they trust you, the more they're going to share, kind of important information that you need to know as their, as their doctor.
[00:26:13] Right. And the more willing that they're able to actually follow up. With care, and because I'm not the only trans person that has put off going into the doctor, because I don't want to have to deal with some of the things that I've dealt with. So, and that impacts people who are, if they have a chronic health issue that needs managing, right.
[00:26:31]It's like, that has a direct impact on their overall health, if they're putting off care because they don't want to experience care or be, I mean, there's plenty of folks that are denied care, I've been denied care, right. So it's like, it, it happens. And so yes, there's like kind of like horror stories about people being denied care and then there, and then there's just like non affirming care.
[00:26:54] That's going to be subpar care. And then there's, how can we be affirming and really [00:27:00] provide great care to folks that are coming in to see you and really, really need folks to be affirming of who they are in all the different ways that you can. Whether that's the bathroom is that you have at your facility, whether it's the forums that you use, whether it's, whether you're you're mis-gendering me or using, my name or not.
[00:27:20]Those are all gonna be things that, that play into my experience. As a patient, I, I just, I really appreciate you also sharing that, your experience, but also the concern for every human being has healthcare needs. At some point that they need to talk with the physician about, and it's just heartbreaking because I've said this before, but I truly believe that anybody who is a human being deserves the best medicine possible and in a model like direct primary care where you have the time to develop relationship based medicine [00:28:00] based on that relationship and not based on the clock running or the insurance codes.
[00:28:06] You mentioned excellent examples of how a physician can practice in a more affirming way with regards to forms with regards to facilities. One of the questions that I have is around the idea that a doctor might be taking care of a person before and after a transition. Is that, is that the correct terminology?
[00:28:30] Yeah. I mean, I think that's a, it's, it's something that comes up definitely. Absolutely. For, for, for doctors that Some of the questions that doctors are going to ask are really appropriate, as opposed to maybe some other providers asking questions that like really don't need to be asked, right.
[00:28:45] Cause it's like, it's more about curiosity and less about what I absolutely need to know to provide appropriate care. So I think that but just knowing that some of those questions can be upsetting for folks and, and bring up a lot of stuff. It's not just [00:29:00] super easy sometimes to talk about those issues.
[00:29:02] So I think being really aware of that and then in terms of transition, being really aware of the fact that lots of trans folks part of their journey is not medical transition. Right? So some folks, assume that, okay, well, you go, this is, these are your pronouns. I'm going to assume that you're gonna go through this process.
[00:29:21]That is part of that problematic, assuming that happens. So, and that trans medical isn't, that happens in terms of just assuming that like, to be. To recognize you for who you are. It means that you have to follow this specific quote unquote transition. And that transition is a one time thing.
[00:29:38]So for me, I consider transition can mean lots of things to different people, and it can be a lifelong journey. And it doesn't go in a specific order. So that's why sometimes it is. Yeah, it is challenging. I think you, there are ways to ask certain questions in ways that are gender neutral language or being really specific to the, to the body part, [00:30:00] but it's not in connection to gender, so instead of saying, well, women need to have pap exams, like you can say, like we provide services to individuals with. Ovaries and uteruses and, vagina, is it, like there, there are things to, to, other affirming language can be like inward facing channels versus out outward facing genitals.
[00:30:22] Right? There's a lot of I think ways that folks can make their materials and their forms and their questions less problematic and more affirming. And so, one of the, some of the things that I would suggest is like gender spectrum as an organization, Fenway health or Fenway Institute is another and then world professional association for transgender health or w path are just a few out there that folks can start to get training and information about standards of care.
[00:30:51] For gender diverse folks and ways to conceptualize care ways to approach care, folks can ask like, so if I'm [00:31:00] going to the doctor and this doctor has in my chart that I've had a hysterectomy, then like making sure that you're not asking me, like when my last menstrual period is, if I've come to you over time and not like a brand new person.
[00:31:11]But you can also just ask, like, which of these, do you, do you need care with like, I mean, there's just ways to do it that take into consideration that, there are men that have periods and there are women that don't and so like, I think that just there's a lot that needs to be done in terms of improving.
