The Care Doctor: Rhett Brown, MD (Part II)

[0:00] Too often, transgender patients go in and they’re being told that there’s something wrong with them, that they don’t take care of those type of people in their practice. They’re not being told, hey, you know, this is a part of medicine that I don’t do, but let’s get you to who does it well and have that resource and continuing it. That’s the part in this population that they don’t get.
Welcome to the Prescription for Success podcast with your host, Dr. Randy Cook.

[0:37] Music.

[1:01] Today, we’re back to bring you part number two of our conversation with Dr. Rhett Brown.
If you haven’t already listened to part one, please do.
It’ll be episode number 159 at rx4successpodcast.com or wherever you get your podcasts.
Now, let’s get back to my conversation with Dr. Rhett Brown.

[1:29] Let’s get you back into your professional life and your development as a family practitioner.

[1:37] I gather when you got into your residency program that you felt like it was a good fit, am I correct?
Yes, I was very fortunate to have gotten into the Charlotte residency program. It was the Carolinas Medical Center then. And it was not where I thought I was going to end up, coming out in med school in the South in the mid-80s and the height of the AIDS epidemic.
I was like, I’ve got to get out of here if I’m going to ever, you know, be able to be open and live an authentic life.
And I interviewed all over the country.
Had to escape the South.
Though at that time I was like, I really don’t want to go anywhere where I can’t get sweet tea either.
I had to let that go.
So I interviewed in Denver, Seattle, Cincinnati, I think I interviewed in Chicago.
But I was interviewing in unopposed family medicine programs because I thought coming from Charleston where the family physicians were not always given great respect, that would be the best place.
And Charlotte was sort of a throwaway interview to appease my parents who didn’t want me to move so far away. And lo and behold, it was the best interview I had.
I thoroughly respected everyone and realized that I would actually learn better from other residents than I would necessarily being with just attendings who I could get feel intimidated by.

[3:07] And met people during the interviews who would just change my life. And I was incredibly, smart enough to rank that first and got accepted. And it made a huge difference in my career.
Let’s go ahead and talk about what’s going on right now, and if you need to fill in some space between, and I know it’s a big leap, but you have been very successful throughout your practice career, but you actually have established a practice that is based upon holding yourself out to the public as an expert, for people with gender identity issues. So with that basis, tell us about where you are now. Opened a year and a half ago, my own practice with Dr.
Carson Rounds of Vance Care Midtown in Charlotte. And just to pardon the interruption, you had actually worked in more traditionally established groups, leading up to that, correct?
Correct, correct. So I’ve had a career doing everything. So I had my own practice in the 90s during the HMO stuff, we had to be vertically aligned.
My practice was purchased by Nall Clinic, a multi-specialty group with 140 doctors.

[4:37] And then in 2000, ended up that practice, because of financial things, ended up closing.
And that’s actually, I had an opportunity to say, okay, I’ve been in Charlotte all these years, now’s an opportunity to go. And I joined a group in Atlanta, And that’s where it was like.

[4:56] I can finally be myself at work because Atlanta was a lot more accepting. And that’s when that, last little bit of internalized homophobia and being still leading a little bit of a double life because in the 90s in Charlotte, I was still somewhat professionally closeted and it’s me and my partner would be out at a mall or somewhere and I would run into a colleague or a patient.
We had head signals and head signals that identified that he needed to pretend like he didn’t know me and walk away so that that wouldn’t be. Moving to Atlanta, much more accepting that internalized xenophobia resolved. And so when I returned to Charlotte as an offer to be medical director of the residency program, I interviewed and said, I will be an out gay doctor here. I’m not going to hide this anymore. And I want in my contract that you will not discriminate against me based on that.” Again, this was way before gay marriage. This was way before domestic partner benefits. And the CEO of the company at that time said, of course.

[6:09] Turned out I was the only employee of the hospital system that had that protection. Wow.
And then I ended up leaving the position years later because there’s a new CEO who is an amazing leader, amazing person who lives his vision and mission to take care of healthcare, but he’s also an evangelical conservative who did not feel that this lifestyle was not chosen, that I don’t think was chosen, but that we have a disagreement on that belief, though I respect him in a lot of ways. When contract renewals came up, that protection was removed from my contract.
And I left. I said, I can’t continue working here, despite the request from people I work with not to leave.
So every time I see the symbol of this community, of this hospital, it gets me angry, because you want me to give this many hours of my life and the talents that I have, and you don’t want me to bring my full self to the office.
And I can’t continue this. And so I left and joined Novant Health, which had a much more.

