My career initially started off in Homeless Outreach and Community Assertive Treatment, during COVID, like many people, I had to transition to working telemedicine. It was during my telemedicine experience in 23 states across the US that I witnessed that I was not alone in my experiences as a woman seeking healthcare. In fact, many women often felt written off or forgotten by the medical profession. It seemed to take an unreasonably long time for women to be diagnosed with conditions specific to women such as: endometriosis, polycystic ovarian syndrome, breast cancer, uterine cancer, cervical cancer, ovarian cancer, autoimmune disorders (like sarcoidosis), connective tissue disorders (Ehler's Danlos Syndrome, Hypermobility Spectrum Disorder). The neurodiverse women with ADHD, OCD, and Autism Spectrum Disorders suffered for 30 or more years without a diagnosis.  The disparities were especially worse for LGBTQI and People of Color. 

 

The most surprising trend that I encountered in 2020 was newly pregnant women were being asked by their psychiatrists to find a different psychiatrist for the perinatal period. Seriously? How could one justify doing this to a newly pregnant woman during a global pandemic with a national shortage of psychiatrists and mental health providers? Much of my training at Vanderbilt University Medical Center was spent working with pregnant women. I was in Nashville during the height of the opioid epidemic and had detoxed hundreds of women with buprenorphine and methadone. I was well aware that there were many medications available to pregnant women. After prescribing methadone to women in the throws of addiction, my anxiety and fears around prescribing medication to pregnant women really subsided. So here I was looking at a newly pregnant and scared woman on the screen. Would I turn her away as well? Absolutely not.

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I explained to the women my previous experience and asked if they were comfortable working with me throughout pregnancy. Everyone adamantly said yes and then I hit the books. Since that time, I have pursued continuing medical education, conferences, and research activities in reproductive psychiatry. I've learned a great deal over the years and some of the lessons were from my direct experience as a mother who experienced a "geriatric" pregnancy, cholestasis of pregnancy, pre-eclampsia, rapid weight gain while breastfeeding and postpartum OCD. 

 

Surprisingly, my skills from homeless outreach translate extremely well to Reproductive Psychiatry.

 

In Reproductive Psychiatry and Homeless outreach, I have to:

• Think quickly 

• Stay on task and not be distracted easily (your babies, kids and cats will not bother me)

• Use de-escalation skills and grounding techniques

• Meet patients where they are without judgement

• Be flexible

• Consider alternative and individualized treatment plans based on patient's values

• Prioritize my patient's goals

• Monitor and respond appropriately to complex medical problems

• Have genuine curiosity and love in my heart for my patients

• Advocate for patients with other medical professionals 

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For LGBTQI People: I use the word woman to describe people born with a uterus and those who identify as a woman. My hope is that this does not deter anyone from seeking care with me. I recognize and appreciate that not everyone with a uterus identifies as a woman and conversely, not everyone who identifies as a woman has a uterus.  Upon meeting all my patients, I ask for preferred name, pronouns and gender identity to ensure that I am supporting them on their journey. One of my passions is working with LGBTQI patients and the many challenges they face, especially transgender, nonbinary and intersex individuals. 

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For People of Color: I research and recognize the barriers you have in accessing care and tolerating psychotropic medications. I may not understand everything you are going through, but I will try while being forthcoming about my limitations to you and myself. I will be thoughtful about your care and advocate for you with other medical professionals.  ​

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