In this episode, Linda Gromko provides a transgender advocate’s perspective on healthcare. She joins the Perspectives on Healthcare Podcast from Seattle, Washington. A member of the Baby Boomer generation, she practices family medicine with a specialty in care for the transgender population. She has extensive experience in the medical field from being a candy striper to becoming a nurse practitioner to becoming an MD to developing a specialty in transgender care.
Here are 3 things that stood out as Linda Gromko gave a transgender advocate’s perspective on healthcare:
· A primary care provider has the capacity to intercede on behalf of their patients
· It is imperative to be willing to learn from your patients and listen to their experience
· Always give your best. It may vary from day-to-day but always give your best!
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Here is the transcript of Linda Gromko: A Transgender Advocate’s Perspective on Healthcare
Rob Oliver: Thank you and I appreciate you being with me today. My guest today is Linda Gromko. She is a member of the Baby Boomer Generation. She practices family medicine with a specialty in transgender medicine. So, Linda, welcome to the show.
Linda Gromko: Rob. It’s good to be here. Thank you.
Rob Oliver: Absolutely. So we’ll jump right into it. Tell me a little bit about yourself and your role in health care, please.
Linda Gromko: For heaven’s sakes, Rob, I have been in health care forever. It seems I started out as a candy striper when I was 14. That’s a long time ago. So in any event, I found healthcare to be just fascinating. And so when I finished high school, I went into nursing. I kind of decided to go into nursing because I knew I was going to need a job right away after I got out of high school. But then I really found it fascinating. And I knew I was going to want to teach in some capacity. So I had an opportunity to be a member of the third nurse practitioner class at the University of Washington School of Nursing. And it was not what I had intended to do, really. I mean, I wanted to get a good broad background, but the idea of being a primary care provider was not really on my agenda at the time. Now the free tuition, the style pen, the books that I got was right up my agenda. That was fine. But at the same time, it wasn’t exactly my life plan. But then my first job out of nurse practitioner training was at Planned Parenthood in Seattle, and I loved it. And it was terrifying at first. But I also found that being in the nurse practitioner role gave me a lot more. This is going to sound a little bit not quite right, but it gave me more power. It was like I had the capacity to help people and to intercede with a benevolent power that I hadn’t seen before. And that was wonderful to me. So I decided that I was 25 at the time. My son was just a kid. I went to medical school and my son was four. And so I figured that I was kind of at the peak of my capacity at 25 when I was doing lectures and I was coordinating educational experiences. But I was also doing clinical work. And so I thought I’m going to go to try to get into medical school. And Lo and behold, I mean, it wasn’t exactly a fluke. It certainly wasn’t handed to me. I started taking classes after work, and I took them one at a time. I went into calculus for one quarter and then I took organic chemistry the next quarter. And then by that time, I was really out of my closet because there’s no way that somebody with a two year old at the time would be taking these kinds of prerequisites. So I went into medical school. It was again terrifying in many ways. But it was fascinating. And I found that the capacity that I had to I think about the term be an influencer. It just sounds kind of tacky today, but it’s very true. And the capacity that a person has as a primary care provider or as a nurse practitioner, somebody who’s able to intercede and advocate for people is different than anything I’ve experienced. And it happens so easily. And it can happen so naturally if we, as healthcare providers, are open to that.
Rob Oliver: Interesting. You’re talking about being an advocate for your patients…
Linda Gromko: Yeah.
Rob Oliver: And that seems so different than the typical medical model that we’ve looked at that we’ve been dealing with for years. What opens your eyes to that? Because it doesn’t seem to fit with the medical education that was being provided at the time.