[7:29] Accepting mission and vision and already had sexual orientation protection in their contracts, and ended up becoming medical director of the LGBTQ service line for Novant and.

[7:41] Had a great run there. But I had been practicing, you know, in the gay community. It was known who I was that wasn’t really out to the general population. So I had taken care of a lot of LGB patients for 20 years by this time. This is 2009, 2010. But no one had ever knocked on my door to ask about transgender care. Not that I would have known what to do because we weren’t taught it in med school or residency. And because no one had sort of asked me, I assume there was this big box of knowledge that I didn’t have. And a friend who was a psychologist in town, Lisa Griffin, had a very almost exclusive transgender population of patients she cared for, took me out to lunch. And she said, I want to know why her patients were having to leave Charlotte to get care. And I just, I don’t know, I didn’t take care of him and no one had ever asked me about it before,” and she just says, you’re a gay provider in this town.
You’ve got to do better.

[8:42] And so, after blushing and feeling a little sheepish, I said, okay, you called me out.
I don’t know. Give me a year. Let me go to conferences. Let me get some books. Let me find a mentor. Let me figure out what I, let me find out what I don’t know. And it was like.

[9:03] Oh, my God. From the medical standpoint, this is easy. The medicines are testosterone, estrogen, spironolactone. I’ve been writing those medicines for 20 years, so I had a huge comfort level. I know how to assess patients. I learned and it was like, this is not some great dark mystery that I had just sort of blown up in my mind that it was going to be. A year to the date later, I get a phone call from her that I have a new patient coming the next day that she had sent me that she’d give me the year and it was time to do and saw the patient and I think the patient was to like me because they told two friends who told two friends who told two friends and for long I was having a fairly big population of transgender patients. And this again is how naive I was at the time, even though, you know, being a gay provider, you know, it’s like, I manage diabetes. I manage high blood pressure. I manage depression. I manage asthma. This will just be one of the other things. I manage, you know, menopausal hormone therapy. This is just something else I just manage. How many patients am I going to get in Charlotte? 30, you know, 40 at the most. It’ll just be a small part of my population that I take care of.
Of, oh my God, it was.

[10:33] Almost a need that I couldn’t meet. I had patients traveling from five states to get care.

[10:40] Within a year, I had hundreds of patients. By this time now, I’ve been doing this since 2010.
There’s thousands of patients I have cared for. And it has been a wonderful blessing, for someone in their mid-career to partner with people who are learning to become their authentic self and blossom and sharing their life’s journey. And there’s so many patients that I see every day who don’t want to be in the office. The diabetic really doesn’t want to come in and see me. The person with high cholesterol really doesn’t want to be there to see me for this. These patients want to come in and see me because they know that I am part of them becoming their authentic self and they are happy to come in and see me. Yeah, I bet they are, Rhett, and I have to I’m a little bit embarrassed that I have not heard of any such significantly focused medical provider.
Is that because I’m living with my head in the hole in the ground?
Is it that rare or is yours the only one in the United States? Give me the facts.
It is rare and it was a, for most of us, you know, at our, in my age group, This is not something that may have been mentioned as part of psychiatry course, but nothing really dwelled on in med school and definitely was not anything, you know, taught as, you know, a course in residency.

[12:08] So when you don’t know, you just don’t know. If you’re not challenged, if you’re not being asked to learn it, it’s very easy to just, I’ve got enough stuff to do. I’m doing, you know, other stuff.