[00:31:31] Yeah. Improving, affirming care for folks long-winded yes. When I hear you sharing what you did and what you have, I just. I feel that if a direct primary care physician is looking to be more affirming and they know that they have the time to do that, and they've already built a relationship with someone or they expect to build a relationship with someone.
[00:31:56] I think that's, that's wonderful to know that, to, to keep in [00:32:00] mind that that journey is not like you just pointed out, like it's not a transition that happens, over six months, this transition moments, it can happen even for a person's life. And, and I think that it's wonderful that direct primary care allows those advantages to provide affirming care for, for a patient over the longterm versus piecemeal visits.
[00:32:21] And I wonder, when, when we were preparing for our interview, I definitely am no expert when it comes to using gender affirming language. And so I reached out to you, I asked, what is. What is what are affirming questions because that I value you so much. I've known you for so long that I want to honor you as a person.
[00:32:46] And I want to use as affirming care as I can as affirming terms as I can. And so I just want to highlight also that, especially if you have a relationship or you're clearly wanting to be affirming with patients, I [00:33:00] love that just like you and I did, you can open that dialogue with your patient and say, Hey, I'm really trying to do the best by you that I can to be affirming.
[00:33:10] I like we're like, one thing that comes to mind is starting out very general. And then, there are the typical forms and if you have a form. On your website, because you need to know who's going to come in your door, having something that is very general, and then open that discussion with the time that you have at their first visit to paint a foundation of this is an affirming practice.
[00:33:37] I am an affirming doctor. Let's talk about what language you like to use, what language you don't like to use, because like in your example, how you embrace the word queer, and some people can consider that derogatory. I just feel it is very sterile. If you have a list of terms and you check box off what you identify with, it's very different than if you have that [00:34:00] dialogue with a patient as a discussion.
[00:34:02] So, so I, I really, I, I love what you've said and what you've shared, and I think it's really eyeopening to reevaluate how we, as doctors are practicing and how to effectively build more from in care into our practices. Great. And I know that, when we're seeing a lot of different folks, right.
[00:34:23] Not necessarily always going to keep in mind, but if we have that noted right in the chart, and we look at that before we see the person, right. That can kind of jog our memory. And I still sometimes need to do that. I'm like, okay, well, that's remembering this person's pronouns remembering, really taking a look though at the way that you get information, health information from people.
[00:34:45] And is there a way to ask that in a gender neutral way, is there a way to ask it only when necessary and what, and in what ways is it, is it being tied to gender or not? Right. So like women's health. Like I constantly be like, [00:35:00] oh, are you coming in for a woman's health issue? Right.
[00:35:03] And it's like, I don't know, it's like, I know what they mean by that, but it's like, again, like we now know like plenty of, men need an OB GYN, right? Like just like that's, that's the thing. So, and we'll travel for an affirming person, they're, they keep on asking me, my healthcare system wants to ask if I want to change because it's a further away person, but I found this person and they're great and I'm not changing because of my other horrible experiences.
[00:35:31] So I will drive, I will drive a distance to see my OB GYN. So, and in terms of not affirming care that just to put that out there again, it can really be varying, but we're talking about a primary care doctor. Getting upset with me because I was just having to mention, I was going to be getting top surgery.
[00:35:49]So that would be like chest masculinization, short surgery, but I was there for other things. Right? So actual health related things that were not related to my gender. And instead of talking about those [00:36:00] issues, I kept them wanting to like, Hey, let's talk about the other, physical health issues and I'm coming in for it's like, no, no, no, no.
[00:36:05] I'm very, very upset that I wanted to quote unquote trans be a man when I'm married to a man, like, why would you want to be a man? If you're married to him, couldn't get past that. And just eventually circled psychiatry on a piece of paper, like handed that to me and walked out the door. Right. So, and that is in a kind of quote, unquote, fairly progressive area in California.
[00:36:31]And then I've had another primary care doctor kind of grimace kind of in disgust because I was going to be getting some trans related, like, gender affirming surgery and said, okay, so you're getting a divorce then. Right. Was like, what was the first question she asked? And I hadn't mentioned nothing to do with having any issues in my relationship.
