Equitas Health is taking big steps towards a more comprehensive and inclusive model of care, and this next evolution starts with nurse practitioner Mimi Rivard.
After starting her career as a nurse during the AIDS epidemic, Rivard developed her approach to care that centers around the patients’ own goals and what they currently need from their healthcare journeys. Now, as an influential part of Equitas Health’s medical team for the last eight years, Rivard has carried this method over to provide more gender-affirming care to transgender, gender non-conforming, and non-binary patients.
However, Rivard won’t be alone as she takes on her new position as the inaugural Director of Gender-Affirming Care. She plans to work closely with Clinical Pharmacist Teagan Vaughn to develop training that standardizes gender-affirming care across all healthcare teams and to broaden their reach to make comprehensive services available to patients across Ohio, and even across the country.
The Buckeye Flame spoke with both Rivard and Vaughn to get a better understanding of this new position and how they plan to make a difference through this innovative approach to healthcare.
How would you define your approach to healthcare, and more importantly gender-affirming care?
Rivard: Much of the way that I practice is based on those core foundations and principles in medicine. Just the things we hear about like non-malfeasance, do no harm, always act to the benefit of others, respect the patient’s autonomy, and justice – which is equitable care regardless of the ability to pay. Those are my core foundational values in terms of why I practice the way I do, but I think with the patient experience it’s a combination of palliative care, culturally humble care, promotion of health literacy, and motivational interviewing – those are the pillars of the care model. One of my favorite sayings when I’m teaching is, “Don’t just do something. Sit there. Listen. Just listen.” And people tell you who they are and what they hope for and what they need from you. I think those are skills we can teach medical providers.
Vaughn: Gender-affirming care is kind of a microcosm for a larger issue in healthcare and patient-centered care in general. In gender-affirming care, there are not as many real, true, easy goals for every person. For hypertension, you usually want your blood pressure to be a certain number. For diabetes, you want people’s blood sugar to be a certain number. For cancer, we want people to be cancer-free. But, for gender-affirming care, really our only goal is to have people achieve their own goals. So, in order to go about doing that, it’s really a conversation with patients to determine where they are and where they want to be. Then our job is really how do we get them there and how do we help them on their healthcare journey to really live their true, authentic selves.
What doors does this new position and joint project open?
Rivard: I think it will open doors in that we will be able to replicate what happens in Columbus across the state. It will allow for us to have a strategic plan for growth. It will allow more resources in building and developing support structures around the healthcare of the community, and it will have someone helming something that could lead to having a center of excellence here in Columbus where medicine and surgery are combined.
Vaughn: One, Equitas Health is going to be positioned a little better to see more trans patients and get more people engaged with their healthcare. But also, on another level, [we can]really take that extra step and become that regional leader in trans and gender-affirming health.
Another one of our goals, longer term, is to see more patients and get more people involved in their care, because we do know that there is a vacuum of trans health experts, not just in Ohio, not just in the Midwest, but really in the whole world. So, our goal is to really get more people engaged. One of the unexpected benefits of 2020 has been that we’re able to see patients electronically. So, for anyone in Ohio, we’re able to get them in for a visit, whereas before if you did live out a little ways from some of the major cities, sometimes it’s harder to access culturally competent care. With telemedicine we’re able to bring folks in so they don’t even need to leave their home. We also work closely with Equitas Health Pharmacy, which is a great culturally competent resource for people accessing medications. Equitas Health Pharmacy can deliver for most patients anywhere in Ohio as well, and can complete part of the distanced-medicine loop.
What are the most important principles you teach to other healthcare staff and employees?
Rivard: I think cultural humility is probably the most important aspect of medical care at this time. I think without that you really lose so many opportunities to know people. And learning about patients’ family, career, what their passions are, what their strengths are, and what barriers they face allows the patient to control the narrative and really creates an equal footing environment. I think if providers don’t have an understanding of how cultural humility impacts the care relationship it’s almost a setup for failure.
Why is it important to connect patients through all parts of the care team?
Vaughn: At Equitas, we’re very lucky to have a patient-centered medical home, so not only do we have excellent primary care providers, but we also have wonderful pharmacists and some really great nurses. We also have really excellent behavioral health, different case management services, we have dentistry – almost everything someone would need on their healthcare journey. We’re lucky to be able to provide that care to folks as a whole team, because we know it’s not just that someone needs hormones. At the end of the day, they are also a living, breathing human being. As a team, I think we’re able to take care to that next level in order to really give the best support and the best health for folks.
Mimi, what does it mean to you to be the very first person to take on this new position?
Rivard: Honestly, I have some mixed feelings about it. I’m thrilled to be able to do this. It’s really just given me the ability to execute my vision. To see this vision, I’ve had come to fruition. So, on that level, it’s incredible and I’m so honored and I’m going to work so hard to do this community proud. But, my hope is to be the last cis person that has this job. I feel that this generation of people that provide gender-affirming care, we will need to do our best, but I hope my replacement will be someone of trans experience. I want to be able to be replaceable. That’s kind of how I feel. I think it’s amazing, but also a little bit heartbreaking that someone of trans experience isn’t in this position currently.
- Learn more about Mimi Rivard and gender-affirming care by visiting the Equitas Health website.