FP Finds Her Calling in LGBTQ+ Care

Her patients, many of whom travel from other states to see Bast because of her expertise in caring for LGBTQ+ patients, are grateful.

“I have patients cry in my office regularly because they’re just so glad that we’re here and they have a safe place,” said Bast, who will share what she has learned with other family physicians at the Family Medicine Experience Oct. 26-29 in Chicago. “They’re afraid. It’s not an easy time to be LGBTQ, especially trans.”

Bast is one of the plaintiffs in a federal lawsuit challenging a new Indiana law that prohibits clinicians from providing gender-affirming care to minors. A U.S. district judge issued a preliminary injunction in June that blocked enforcement of the law.

“This is not something I ever thought I would do as a doctor, but we really wanted our patients to know that we stand with them,” said Bast, who has about 1,200 transgender and non-binary individuals in her clinic’s roughly 3,000-patient panel.

For years, Bast doubted she would become a doctor.

She entered Mount Holyoke College in 1988 with plans to ultimately move on to medical school, but she struggled with organic chemistry and graduated with a degree in art history.

“I didn’t ace organic chemistry, and I had always aced everything else in my life,” she said. “That was a real blow.”

Bast got married, started a family and found she loved the childbirth classes she took as an expecting mom. She earned certifications as a childbirth educator, doula and midwife. She delivered hundreds of babies, many in the homes of her area’s large Amish community.

“I loved working as a midwife, but I always felt like I wanted to take care of the kids, too,” said Bast, who went back to school at 36. “When my youngest went to first grade, I realized I still really did want to be a doctor. Even though I was older, I decided I was going to go back to school, do my undergraduate science again and apply to med school.”

Bast, who identifies as a gender-expansive lesbian, developed an interest in the health care and health disparities faced by the LGBTQ+ population. One of her first medical school projects focused on creating a safe sex guide for lesbians because there was nothing easily accessible on that topic.

As she was entering residency, a former patient from her midwife practice called to ask if Bast would see her child.

“She said, ‘My child who you identified as male on the birth certificate has identified as female. I can’t find a pediatrician who will see her,’” Bast said. “I said, ‘Well, I’d love to see her.’”

Bast completed a rotation at Lyon-Martin Community Health Services in San Francisco focused on trans care and also made connections with other physicians who had experience caring for transgender patients.

“By the time I was ready to graduate residency, by word of mouth, I had 80 trans patients who were traveling to me in this small town in Indiana from up to three hours away,” she said. “I interviewed at local FQHCs, but nobody was quite ready, in 2016, to say, ‘Yeah, we’re really going to embrace this work.’”

Bast and her partner opened a new practice instead. She said about three-fourths of her patients are “LGBTQ in one stripe or another.” Patients now travel as far as seven hours to see her.

“I hadn’t taken any classes on how to open or run a medical practice,” she said, “but, mercifully, there were people willing to help.”

One practice owner shared budgeting tips and a recommendation for an electronic health records system. Another passed on an AAFP practice manual, complete with that physician’s related sticky notes.

“She told me, ‘You can do this,’” Bast said. 

Bast’s practice is on the campus of a community mental health facility in Goshen, Ind. She sees many of that organization’s patients for primary care.

“I stopped doing OB after my second year, partly because it was just me at that point and leaving a room full of patients waiting while I went to catch a baby was hard,” she said. “I still do everything else a family doc does.”

That, she said, includes HIV care, preexposure prophylaxis for the prevention of HIV infection, and testing and treatment for other sexually transmitted infections.

Patients aren’t the only people traveling long distances to meet Bast. During the past three years, dozens of primary care physicians and nurse practitioners from across the country have come to Goshen to learn about LGBTQ+ care from Bast, an adjunct clinical assistant professor of family medicine at the Indiana University School of Medicine. Her course, which was accredited by IU, offers a day of didactics and a day of shadowing Bast in her clinic.

“There’s been some literature showing that when we just go to a conference, we don’t necessarily come back and put it into practice,” she said. “What we we’re hoping to do is to help people see what it’s like to actually do this work.”

Bast will present two topics next month at FMX. One session, she said, will cover “basic LGBTQ+ care competency.”

“We’ll identify what the barriers to care are for folks in the LGBTQ+ community and how to mitigate them,” she said. “These are the small, fairly easy things you can do in order to make their experience more welcoming and maybe make folks more likely to come see you.”

The second presentation will cover gender-affirming hormone therapy for adults.

“My goal has been to normalize this care,” she said. “You’re probably serving LGBTQ people, and you don’t know it. If you don’t know it, it’s because they don't trust you enough to tell you. So, here’s how you make yourself more friendly so that they will trust you and you can do this work.”