[00:36:50] Right. So that was not like it wasn't coming in, in distress about my relationship or anything. I was coming in for a health issue. And so those are some of the things that kind of spill out of folks because of their discomfort, [00:37:00] because of their lack of training because of their own personal biases. So some of the work I think folks need to do doctors need to do, and this.
[00:37:09] Systemically on lots of things, right? So I think racism, sexism, transphobia, homophobia, just like any other system in mental health included all that includes me. There are systemic issues in, in care. And so doctors need to be examining their own internal biases and educating themselves so that they can provide good care to folks.
[00:37:32] So important to hear, especially after them after last year than the year that we had. And the year we had with challenges surrounding all of those ways to to be affirming to others who are the same or different than you in, in all of those boats. Right. So, w we've talked about ways to provide more affirming care.
[00:37:57] And earlier you had mentioned [00:38:00] that. I mean, even, even you, yourself, you caught yourself saying the word identify as, so I wanna, I want to talk about that because I frequently will use somebody identifies as, and it wasn't until you had pointed out that that can definitely be not affirming. And so I want to ask, tell us a little bit more for the listeners to hear.
[00:38:22] What does that mean? If you say, what do you identify as, how can that be non affirming and how can one. Practice or how can one adjust if they've used that and they want to backtrack a little bit and say, oh, something different to use more affirming terminology. Yeah. Yeah, absolutely. I mean, it's something that I catch myself still doing.
[00:38:47] And so again, like, language is always evolving and it's evolving more towards more affirming care. So just like it used to be like, like sex reassignment surgery, and then it was gender confirmation surgery. And now it's gender [00:39:00] affirming surgery. Again, the difference between that, it's like, I'm not changing sex as like, right.
[00:39:04] And I'm not confirming my gender. Right. I, I am. Provide I'm getting access to care. That's affirming to the gender of who I already am. So similarly, like when you say preferred pronouns, it's like, well, it's not a preference. It's just my pronouns. It's, it's who I am, identifies as oftentimes folks are arguing that, like that saying, like, it's not really who I am, but like, I identify as that.
[00:39:26] Right. So it's that separation between like, no, this is who I am. What's hard is that I have to times talk about identities and labels and things like that. So I talk about marginalized identities and intersecting identities that are marginalized. Right. So, I use that term a lot. And so I think it's difficult.
[00:39:43]But I think that anytime that you can just say, this is who, this is who this person is. They are a, I, I, I am a white queer trans man. Gender nonconforming trans man. That's just who I am. That's not who I identify as, right. [00:40:00] So I think removing the identify as, as much as possible, but we can still talk about identities, right?
[00:40:05] Because those are like identities that we all hold. So, and I think sometimes that is hard to shift our language, but just like, it's hard for, for, y'all like, it's hard for me. And ableism is another thing that comes up a lot in language, and that is something that is super challenging for me too.
[00:40:20] And I continue to have to learn and check myself and evolve my language to be more affirming of folks. And if a person uses non affirming language or something that is frankly offensive and they catch themselves, or they think about it after a patient visit has, has finished. What advice would you give to them to adjust their care in the future?
[00:40:46] Yeah, I mean, I think again, some folks are like, oh, well, I'm just so nervous. They're going to get so upset at me. We can tell the difference between someone who's trying and not trying just to be really, really clear now I'm not speaking for all trans folks. I never [00:41:00] can and ever will, but you know, a lot of the folks that I've done training with and things like that, we're really clear that I can tell when you're trying and when you're not.
[00:41:09] So, I've been around other folks like other therapists even like in work with them when they're never getting it. Right. Right. And. I'm like, I don't think it's just because they just can't get it. Right. And oftentimes transphobic stuff comes out like really hardcore transphobic stuff. So for me, it's, it's telling if you're really never getting it right.
[00:41:34] So if someone just corrects themselves or, once they get it wrong once, but then they're using it a couple times. Like, that's, that's what I asked for. Right. And that's what I think can people can really tell what the difference is. So what is difficult sometimes is if you're really exhausted and then the person makes a mistake and then they spend like 10 minutes talking about how they really try.