[12:19] And I can relate it to a little bit how I approach, I have not joined and have not chosen to do like suboxone therapy. There’s a lot of people with opioid disorders who need more providers. I have just, you know, I’ve got so much to do.
Let somebody else do that, which I’m a little embarrassed to say, but it gives me some insight into why not every primary care doctor is jumping and has learned to do this, because it’s a little bit of extra work to get this information. Well, realistically, I don’t think it’s something that every primary care doctor ought to be doing, because there is a body of knowledge, there’s a significant degree of science that I think we can probably agree is not commonly taught in medical education, even at the residency level?
Or, I mean, I’ve been out of it for a while, but did I miss something?
No, there’s rules, there are requirements now, but in our generation, and 10 years ago, there definitely wasn’t.
My concern is, I, at one time, as a family physician at residence, I did OB, you know, I, you know, and delivered babies.
Of course.
I don’t do that, right. So do nurse practitioners. But if you come in to me and you’re pregnant, I know who to get you to, who’s going to do that safely for you.

[13:43] I’m going to say, isn’t it, let’s celebrate your pregnancy if your pregnancy wants to be celebrated and let’s get you the care that you need to have a healthy pregnancy.
Too often, transgender patients go in and they’re being told that there’s something wrong with them, that they don’t take care of those type of people in their practice.
They’re not being told, hey, this is a part of medicine that I don’t do, but let’s get you to who does it well and have that resource and continuing it.
That’s the part in this population that they don’t get. Exactly.
Majority statistics show that 25% to 30% of transgender patients have had medical damage by being not accepted at their primary care office.
So when I started doing this and patients told patients who told patients, had patients traveling from five different states around North Carolina, to spend, you know, driving two to three hours to have a 15 minute appointment with me to get the care that they needed.
And, you know, for a long time, again, it was just something I did until I had a patient, Corey.

[14:53] Who changed this from just a part of my practice to a passion in my practice.
And Corey was someone I had started meeting in late in high school, assigned female at birth, who had such dysphoria and just so uncomfortable in their own body, they would only take a shower once or twice a week and only in a completely darkened room, so they didn’t have to see their body, didn’t have to see their breast because that’s not who he was.

[15:29] And we worked together and got him on therapy, got him on testosterone.
He had top surgery. He blossomed into this successful videographer.
He was directing rock and roll videos and stuff and just so much better in his early 20s, and having a good life.
And he got his name changed and he got his gender markers changed, doing very well.
And he was by himself in Western North Carolina on the Blue Ridge Parkway, and unfortunately, got involved in a very severe automobile accident.
One of those accidents where you have to get the jaws of life to cut you out of the car.
So here he is, Maddox, by himself, being placed on. And you can imagine that hardboard and that collar around your neck.
And you’re being transported to the local safety net hospital.
And they take him to their small emergency room their trauma room and they’re doing what they’re supposed to do. They’re doing their survey of injuries. They’re cutting the clothes off. Are there any broken bones, anything sticking out? And as his pants are being taken off, the nurse shouts out loudly. Remember, he’s awake during all of this. Well, looky here folks. We have a freak. Oh my god. This nurse then took it upon herself to go in even though his driver’s license and insurance card listed his name as male.

[16:59] She changed it to his what was called dead name, his name at birth, changed the gender markers to the gender assigned, and throughout the rest of the hospitalization was referred to by the feminine name, feminine pronouns.

[17:14] The hospital did more trauma to him than the automobile accident did.
He came back to me after he got out, so terrified of ever having to enter a hospital again.
I bet.
Depression was so severe of just, I’m never going to be accepted. I’m never going to be be able to live a normal life.
This is what happens when we go seek health care.
That’s when it became a passion that things have got to be different.
This cannot be accepted.
So I created a rotation. So residents, med students, nurse practitioner students can come spend four weeks with me to get this care.
Lecture at med schools, residency programs, PA schools. I became a president of the North Carolina Academy of Family Medicine and transgender was part of my accepting talk that this needs to be part of who primary care is. That caring for the individual means accepting them and providing guidance. You don’t have to do the hormones that you need. The provider needs to know how to get that person to the right care, to take care of them in a loving, accepting way.

[18:36] That’s when it changed and became Horror of Passion. And Charlotte, getting together with a couple of others, we formed the Charlotte Transgender Healthcare Group.
Because we all realized that none of us knew really what we were doing from a training perspective.
And so what started with eight people around a conference table in my office one night, has grown to a group of over 70 providers, including physicians, family physicians, internists, pediatricians, psychiatrists, surgeons, plastic surgeons, infertility specialists, OBGYNs, psychologists, licensed clinical social workers, licensed professional counselors.