Linda Gromko: Well, medical education. There’s so much I could say about that. A little PTSD from that, I’ll have to admit. But you look at what works. Okay. And you see that there are let me give you an example, the population that I’m involved with right now, I have been working with the transgender population for about 23 years. Okay. I got no training whatsoever in either medical school or in nursing school on that. But one day and please get me back on track if I digress or if I wander too far. But what happened? I was working in my own family practice, which I birthed. Okay. And so what happened is that a woman came to me or asked my receptionist. Rather, does Dr. Gromco treat transgender women? And my answer was, well, not yet, because I really didn’t. And I said to my receptionist to let her know that if the woman is willing to understand that I’m a rookie, I’ve had no formal training, but I’d be willing to follow along with her if she’s able to help me learn what she needs me to know. I’m happy to follow along. And that’s where probably one of the greatest advocacy postures that I’ve ever taken began Rob. And curiously, though, there was another woman before that who had asked if I would treat her as a transgender woman. And I said, I’ve never had any training in this. I truly don’t know anything about this. It would be almost irresponsible for me to treat you. And so it felt to me like it was the medically correct thing to do to decline her request. And then after some time, it occurred to me, no, the medically appropriate thing for me to do is to take the skills I already have build on those skills. Learn. It’s so fascinating, because when I started doing trans medicine 23 years ago or whatever. Nobody else was doing it. I think there were about three or four people in Seattle that I could even ask for help. And so I look back on that. And I think, my goodness, that was quite a leap to take at that time. But I’m so glad that I did, because if any group needs advocacy, it certainly is this population. I’m not implying that there are not many, many groups that need advocacy and such, but this group, in particular, I think, really benefited from having a strong voice, a strong doctor who was willing to learn and do what was necessary. So that’s how that started. But I’ve got lots of experience and advocacy.
Rob Oliver: Sure. And it’s so interesting because I’m thinking that because there’s no training in medical school, no training in nursing school, then the medically responsible approach that you had originally taken means nobody is there to treat that population.
Linda Gromko: Yeah.
Rob Oliver: Very interesting. What does quality health care mean to you? I think this is interesting from a number of aspects, both from your own personal experience of being candy striper nurse practitioner and MD, as well as dealing with having a family medicine practice and working with the transgender population. I’m anticipating your answer with bated breath, which is quality care?
Linda Gromko: Oh, my goodness. Rob, quality care. I wish I had a prepared answer for this, but I can tell you what I believe to be some of the essences of that. Okay. Because of course, it varies from every situation is going to be different. And what your best is. I don’t know if you’ve ever read the book before agreements. Rob, have you read that book?
Rob Oliver: I have not.
Linda Gromko: Oh, do read. It. Fabulous. But the author has four rules, and the first rule is be impeccable with your word. The second rule is don’t make assumptions, don’t take things personally and always do your best. Okay. Well, your best. According to Ruiz, who wrote the book, is it’ll vary from day to day. It’s not always going to be what’s, 100% for me today, maybe 50% for me tomorrow. But if I go into my practice and if I go into my patient’s room with at least the intention and the goal of doing the best I can at that moment with the resources that I have. And that varies a lot. I mean, we have resources that vary according to insurance plans. For example, we have resources that vary according to what a patient is able to provide. I don’t mean financially, but I mean from their heart. And what are they willing to provide as far as what kind of resources can they bring to the brochure? Can they do? I think I probably learned a lot about quality care when my late husband went into renal failure and we did home dialysis. Okay. And going that a lot of extra steps to make certain that that was available to him at home. I mean, can you imagine here I am learning how to do home Hemo dialysis, talk about terror. I was absolutely mortified, but we did it and we did it together, and it gave him the best quality of life that he would have had available to him. And that’s wonderful.
Rob Oliver: Yeah. I really appreciate you sharing your personal story with that. Can you give me an example of quality health care that may be related to the population that you serve?
