With Exotic Cats and Video Games, Doc Builds LGBTQ-Friendly Family Practice

William Powers woke to the sound of the smoke alarm.

It was Sunday, November 12, 2017, and the Michigan doctor was fresh off a victory lap. Two of his three prized cats had recently been named Guinness World Record holders. At 19 inches, Arcturus Aldebaran was the world's tallest feline. And Cygnus Regulus, a Maine Coon, proudly swished the longest tail of any living domestic cat.

But when Powers emerged from his bedroom, he found his massage chair engulfed in flames.

He ran to the kitchen, only to realize he hadn't unpacked his fire extinguisher after a recent move. He strapped on a fire mask to look for the cats, but when the mask broke, he collapsed from smoke inhalation. He woke up, ran to the basement to search for them, but passed out again. When he regained consciousness, he stumbled out of the burning building, moments before the windows blew out, glass lacerating his body as he stood helpless on the lawn.

"The house burned to the foundation and destroyed everything — literally everything," Powers said. "All that I could recover fit in a 5-gallon bucket." His  cats had died.

Powers was devastated and eventually sought psychiatric care. "I just could not accept the level of grief I had," he said. "It broke me." He was fired from the clinic where he'd been working, which Powers attributes to the duration of his recovery and to the stigma attached to doctors with mental health issues. "I didn't do anything wrong," he said.

With the help of his wife, Lauren Powers, DO, he slowly recovered. The couple traveled around national parks in an RV. They played video games and went to electronic music concerts. And they got four new cats.

Throughout his 15-month recovery, Powers remained motivated by his former patients, some of whom visited him. "They convinced me, like, we need you. You have a purpose."

A Dream Family Practice

When Powers's psychiatrist cleared him for work, he decided to open a clinic on his own terms. "I started envisioning my dream clinic — what it would look like, what would be in it," he said.

By then, he had established a reputation in the transgender community as an accepting physician. He imagined an inclusive space for all his patients, filled with the things he loves most: cats and video games.

Dr William Powers with Polaris

Powers Family Medicine opened in February 2019 in Farmington Hills, 20 miles outside of Detroit. Powers, now 34, installed a customized video arcade console in his waiting room and gamer art throughout the space. Three new cats, Hyperion, Polaris, and Phoenix, keep their own rotating office schedules. (A fourth cat, Altair, stays at home.)

Phoenix greets patients at the reception desk.

At first, everyone in his life except his wife warned him that his unconventional family practice was going to be a miserable failure. It was too eccentric, too unprofessional. But Powers was unfazed. After his brush with death and long recovery, he decided to make his dream clinic a reality. His gamble paid off.

Within 6 months, 1000 patients had flocked to his practice, reaching the cap he had set for himself. "I see a maximum of 20 patients a day now so I can do a good job," Powers said. The clinic accepts insurance, Medicaid, Medicare, cash, and Bitcoin.

Many of his patients knew him from earlier in his career. Back when he was a resident, he had become interested in transgender care after treating his first transgender patient. Today, 95% of his patients are either LGBTQ, HIV-positive, in polyamorous relationships, or practicing a kink or sexual fetish.  

They don't all need specialized care, Powers said, "They just need a provider they can trust." Many have been unable to talk honestly with doctors in the past. "They come to me because I'm known not to judge."

Richard Kuzma, DO, a family physician practicing in North Carolina, describes Powers' new practice as "approachable." He's known Powers since they were co-chief residents at the Detroit Wayne County Health Authority.

"Dr Powers has a genuine care for people that can be hard to believe, until you see him demonstrate it consistently over months and years like I was able to do," Kuzma said.

That said, Kuzma has been skeptical since residency of some of Powers' treatments for transgender patients. "He and I would actually debate this, often in front of the residents because we wanted them to actually see that dialogue," Kuzma recalled. Powers has continued to share his approaches with the broader medical community, he added, which has made him somewhat controversial.

"It's a very sticky position to be in, when so many colleagues don't agree with what you're doing," Kuzma said. "However, every time I've seen him debate this with people who are very clearly not supporters, he remains professional, he remains on topic, and he remains supportive of the patient."

In fact, Kuzma adds, "the most concise compliment I can give to a physician is that I'd send my own family to them, and I'd absolutely say that of Dr Powers."

Feline Companionship and Video Game Anonymity

When designing his new practice, Powers embraced the belief that human–animal interactions in the clinical setting can improve a patient's mood and energy level. He hoped that his cats and other unusual features of the clinic would not only attract newcomers but make them more comfortable once they've arrived. Patients can choose not to interact with the cats, but Powers has observed that many LGBTQ patients are nervous when meeting a new provider. "I'll walk into a room and there's perceptible anxiety. So I'll grab one of the cats. It completely alters their perception," Powers said. Once the cats are around, people calm down, settle in, and open up.