[19:23] Speech pathologists, physical therapists, that we meet once a month on Zoom to.

[19:30] Educate each other, to find how we can provide better care for that service. We, are the largest such organization in the country now. I’ve been just amazed by.

[19:42] What I’m hearing, not because I’m surprised that there was a need for it, but it sounds like, please correct me if I’m wrong, but it sounds like Charlotte, might surprisingly be the center of knowledge for transgender care at this point. Am I misreading this at all? We do well in the southeast, but we don’t have the researchers, I guess, say the academic part. So Boston and Philadelphia have centers that are probably more advanced.
Because they have like one clinic that’s doing all of this. We are a clinic that is connected in a mission, but we’re all financially independent. We’re Switzerland. We’re not financially connected as such, but that allows us to be present everywhere that’s needed that way as well. And I should think that there are academics not only in this country, but around the world who are interested in what you’re doing. Do you get a lot of inquiries, I hope?
We do. We do. We have partnered with UNC Chapel Hill and UNC in Charlotte to do different research.

[21:03] Studies and understanding access to healthcare for this community. So yeah, we are open to doing So the more we have converted our little group that just started, we converted it to an actual non-profit.
It was a 5013C last year. And we were fortunate enough to receive a $1.2 million grant to help provide transgender health care to those who can’t afford it.
Well, that’s really profound. And at this time, we are all worried about the backlash that is happening, which is very, very disturbing.

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[22:58] Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches. Here on Rx for Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.
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[24:10] We’ll get back to our interview in just a moment, but right now I want to tell you a little bit about Physician Outlook. If you haven’t discovered this remarkable magazine, please do so very soon.
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[25:21] Well I think that was exactly where my next question was going to come from. Not Not only are you doing something that is dramatically outside the lines globally, to be doing something like that in Charlotte, North Carolina, got to be a bit of a big deal.
I know it’s been a very long time since I interviewed for my residency at Wake Forest, but I remember the conversation when I visited there reminding me that if you’re going to have a cocktail in a restaurant, you got to bring your liquor in a brown bag.
So the culture is profoundly conservative.
How do you explain your success? You can just go back to pure economics.
It’s an unmet need. There you go. And if there is a population who needs this health care.

[26:21] You provide it, it’s going to happen.
So some of it’s, you know, that’s not the reason I’m doing it, but the reason it’s successful is there is an unmet need to have these services provided.
North Carolina had, you know, years ago got involved in the HB2, the bathroom bill that became infamous. And we did, we tried to do some lobbying on that and fortunate that businesses stood up and complained and pulled money from North Carolina to get them to change it.
But one of the things that I do, you know, go back to is, you know, crises create opportunities and situations. So I had the opportunity during HB2 in North Carolina through the, our academy has something called White Coat Wednesdays, go up and you do some general lobbying, but you’re also the physician for the legislature that day. So if anyone has any medical questions or anything, you do sort of office visits up there.
And this is during the sort of height of the HB2, the bathroom bill that North Carolina had, that you could only use a bathroom the gender you were assigned at birth.

[27:44] And there had been some protests the weekend before against that bill.
Anyway, I was up there that Wednesday and I was asked to go to a staff member’s office because he was having a little problem with a cough and congestion and allergies or something.
And I had been given strict marching orders by the head of the academy, a good friend of mine, Greg Riggs, he says, you are here for the academy. You’re not here about the transgender issue.
And it’s like, you know, got it. So go up there. And as I’m examining and taking the history from the patient, he drops that comment to the effect of, with the kind of people that were here this past weekend, no telling what I may have caught. And I let that comment just go.

[28:35] And he brought the comment up again a few minutes later, saying the same thing. And I just said, okay, you brought it up twice. I stopped. Well, you need to know that several of those people that were protesting were my patients, people I care for. And he just sort of stopped and turned around and says, you care for transgender patients? Yes. He said, can I ask you a question?
Sure. What does it mean to be transgender? So here’s a staff member that helped get this while passed who had never really understood what he was passing, had never really talked or spoken with someone that was trans.
But yet he was, you know, doing his job, working for his congressman to get this law passed.
And we shared, he said, can you come talk to the head attorney for us? And so, sure. So, we went and called Greg and said, hey, you may want to come with me because they’re asking me about trans questions. And so, we went and talked and wanted to know what it was like for transgender patients in North Carolina and things. So we had a great conversation and, out of that, we didn’t get the law changed. But one of the things that we talked about was.