[00:41:58] And it's, this is really hard [00:42:00] for them. And they're so sorry that it's a lot to put on the other person. Right. So just simply correcting yourself and moving on, if you really feel like it was egregious, then you want to just say, sorry, it's like, sorry about that. And then you correct yourself and you move on, like, but you know, Not talking about like, oh, now take care of me because I'm really upset that I have not been affirming to you.
[00:42:21] And now you're actually caretaking. My feelings about it when I'm not providing affirming care to you like that sometimes happens, so, but in terms of whether or not I correct people also don't assume that just because you're not being corrected by that person, that, that person's fine with it.
[00:42:36] So people are like, well, they were fine. I'm like, what were they though? Like I think that there's been plenty of times that I don't correct a provider or, so an example, I was gonna get my hysterectomy and because of COVID, there was a lot of stress going on and I get, get it. Like the healthcare folks were really stressed, but there was a lot of mistakes happening.
[00:42:58]And I was starting to get kind [00:43:00] of nervous where I wasn't nervous before. And when I'm nervous, I'm like, you know what? I don't want to deal with mis-gendering on top of. Being stressed out that I'm about to have surgery. So I started kind of correcting people and like, let's, let's do some self-advocacy Mel, like that you ask your clients to do.
[00:43:16] And I, and I, said that and one of the folks that was going to be putting in my eyes was clearly kind of annoyed now, probably having a bad day. Cause it seemed like they were having a bad day. So, but I stopped correcting. The folks around me, because I was like gonna be putting some in my arm.
[00:43:34] They're going to be doing these other things to me. Like, I kind of don't want to piss them off anymore than I already have. That shouldn't be something that I have to experience. I shouldn't have to worry about the fact that I'm just, Hey, so on my chart and I'm also just asking, can you, can you provide, affirming care in this moment that shouldn't be something that then I'm kind of concerned to ask for, because that's going to be something that's going to be problematic.
[00:43:56]Because they're, they're sticking a needle in my, so a lot of times I'll hear people. People were like, [00:44:00] oh, well they were seemed great. I like I've, I've actually worked with a lot of folks and they seem like they, that I, that everything was really good. And like, well, I mean, did, do you really know that though?
[00:44:12]I think that there's plenty of times that I don't provide feedback. When, but it doesn't mean that I have had a great experience with somebody. So, that's just another like assumption not to not necessarily make that assumption for folks, but again, I think there's ways to just really quickly acknowledge correct.
[00:44:28] Move on. That's the best that I, that people can do. I think when you mentioned that, like you, as an individual will drive to see your OB GYN, is there a place, cause you've mentioned resources like w path like P flag and others, but is there a place where people in the LGBTQ plus community will go to like a Yelp or something that is a collective of.
[00:45:00] [00:44:59] These that I saw this doctor today and they are amazing. And this is why they're amazing. Is there something like that? That, cause I'm not aware of it, but I'd love to hear if there is. Well, I mean, I think there's, there's, I mean, there's so many different lists. I'm not aware of all of them. I think they're constantly being made and remade.
[00:45:19]So for instance, there's, there's lists for folks that will provide an assessment and a letter without charging, for folks to be able to access medical care that for, for transition related purposes. And then there is de Lista that is like for, for providers that, that are knowledgeable and affirming usually.
[00:45:41] I mean, but there's so many different lists and oftentimes folks, they're, they're using insurance or they're like, not using insurance or they're in a certain location and they can't travel very far. So oftentimes it ends up being forums. Whether it's on Facebook or, some other platform that folks are just [00:46:00] like work.
[00:46:00] We were in groups and we find each other in community. And then we share that information with each other. It's like, Hey, let's say someone is, I don't want, I don't want to mention certain healthcare systems, but they're like, oh, I'm in this healthcare system. And I need a like trans affirming gynecologist, like who, who do people recommend and things like that.
[00:46:17] So, and some folks put those lists together and things like that. But I, it oftentimes I think there might be like a, a big one, but I feel like they're incomplete. A lot of the ones like, oh, they have a lot from this area, but they don't have from like in another state, they're missing a lot of folks. So, or it's one particular type of.