Hard at work in the clinic

To make sure that the felines benefit as many people as possible, Powers selected exotic hybrids that produce less of the allergenic FEL D1 protein. "I have tons of patients with cat allergies," he said, but none have had an adverse reaction to the animals in the office. He has also had the cats tested for zoonotic diseases like toxoplasmosis and carries insurance in the event they harm a patient. But that's unlikely, Powers said. "When I got them as kittens, I trained them for this purpose. They were around a multitude of people from a very young age," making them particularly social.

As for the video games, Powers didn't feel constrained by how clinics are supposed to look, or what kind of diversions should be offered to pass the time in a waiting or exam room. An avid gamer since childhood, Powers turned to video games to cope in the aftermath of his house fire. "For me, they're immersive worlds I can kind of lose myself in for a while, and I can forget about my grief," he said. "They were literally what stopped me from going completely insane after the fire."

He believes the same can be true for his patients. "They're living with HIV. They may be living with family members who abuse them. Many have hated the body they have lived in since they were little," he said. But when they're playing video games, they're creating and inhabiting fantastical worlds.

Game console in the main waiting room

The gaming ethos permeates Powers Family Clinic in other ways. When patients check in for their appointments, they give the receptionist their initials. She hands them an "amiibo" — a statue of a video game character like Pikachu from Pokemon or Princess Peach from the Super Mario Bros. For the rest of their visit, patients are referred to by the names of their amiibos. It's a fun way to enhance patient privacy, which is especially important for people whose gender, sexual identity, or health status could lead to discrimination. "We're fiercely protective of their privacy," Powers said.

Video game amiibos

Primary Care and More

For Powers and his 3-person team, it's all about providing patients with a much-needed sense of safety and respect. Powers noted that gender identity is not protected in the state of Michigan, nor at the federal level.

Discrimination is pervasive, even in healthcare, he said. That's why he  created a clinic for everyone, one that goes beyond providing the primary care that all patients need. For example, Powers prescribes hormone therapy to transgender patients and pre-exposure prophylaxis (PReP) to 100 or so of his patients at high risk for HIV infection. The latter is something that he hopes more primary care providers will discuss with at-risk patients. Although not required for PReP prescribing, Powers is an American Academy of HIV Medicine-certified HIV specialist.

He trained in the standards of care of the World Professional Association for Transgender Health. It can be difficult to find clinicians who provide this type of care, he explained, which is why, upon opening his new clinic, "patients began coming from all over the place."

His approach to transgender care has evolved over the years, he said.  "There's very little research to support what we do in transgender medicine."  So he began reading the self-reports of transgender patients online and listening to his patients' experiences. "I tried, I learned, I adapted," he said.

It was from this informal research that he developed the so-called "Powers Method," which he shares with physicians around the world through a regularly-updated and freely-available PowerPoint presentation.

"What makes a great doctor, instead of just a good one, is knowing when to deviate from the guidelines to do the right thing for the patient," Powers observed.

And he does deviate. For example, Powers targets a much higher estradiol level than other doctors, and reaches it using only bioidentical hormones, not synthetics.

Before the fire, Powers had been working on a research paper of his findings, but lost his work in the blaze. He's starting again from scratch, but right now, he believes that his strategies are validated through patient experiences and outcomes. Powers said he's never had a major adverse event under his care.

A Hero For the LGBTQ Community?

Lately, Powers has also been dealing with the burden of minor celebrity. When he shared his story online, the post went viral. News media, prospective patients from around the country, and even producers interested in making a TV show about his life reached out to him. It reminds Powers of the days when he was raising world-record-holding cats (Arcturus and Cygnus were written up in People magazine, and appeared on Good Morning America), except he doesn't think he has the same stamina that he had before the fire.

"It's a lot of exposure and demands on my time," he said. "Some days, I just want to go home and play video games and pet my cats." He currently takes a mental health day once a month, which he offers to his employees as a paid vacation day. And he still takes his RV to the woods whenever possible.

But Powers feels that his patients, who are from some of the most vulnerable groups in the United States, need his help. And as a straight, cisgender white man, he believes he can amplify their voices. "I recognize that there is a massive need for some kind of hero to stand up and speak for them," he said. He feels compelled to fill that role.

The fire changed Powers's life forever. Still struggling with PTSD, he admitted that "a fire alarm will ruin my whole day." But the experience also made him more sensitive to other people. "I have a lot more empathy for my trans patients who may have lost their family, their job, their stuff, their car, their stability, and their feeling of safety and trust in society," he said. "I know what that's like now."

Powers with Hyperion

Eleanor Cummins is a freelance journalist whose work runs the gamut of science. Her work has appeared in Popular Science, Vox, and Gizmodo.

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Cite this: With Exotic Cats and Video Games, Doc Builds LGBTQ-Friendly Family Practice - Medscape - Nov 18, 2019.