[29:46] How hard it is for transgender patients to get things like driver’s license changed.
And what came out of that conversation was a totally streamlined, easy way that doesn’t require near the red tape for a transgender patient to get your driver’s license gender marker changed. So, you know, it’s like, was it successful in getting that bill changed at that time? But we did get something that was very important to my patients done. So, you know, every crisis, every communication, every conversation, you don’t know what the effect is going to be on the back end. Where are you going to plant a seed that change may happen? I’m just astounded that you have been as successful as you are as a private practitioner. I am curious if you are aware of similar practice any place else in the United States, or is it just you alone right now?
No, there are lots of practices that are full LGBT accepting and thriving. And I will say, you know, I’m happy that I may have had some influence or helping, but I have.

[31:01] Mentored or taught so many physicians and been mentored to gay physicians particularly in Charlotte and North Carolina that, There are a lot of practices now that will provide transgender care that I have helped, you know, I don’t want to take credit, but I will help mentor, I will bring in, I will, they can call me on the phone, I will counsel, I will review labs.

[31:37] So that I don’t think I am that unique anymore. I have really tried to mentor up because there’s so much need that I don’t think I’m that unique anymore than I may have been 10 years ago.
And I’m very happy that I’m not that unique.

[31:58] What a blessing for you. It must be to be right there out in front of the battle.
I’m sure it must be incredibly rewarding for you.
I have really enjoyed this conversation and frankly I think I could take it on for another couple of hours.
I appreciate you not being totally bored, so thank you. And as I say, I could keep right on talking.
I don’t know if you can hold a podcast audience for that long, so I guess we’re going to have to move along and do what we came here to do and that is to give you an opportunity to speak to our audience all by yourself without my interference or intervention.
So, audience, please give us your ear while Dr. Rhett Brown gives us his personal prescriptions for success.
So, thank you, Randy. I appreciate this and I spent some time sort of trying to be quiet and think about sort of things that have been important to me that have helped me along the way.

[33:11] And the core is that I mentioned and how important my parents were as my mentors and guiding lights throughout my life and the philosophy of medicine that I developed, which is to provide support, guidance, and acceptance to my patients. That also means to yourself as well. Supply support, guidance and acceptance and allow yourself to be self-forgiving and self-compassionate.

[33:42] Remember health is a choice and for you as a provider, your own health is a choice.
Make sure you get adequate sleep. Make sure you’re moving every day. Make sure you’re making good, wise food choices. That you’re practicing a mindfulness practice in some way as a part of your habit. And you spend time regularly with people that give you joy because we steal other people’s joy and add that to our own life. That if you are focusing on that to take care of yourself, it allows you to be in a better position to live our mission of taking care of others and being present for them. Start with yourself. Read a personal improvement book at least once a year. My favorites are Stephen Covey’s, Brené Brown, and James Clear. Their books and their insights continue to enlighten and enrich my life. Make time for joy, celebrate the small milestones in your life, and be kind to others and to yourself.

[34:52] Well, there’s a lot of wisdom in that, Red, and I’m not surprised. You are a remarkable human being and I’m really grateful that you are willing to spend some of your valuable time with us today. Before we go, I want to give you an opportunity to share with us and for our audience where you can be found. If you want to share email addresses, Facebook pages, anything that you’ve got, we’d love to hear it. So I’m Rhett Brown on Facebook. My work Our email is rbrown at advancedavancecare.com.
Well thank you for sharing that with us. We of course will have some notes that the audience can look through on our podcast website and I hope people will take advantage of that.
And once again, Rhett, it’s been a pleasure talking to you and I’m so grateful that you were able to join us.
Well, thank you, Randy. I enjoyed meeting you and get to know you.
I enjoy listening to your podcast and the talent that you bring on and your own talent, that you share. Thank you very much.

[36:00] Thank you so much for listening with us today. If you enjoyed the show, you can help us reach more listeners by leaving a rating and a review, especially on Spotify or Apple Podcasts.
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