[00:46:38] Health provider or therapists or psychiatrists or, whoever it might be. But yeah, so I don't have like a specific one that I recommend. I usually encourage people to get onto local because that's where you're going to, like who are the local people. And then there's certain ones just in terms of people are looking for a therapist that I'm [00:47:00] aware of just in terms of like inclusive therapists is a I think a good directory, but, but again, I think it's still growing and there's still a need and a lot of the different states for them to have more folks on there.
[00:47:12] So they're developing, I think. And do you find, especially with you having had medical care, do you find that as you see doctors who are who are affirming, that they know of other firming doctors to refer to. Yes, usually. Yeah. Yeah. So that's, that's part of it is when you start to be practicing in a certain area, you start to then be aware of, I kind of have like a, some diff like these are, these are doctors that will provide care.
[00:47:45] And I think that they're not going to do much harm and, and then, then I've got the folks that are like really knowledgeable and really affirming and, great. Sometimes it's hard, it's, it's a matter of access and things like that of, of, of who you might need to go to. But definitely, yeah.
[00:48:00] [00:47:59] Usually folks are aware of. Yeah. If other of other folks, and I think it would be great to just start to be aware of. I think part of the process is okay, if someone wants hormones, like who are you going to refer to somebody once, surgery? Who, who are the folks that you're aware of, that folks are going to be able to be referred to.
[00:48:18] And, and again, sometimes that's when you want to be a part of forums that are about providing affirming care, so I'm a part of a lot of different groups that are about providing gender affirming care so that I can be networked. So if I have, a client that moves across the country, that I can kind of reach out to folks and like, okay, who are folks recommending for over there?
[00:48:39]Because I can't be aware of everybody in the United States or beyond. Right. So, so that's when you rely on those networking platforms to be able to, to connect folks. And that said with the pandemic, physician licenses with regards to practicing.
[00:48:54] Another states was really relaxed, especially in the early days of the pandemic. [00:49:00] What about for a person who has a vanilla Mufti for your practice? Can you practice outside of the state of California because you're doing tele-health? No. So I think right now I think the pandemic has really made it a good point for.
[00:49:15] Revamping the systems that we have for it's just so many folks had to like move suddenly or, and things like that. And that like the continuity of care that's lost when someone has built a relationship is really problematic. Some states made it easy to get like a temporary license in some other states, but oftentimes not, or for a very short period of time.
[00:49:37] So it ended. And so you can't and there are different requirements in each state and a different process and some have some level of reciprocity. Some do not at all. I mean, it's, it's, it's all over the place right now. And I think that there's a push to. To change that because it's, it's really the fact that you have the schooling, the training, the testing.
[00:49:59] It's [00:50:00] like, how can we, I mean, for me, I'm, I'm a big proponent of pushing for more of an ability to get reciprocity or kind of a national, like, license or some type of way of being able to follow your clients or your patients when, when needed until they can at least find someone, so it's that it's not just cut off.
[00:50:18]Because I think that, do I know folks that sometimes do that? Like I just, like, I'm not going to do that, given that like my licenses for California. So, but it's been something that's been really problematic because people were like, oh, well, but I'm going to be moving in a month and I need help right now.
[00:50:30] And it's like, well, unless you can find someone that's like licensed in both this state and the state that you're moving to, which is sometimes difficult. Right. So, yeah, I think it's, I think the pandemic has really. Shown some of the concerns with access to care and continuity of care and tele-health parody and like all of those issues that are coming up that will hopefully, maybe maybe improve.
[00:50:55]Now that I think more people are aware of them, that's just [00:51:00] incredible. I, I am paralleling everything you're saying with regards to primary care in my head, as I'm sure the listeners are because those realities are ugly and they're real. And especially when we frequently see healthcare tied to employment, it's really, we talked about how people are accessing platforms that are virtual because they are affordable and they are accessible and they don't care where you live.
[00:51:29] I think that is really. It, it just allows us to think about how, even as an LMF T your practice has a lot of similarities with regards to the challenges that you face versus somebody who's in a direct primary care setting. Yeah. Yeah, definitely. I mean, like part, part of the, some of the things that I want to do is get eventually get licensed in some other states to be able to provide tele-health to those folks.