Linda Gromko: Oh, yeah. I think that in the transgender population, for example, quality of care, I think, has to do with, first of all, you want to know as much as you can come to the table with as much information as you have. And it’s like I don’t have all the information because all of the information isn’t there. People want to draw from the comfort of good research studies and the science of good studies and such. I didn’t have that at the beginning. Okay. So I had to use a lot of common sense in the medicine that I practiced. Well, common sense, as you, I’m sure have observed over the years. Isn’t that common in medicine? I mean, common sense is probably one of the best tools that I have to use. So if something seems right, I want to come to some sort of an agreement with the patient. It’s not talking them into something, but it’s basically asking the patient, what is it that you need? What can I do to help you today? What are the things that are on your agenda that will make your life better for where you are right now? Those are powerful questions.
Rob Oliver: Yeah, very powerful questions. And definitely meeting the patient where they are, which is huge. What do you wish people understood about your role in health care?
Linda Gromko: I think that I always look at this Rob as being an impossible job. Okay. The work that I do, it’s impossible. When we’re medical students, we’re trained as to list out what a differential diagnosis is. Well, basically, a differential diagnosis is what could this be? If a person comes to you with an aggregate of symptoms and concerns, then the differential is creating that list of what might this be? Okay, well, that’s tough. And it almost feels infinite at some point. And so you have to start out by thinking in terms of what are the needs, what are the desires of this patient? What basically do they need? People come to a doctor sometimes feeling that I will have answers, and I have information which I’m happy to share. I have opinions. But when it comes to do I have an answer for a particular individual or what they might do in their situation? Let me give you an example of this. Sometimes when I’m working with somebody and the diagnosis isn’t clear, or maybe it’s multifactorial. And there are a lot of things that are going on for that patient. And sometimes I’ll say, in your heart of hearts, what is your best guess here? What do you think is going on? Do you have any particular fear? Is there something that keeps you up at night about the symptoms that you’re having? Do you have a particular I’m rambling, but do you have a particular worry about this or just plain? What do you think it is? And I’ll get the answer from a few people. I’ll get the answer. Well, you’re the doctor. It’s like you’re the one who’s supposed to have the answers, and I will often respond, but it’s your body and you have the inside track. You have information that I can’t possibly access. Does that answer a little bit?
Rob Oliver: No. I think that that’s a very well made point that this has to be a collaboration with the patient because you can only operate based on the information that the patient provides. We just had Justin Ayars, who has almost http://www.equalitymd.com and serves the LGBTQ+ community. And what he was saying was a lot of times in that community, which is broader than what you’re talking about. People are almost afraid to be their authentic selves with their doctor. And as a result, the quality of care that they receive, the type of care that they receive is not up to standard because they’re not providing all of the information. They’re not just being full in their disclosure of everything that’s going on in their lives. So, very interesting.
Linda Gromko: Or they’re afraid. Rob, there’s a lot of bias that will operate in the area of trans medicine. As an example, I think that physicians tend to be grounded and feel comfortable. I’ve never felt comfortable. People tend to feel grounded when they have a study, when they have a residency program behind them or whatever. But when you’re doing something that’s a little bit more newer or innovative or whatever, you don’t have all of that backing. And so it takes a little bit of courage to branch out on that. It’s funny. I’m conservative medically. I’m politically and socially Liberal, but I’m conservative medically, but at the same time, you have to branch out a little bit. I’m sorry, I’m not sure where I was going.
Rob Oliver: It’s quite okay. Let’s do this. What excites you about the future of health care?
