Care Resource is a nonprofit, Federally Qualified Health Center (FQHC) with locations in Midtown Miami, Little Havana, Miami Beach, and Fort Lauderdale. Since its founding 35 years ago, Care Resource has shown dedication to LGBTQ+ healthcare and the health of South Florida’s underserved communities. The health center is continuously recognized as a leader in LGBTQ+ Healthcare Equality Index (HEI). Care Resource’s best practices in LGBTQ+ care include, but are not limited to: an Equal Employment Opportunity Policy to ensure non-discrimination in management practices and decisions, LGBTQ+ Patient Training for staff, and an LGBTQ-inclusive patient non-discrimination policy. Care Resource chats with one of their own, Robert Goubeaux, DO, Medical Director at Care Resource.

Care Resource: Tell us about your professional background. How did you find your way to Care Resource?

Robert Goubeaux, DO: I completed my family practice residency in 1997 and then I joined a group practice where I stayed for about 19 years. During that time I was also the Family Practice Program Director and it just so happened that my chief resident at the time was Dr. Sheryl Zayas who became Care Resource’s Medical Director after she graduated from residency! Dr. Zayas had reached out to me several times to invite me to join Care Resource. After learning about the center’s commitment to the community, I decided to make the change. In April 2016, I accepted the position and began to serve as Medical Director of the Miami Beach/Midtown offices in November 2016.

CR: When you first began to practice, what was the general understanding of LGBTQ+ healthcare?

RG: At the time, it was still very taboo to speak of LGBTQ+ health issues; the environment for LGBTQ+ healthcare was not positive. Often, people who were LGBTQ+ weren’t comfortable going into the doctor’s office because they didn’t know whether they would be welcome. Back then, because of HIV, people were really discriminated against. Doctors refused to see patients who had HIV and would make their beliefs known, saying “this [HIV] is your fault.” However, the group practice I worked at welcomed all patients, no matter their sexual orientation. I received many LGBTQ+ patients, especially through friends’ referrals because I was openly gay. When I joined Care Resource, I transitioned even more into LGBTQ+ healthcare, including preventive care.

CR: How is Care Resource a safe space for LGBTQ+ patients?

RG: We have our roots in the LGBTQ+ community. We started out as an AIDS Service Organization (ASO) and then we became known in the community through AIDS Walk Miami and The White Party. We were at the forefront of the community, so people knew that they could come to us; we were a safe place.

As we have evolved into a health center for the general population, we’ve done a good job of making other members of our communities feel welcome and comfortable. We serve all marginalized communities, and we go out into the community for outreach to make sure people know that. At Care Resource, our providers see everyone as a person and treat them as such—not a label.

It’s important to care without judgment. As doctors, we took an oath to cause no harm. Making disparaging remarks, such as “you’re not welcome,” or “you deserve what you got,” or even insinuating this, causes a lot of emotional and psychological harm. Some people will treat the patient, but their demeanor is cold, and the environment is not welcoming. There is no compassion in that type of care—instead, we should think: let’s help, let’s treat, let’s educate. There needs to be a level of comfort between the provider and the patient so the patient feels comfortable. They need to know that their provider is there to listen without judgment. Patients shouldn’t have to hold information back from their providers, especially information that could be critical to their care.

CR: What are specific health issues that disproportionately affect the LGBTQ+ community? How can these health outcomes be improved?

RG: With gay men, we need to be aware of illnesses that affect the community such as STIs and the human papillomavirus (HPV) because certain papillomaviruses can affect colorectal health and cause other health issues. We need to perform screenings in order to prevent colorectal and anal cancers and emphasize preventive care.

Also, although STIs are a concern for everyone, we have seen an increase in STIs in the LGBTQ+ community. It’s extremely important to get our LGBTQ+ patients into care on a regular basis and follow up with them, especially if they’re living with HIV or Hepatitis C, in order to prevent further adverse health outcomes. Within our HIV community, providers have realized that when they follow up consistently, we’re catching other health issues earlier, such as diabetes, cardiovascular disease, or high blood pressure.

In terms of our LGTBQ+ community, we’ve seen that if we can take care of all of their needs in one place, they have better health outcomes. Care Resource brings services ranging from primary care to HIV treatment, hormone therapy, and other specialty needs in one place, making it more likely that our patients’ needs are addressed. When they come to Care Resource, they can easily access other Care Resource providers who are also open and welcoming to the LGBTQ+ community.

CR: What advice would you give to members of LGBTQ+ community and sexually active people in general, concerning COVID-19, social distancing, and STI transmission?

RG: During this time of a global pandemic, it is very important that everyone take this very seriously. We recommend social distancing and avoiding any group activities. We do not recommend using any social apps for hooking-up or having sexual encounters. Taking these steps will help not only in preventing transmission of COVID-19, but also preventing transmission of STIs.

For those in our community, especially older individuals, who are living with HIV and have compromised immune systems, it is even more important to follow the recommendations we have all been given. If individuals experience symptoms of fever, cough, and/or shortness of breath, they should contact their provider for guidance. They should not just show up at their provider’s office without calling first.

CR: How does Care Resource further address the various social issues that might affect the health of LGBTQ+ individuals?

RG: We have so many resources to help each individual. Patients come for one service and end up staying for others. For our homeless population and those experiencing substance use disorder (SUD), we have housing and Case Management services. The most important thing is allowing our patients to get everything taken care of in one place instead of having to make multiple appointments at different places. This is especially important for our patients who are homeless and struggle additionally with transportation.

I’m an osteopathic physician, and I was always taught that the aim is to treat the whole person—not just the disease. We take a holistic approach, considering both behavioral health and physical health. We can’t just treat symptoms as a way to slap a band-aid on the root issue. Sometimes general practitioners miss the connection between behavioral health and physical health. They do not investigate the root cause in order to see how the patient can truly be helped. They’re not considering behavioral health issues that could be leading to a specific health outcome.

CR: How can providers find the necessary knowledge to attend to patients who identify as LGBTQ+?

RG: At Care Resource, we receive seminars led by members of the LGBTQ+ community that discuss using personal gender pronouns (PGPs). There are additional learning opportunities, including Continuing Medical Education (CME) courses, conferences on HIV, and Medication-Assisted Treatment (MAT). If general practitioners are interested, they can access the information. Even our national conferences are prioritizing LGBTQ+ health issues in the conversation.

CR: How do you envision LGBTQ+ healthcare in five years?

RG: In five years, I envision that members of the LGBTQ+ community can be seen by any provider and that they would be treated as a whole person. This hope extends to all other marginalized groups. I would like to see more of the general physician population transition into accepting, nonjudgmental, and competent care.

I would hope that we don’t even have to ask, “how are we doing with our LGBTQ+ patients?” I want LGBTQ+ healthcare to be integrated into general healthcare practices. It is important that we know everyone is vulnerable to health issues and that we routinize STI/HIV testing. I have witnessed that people in the straight community, especially the younger individuals, are more open to this. I’ve even seen greater acceptance of HIV testing within the older community. Now some patients are even the ones who insist that they receive testing for STIs/HIV. We are making advances—we just have to keep pushing and educating.