[00:51:54] Because again, like, even within California, California's a big state and there's a lot of rural areas [00:52:00] in California that don't have any affirming providers. And so I've had folks contact me who live far away from where I'm at, because they're looking for someone that they can see that has you know, my training and knowledge and affirming care.
[00:52:13] So to making that possible. Is, is something that a lot of providers have started to do. Like a lot of therapists have begun to be like, oh, wait, if I do that, then I can actually provide even more care to folks that are isolated and have no access. Awesome. I want to ask what is the best way for folks to reach out to you after this podcast?
[00:52:33] And if you could include the best way for those who are at California based and the best way for those who are not California based, I would love that because I'm sure there's going to be questions after. And just like you talked about the network, even if Mel isn't able to see a patient, he might know of a therapist or a provider in another state who is on one of those networks that he knows about, that he can refer your patient to, [00:53:00]
[00:53:00] yeah. Yeah, absolutely. So yeah, so I think One place to go to is my website. So my website is www dot Mel Browning therapy. So altogether Mel Brownian therapy.com and it's M E L L E Browning, the color brown with ING at the end of it, therapy.com. And so I say it and so if you go on there, you can see a little bit more about me and my practice.
[00:53:26]And then in terms of contacting me. So I also have an email address, which is M E L L E. At M E L L E Browning therapy.com. So it's mel@melbrownietherapy.com. So email is a great way to get ahold of me. And then also has my phone number on there, which you can always call them. So yeah, folks can contact me via that.
[00:53:47]I do have an Instagram and a Facebook, which folks can try to message me through those, but I, I usually prefer email to social media sites for, for, yeah, for [00:54:00] accessing, thank you for sharing that I'll include your contact information with your blog, but as a last question, in terms of those social media avenues, I know you talked about the networks and finding people who are local, but are there handles that you absolutely love for being just, affirming in general or affirming when it comes to medical care that you can recommend.
[00:54:26] Medical care. That's a good one. Yeah. I mean, I think I connect with a lot of therapists on there, but I haven't connected with a lot of medical providers I'm open to doing that. Well, I'm definitely open for folks to find me and get connected to me if they provide affirming care.
[00:54:42]Oh, and I also wanted to add, edit in. So gender spectrum has an online kind of forum that folks can ask those questions of and things like that. So like families and parents and things like that. So I reckon I recommend that Fenway health. I kind of follow some of those things, but I, I follow a lot [00:55:00] of the big organizations that provide important services, whether that's trans lifeline or local LGBTQ organizations or local, like for me, a lot of the folks I refer as usually to like, clinics that are drop-in that provide like free services to folks.
[00:55:21] That are gender diverse. So oftentimes I'm, it's, it's very local to where I'm at and they have like once a month, they have a, a drop-in. So you don't have to actually even be a page, a patient at that clinic to go to. So I think knowing about all of those different resources would be important. If, for folks accessing care, because you might come across folks that need yeah.
[00:55:44] That need to be able to access certain types of care and then maybe don't have the resources. Mel, thank you so much for joining us today. This has been such a pleasure. We talk about so much, but I love that we focused in on how you [00:56:00] practice as an affirming therapist and how we can learn as physicians to evaluate our own practices and to learn about affirming care in the future.
[00:56:08] So thank you so much and happy pride. Thank you
[00:56:21] next week forward to hearing from Dr. Elizabeth Eamon of Oodle family medicine in Renton, Washington. Now after Dr. Rebecca Beren's episode, many of you had unanswered questions about virtual assistance. Join in on a free fireside chat with Dr. Berens and her virtual assistant on June 22nd. Leave your questions you want answered@speakpipe.com slash my DPC story.
[00:56:44] And they'll be answered during the event. Registration is open on the podcast website for this event as well. And the AFP DPC summit registration is open@dpcsummit.org. The conference will be held virtually from July 16th to [00:57:00] 18th. So register today, if you like what you heard today, please leave a review and subscribe wherever you listen to your podcasts.
[00:57:06] Tell your friends too. For more information on this episode and much more, please visit my DPC story.com also for the latest in DPC news. Check out DPC news.com until next week. This is Maryal Concepcion.
*Please note: there may be errors as this is an AI-produced transcript.
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