Linda Gromko: Oh, my goodness. What excites me? I think that. Well, there’s so many things, Rob. There’s so many things that do. I just wish that I was going to be around for some of it because as I’m aging and I think, my goodness, I wish that I could see what was going to happen later on. For example, I think we’re going to see advancements that are astonishing. Okay. Like, for example, in the field that I’m working in when I started out, there were very few surgeons, for example, who were doing transgender surgeries. All right. Now I see results that are absolutely exquisite. Okay. I mean, they’re unbelievably good. And I love the idea that that’s going to happen. I think in the future. One of the issues that I see is that a number of people who are transitioning female, that is to see people who are assigned male at birth and then have recognized that they really are female. And there’s a bit of grief that happens when those women have not been able to experience pregnancy, delivery, birth, all of those very important things in their own life. I’m not saying that they’re not parents or what have you, but that particular flavor of parenting, for example, is something that’s not accessible. I think that’s going to be accessible at some point. I truly do. I think that that’s going to be something that will be wonderful to see for people to be able to have that available. I think that we’re seeing people who are sexually functional because of the excellence of surgeries that are available. I see people who are living full rich lives. And in fact, I just wrote this book. It’s called a Practical Reference for Transgender and gender nonconforming adults. And I was doing my outline. That’s the way that I kind of I was actually writing the table of contents, and I’m getting ahead of myself. But I was writing the table of contents, and I found that towards the end of the book, I shifted my focus from the surgeries, the hormones, the presentation, the coming out to parents, all of these issues that are so critical. But my last chapter has to do with how to live long and well. And I thought that is revolutionary throughout the community. I’ve been working on suicide prevention. I’ve been working on information and crisis intervention, and all of a sudden I’m noticing that I’m writing about living long and living well. That is a revolution. I love that. What a wonderful thing. It’s like we’re climbing up Maslow’s hierarchy.
Rob Oliver: Absolutely. Last question for you is what is one thing medical professionals can start doing today to improve the quality of health care?
Linda Gromko: I have always believed that the kernel of health care has to do with the one on one exchange. Rob, it’s always that you can have all of the references behind you. You can have all of the experience and the information that’s out there. But the truth of the matter is that what health care is is an interaction between me and you. If you are my patient, for example, it’s an interaction between the two of us. And I have found that when I was a medical student, it dawned on me that just walking into a room and being polite seriously was huge. It’s like when I can treat somebody with respect, some people that I see are very afraid, not just in my trans population. But I think people in general are very afraid. My Lord, we’re in a pandemic. Everybody is feeling this increase in anxiety and depression also. But I think that if we can recognize the concerns, the fears that we all have. Like, for example, I’ll say to patients, sometimes when we’re trying to work out a diagnosis or whatever I’ll say, well, first of all, none of us is getting out of here alive. Okay. So let’s just establish that. But the goal I have is that I want to help you live as long as you can and as well as you can. That’s my goal. How can we work together on that? That’s nice. But I find that just like I mentioned, that common sense isn’t common. Well, courtesy isn’t common, either. And just that whole framework of this. If I start out as being kind, if I start out as being polite, if I’m respectful and aware of where my patient is, at least I’m trying to be as intuitive and as receptive as I can. Then I think I’ve got a good start. And I think it’s amazing when my husband was a patient, for example, after a kidney transplant, which was unfortunately not successful. We were at the University of Washington. That’s where I trained. Okay. And so people would round on him, for example. And you could see this first of all, when you’re in that bed, people have no idea where you are on the medical food chain. Okay. And there may be eight people in the room, all in white coats and all with clipboards, some texting. You see all of these people, you don’t know what their rules are. But as a patient, you may assume that they all have influence on your life and health. And that kind of thing that may not be true, but you don’t know that. So this power structure continues to be reinforced. Listen, I know that people come to physicians because physicians have information and they have access to care and procedures and that type of thing. That certainly is why people come to me because I have information and I have some access. But when it comes right down to it, we’re really all in this together. And if I can provide information in a respectful way, I remember giving a talk one time, and one of the people in the audience said, this is about transgender health. And the woman said, you make this sound like it’s completely normal. And I thought, yeah, yes, it is normal. And we just come in a lot of different flavors. For heaven’s sake. We all come to the table with a lot of different problems with a lot of different fears. But we’re here to work together on what we can do.
Rob Oliver: Yeah. Thank you for sharing that. I appreciate it. And listen, Dr. Gronko, thank you so much for being with me today. I really appreciate your willingness to be open, to be honest and to share your perspective on healthcare.
Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.