HealthMay 20, 2020

Delivering inclusive care for our LGBTQ patients

By: Andrea Eisenberg, MD

I’m sitting next to my son at a new doctor’s office. After he’s given an intake form, he immediately turns to me. “What do I put down for my name?” he asks. His legal name is his birth name, but he goes by a new name, a name that matches his gender identity.

These seemingly small details can impact your patient greatly. On a broader scale, LGBTQ patients face healthcare disparities and discrimination that can lead to delayed medical care and poor health outcomes. The authors of an article published in Nursing2020 discussed several factors that contribute to health disparities in the LGBTQ population, including:

  • Lower rates of health insurance.
  • Lack of a regular healthcare provider.
  • Bias and lack of education of healthcare providers regarding LGBTQ health issues.
  • Poorer health and earlier death due to chronic stress from living as a gender or sexual minority.

How can we as physicians provide more inclusive care for our LGBTQ patients?

Bias in caring for LGBTQ patients

There are two types of bias: explicit and implicit. Explicit biases refer to beliefs that are conscious, while implicit biases are unconscious and outside our awareness. Both affect the quality of patient care and contribute to disparities in healthcare for vulnerable groups such as LGBTQ patients.

Since implicit biases usually come from repeated personal experiences, they are—like any other habit—the most resistant to change. It requires becoming aware of the bias and then changing the bias response.

The authors of a systemic review published in BMC Medical Education discussed the possibilities of experiential learning as a tool to increase the comfort level of medical professionals caring for LGBTQ patients. Some examples of experiential learning include:

  • Small group discussions.
  • Simulated patient experiences.
  • Presentations and panels led by LGBTQ individuals.
  • Videos of LGBTQ patients describing discrimination in healthcare.
  • Patient encounters.

In the end, the strategies that were successful “included those that increased knowledge about the health care needs of LGBTQ persons, promoted positive attitudes toward LGBTQ patients, and increased comfort working with LGBTQ patients.”

Filling gaps in training

In addition to taking steps to mitigate our own biases, we need to recognize and address our lack of training for our LGBTQ patients’ specific healthcare needs.

An article published by the American Association of Medical Colleges highlights how woefully limited our training is and how this takes a toll on our patients. Instead of introducing LGBTQ content in lectures or small groups or as an optional session, the authors recommend integrating it throughout the curriculum. Teaching transgender care during endocrinology, for example, would “allow for optimal linking of LGBTQ-specific skills with related broader educational themes,” thus making it just another part of the curriculum.

For those out in practice, GLMA: Health Professionals Advancing LGBT Equality offers a free online webinar series dedicated to caring for LGBTQ patients and cultural competence for healthcare professionals.

Creating an LGBTQ-friendly practice

As the authors of a Nursing Critical Care paper on delivering LGBTQ-sensitive care point out, “the heart of patient-centered care is sensitive face-to-face communication.” Nonjudgmental verbal and nonverbal communication are vital in building trust. The paper offers sample scripts on how to address patients and family. Key points include:

  • Either avoiding gender terms or asking preferred gender pronouns.
  • Refraining from assuming patients have an opposite-gender partner.
  • Asking respectfully about a patient’s name if it doesn’t match with their medical record.
  • Being aware that a patient may not be “out” to their family.

Creating an LGBTQ-friendly practice also means cultivating a more comfortable environment in your office. The American Medical Association offers some suggestions for making your office a safe place, including:

  • Displaying brochures and posters in your waiting room that discuss LGBTQ health issues.
  • Customizing your intake forms so they include preferred name and pronouns.
  • Training your staff on how to address patients.
  • Listing your practice in the GLMA directory.

Ultimately, it’s up to every healthcare professional to educate themselves about gender identity and sexual orientation and come to terms with their comfort level with caring for LGBTQ patients.

The journey with my child, as he transitioned from my daughter to my son, has opened my eyes to both the daily struggles my son encounters, like dealing with public bathrooms, and the daily reminders of how special, quirky and authentic he is now that he has transitioned. Although I am a physician and can navigate his healthcare to make sure he has appropriate providers and appropriate care for his specific needs, I worry that once he is out on his own, his future providers may not offer him the same level of care and consideration as their non-LGBTQ patients.

Andrea Eisenberg, MD
Lippincott® Journals
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