I'll Have What She's Having
by Women Who Know How to Stir the Pot
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Dr. Vian Nguyen's Remarks For A Taste of Things to Come Episode 3 Attendees

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Many guests at IHWSH's third pop-up dinner raved about the food, the sense of community in the room and the compelling remarks by Dr. Vian Nguyen of Legacy Community Health. The following is a transcript of her remarks:

“I want to take this opportunity to draw attention to the battle that women’s healthcare is facing and share what are some of the common barriers I see women face, when trying to access healthcare.

I joined Legacy in 2015. Before this, I was in private practice 5 years and was finding that the changes in health care over the last decade, were making it nearly impossible for me to provide the kind of high quality care that made me want to be a doctor in the first place. Legacy has committed tremendous resources to supporting me and my fellow doctors in our efforts to give the best possible care, regardless of ability to pay – a truly rare thing in today’s health care environment.

When the general public thinks of “barriers to healthcare”, naturally we think of the uninsured population.  Certainly we are proud of the work Legacy does to acquire and maintain grants and donations to allow us to serve so many uninsured patients.  But beyond this, there exist other barriers.  Language barriers, access barriers (access could include only having daytime office hours, no childcare), lack of education or awareness.  These barriers may appear simple, but they are examples of why a woman may not pick up the phone to make her appt, despite her even having insurance.

Our system allows us to be innovative in trying different models of care that attempt to knock down these barriers: we have evening and weekend hours, we have patient educators and education classes emphasizing preventative care, we hire adequate ancillary support staff such as nurses, administrative assistants, social workers, which all allow us to provide the care that one patient needs.

So tonight, I chose to highlight 3 general barriers that women face:

Barrier #1:  multiple doctors, multiple offices, multiple appointments.

Women will tend to take care of others first before themselves.  So whether it is their kids, their aging parents, their siblings, and then maybe their best friends, almost always, these other individuals’ needs will come before hers.  So at Legacy, we try to be as efficient as possible and accommodate this multi-tasking woman – she could potentially schedule herself, her kids, and her parents to be seen. On the same day. At one clinic.  In contrast, in my job before Legacy, if I were seeing a woman after she’d delivered her baby, and found that she needed a psychiatry referral for postpartum depression, I would have to first figure out which therapist accepts her insurance, can that therapist see her within the next week and not have a 3 month wait, and on and on. At Legacy, I walk the patient down the hall and help her get an appointment and sometimes even introduce her to the provider who will be seeing her! One clinic, multiple specialties, and a collaborative environment. This direct connection is essential for ensuring retention into the system.

Barrier #2:  lack of awareness, not lack of education

Many women are unaware of the many recommended screenings for even a young healthy woman, which include an annual visit to speak to a provider, have a physical exam and have lab tests. If women do not take care of themselves early on, whether it be because they don’t have access to care, or the awareness of their health, then there could be serious and irreversible long-term consequences to their health and fertility.  There are very specific things which women should avoid that could affect their fertility long term, or just their ability to have a healthy pregnancy such as smoking, drinking, traveling to certain areas of the world. This is in stark contrast to the young healthy man who doesn’t necessarily have the same amount of recommended screenings or suffer any long-term consequences if he literally does not go to the doctor for 20 years. Bottom line - This requires women to make an early financial and personal commitment to their health at an age when it is really the last thing on the adolescent brain.  I see many highly educated women and professionals, that again do not put their health before their careers/extracurricular activities.  We really need to support each other, to advocate for each other’s health. This lack of awareness and lack of prioritizing ourselves, requires a culture shift and perhaps is one of the more challenging barriers to break.

Barrier #3:  the challenges of the healthcare system becoming more burdensome for all

Health insurance has increasingly become more confusing and challenging to navigate: rejection of refills, lengthy paperwork to get medications or a procedure to be approved.  This leaves a provider with very little energy to truly approach a patient in her care, the way we all want to.

Legacy’s mission, the environment of collaboration and team approach is what allows providers to have the energy to push through these barriers for our patients.  Here, because of our staff and resources, I have the ability to collaborate with hospital systems to help patients navigate this system.

Houston’s recent natural disaster really tested Legacy’s system and proved to us that our system works to help patient’s individual needs. After Hurricane Harvey, I started seeing a patient who was pregnant with twins, who had just moved to Houston for a teaching position. Her house was destroyed in the hurricane. She was having a hard time finding a doctor who would see her as a new patient half way through her pregnancy.  We started seeing her, and co-managed her with the high risk doctors we work with.  She could only be seen after school was over.  So we arranged her weekly visits, so that she would not have to ask off of work, a new job she had just started.

The take away from tonight is that anyone here could help us chip away at these barriers, and be part of this change we are fighting for. Events such as tonight, help not only fundraise dollars, but help us create the awareness that is sorely lacking. Please help us spread the word that Legacy is here for our community, and no Houstonian needs to feel that she (or he) does not have a doctor. I really want to thank again everyone here, especially Dr. Choi, for spearheading such a worthy cause.”

Dr. Vian Nguyen is the medical director of Womens's Health Services at Legacy Community Health and a physician member of I'll Have What She's Having. She loves being a mom, and is expecting her third child.