When and Why to Request an E-Consult With the Gender Clinic: A Q&A With Dr. Gina Sequeira

Seattle Children’s Gender Clinic now offers an e-consult service that allows providers to submit nonurgent patient-specific questions via Epic and receive a response from a Gender Clinic provider within three days. There is no charge. Dr. Gina Sequeira answers questions about what kinds of questions PCPs are asking and how to use the service.

Q: Why did Gender Clinic create the e-consult option?

Dr. Sequeira: Kids outside Seattle, and especially in rural areas, have very limited options — or none at all — for gender-related care, for a whole host of reasons. We felt making an e-consult available for providers was the least we could do to help these vulnerable youth get the support and care they very much need.

Q: What kinds of questions are ideal for an e-consult?

A: It’s great for very specific questions about an individual patient. We can give detailed written answers, which is different from when you call the Provider-to-Provider Line. For more general questions, we’ve put together a lot of helpful information for patients and providers on our Gender Clinic website, including a whole page devoted to resources and education materials for healthcare providers.

Q: What are some common questions you hear?

A: The most common question we receive is about menstrual suppression and supporting patients who want to stop their menstrual cycles. For example, a PCP may ask what labs to order for a patient or tell us they’re thinking about starting a puberty blocker for a patient and ask for advice on the right dose. We’ve had questions about what to do when a patient experiences a side effect, and we help them adjust medication.

PCPs also frequently will ask us how they can help a patient who is in distress from experiencing gender dysphoria. They want help clarifying what their role as a PCP is versus when to refer to us.

Q: What other types of questions are appropriate for an e-consult?

Good question. There are many! The e-consult is appropriate for questions of a medical, social work or nursing nature. So far we’ve only gotten medical questions. But we would welcome nursing and social work questions, and we have a lot of staff ready to help answer those questions. Let me give you some examples of the types of questions we can answer.

Examples of social work questions we can help with:

• How can I help a young person who wants to change their legal name or gender marker? (This is a common issue our social work team often supports families with.)
• What resources are available for a parent who is looking for a parent support group (or for a youth needing a youth support group)?
• How can I support my patient in coming out at school?
• What resources can I offer families to support their child who’s transitioning?

Examples of nursing questions we can help with:

• When a provider is starting to administer testosterone, how can our nurses support a patient with injection teaching? (For example, there is a medication we use that is administered by injection every three months and it’s a bit of a unique process with unique preparations which some nurses would like coaching on.)
• How can we support gender-confirming actions of a nonmedical nature (i.e., chest binding, tucking in the genital area to create a more feminine appearance, etc.)?

Q: Who answers the e-consults?

If it’s a medical question, either myself, Juanita Kay Hodax, MD, or Catherine Verriere Sumerwell, ARNP, DNP, will answer. Social work questions are answered by Lara Llewellyn Hayden, LICSW, MSW; Ash Kasenic, MSW, LSWAIC; or Caitlin Thornburgh, MSW, LSWAIC. Nursing questions generally are answered by Sully Sullivan, RN, BSN.

Q: How do I submit an e-consult?

You need to use the e-consult order in EpicCare Link. Providers who do not have EpicCare Link access can request a login. Our website has complete information on how to submit an e-consult.

Q: Is e-consult only available to medical providers?

Anyone who has EpicCare Link access can submit an e-consult to our Gender Clinic. This includes referral coordinators and medical office staff.

Q: Is e-consult easy to use?

Yes! The feedback so far has all been positive. I’ll add we have ample capacity to respond to more e-consults, so please keep them coming. And remember we are here for social work and nursing questions as well as medical ones.