ACP Calls for LGBT Equity, Opposes Conversion Therapy

Susan London

May 11, 2015

The American College of Physicians (ACP) has issued a new policy position paper offering recommendations for achieving healthcare equality for lesbian, gay, bisexual, and transgender (LGBT) patients.

Published online May 11 in the Annals of Internal Medicine, the ACP statement calls for support for transgender rights and same-sex marriage and opposes so-called conversion therapy, which attempts to change an individual's sexual orientation. Its publication comes at a time when the Supreme Court is deliberating legalization of marriage for couples of the same sex.

"We have embraced the concept of health equity for all populations, which builds upon our work for many years around healthcare disparities and health equity for racial and ethnic minorities," Wayne J. Riley, MD, president of the ACP and clinical professor of medicine at Vanderbilt University School of Medicine in Nashville, Tennessee, told Medscape Medical News. "Obviously, the health issues faced by the LGBT community mirror in some respects a lot of the issues that have befallen the racial and ethnic community," such as difficulty with access and clinicians' lack of cultural competency or awareness when it comes to caring for these populations.

"We hope this [position paper] raises awareness among our members that patients come to the patient–physician encounter with different perspectives, different lifestyle choices, and different sexual identities, and that it's incumbent upon us as healthcare professionals, as general internists and internal medicine subspecialists, to provide the LGBT community the best possible culturally competent and relevant healthcare which addresses their needs," he added.

The article represents culmination of work by ACP's Health and Public Policy Committee that began about a year and a half ago, Dr Riley said. To inform its recommendations, the committee reviewed published studies, reports, and surveys on LGBT healthcare and related health policy.

Among the article's highlights, the ACP recommends that nondiscrimination and antiharassment policies include sex identity, a construct independent of sexual orientation. The organization also recommends that public and private health benefit plans include comprehensive transgender healthcare services and provide transgender persons with the same covered services provided to other beneficiaries.

In addition, the ACP supports civil marriage rights for same-sex couples and also recommends that the definition of family include those who maintain an ongoing emotional relationship with a person, regardless of their legal or biological relationship; therefore, patients should be able to determine who may visit and who may act on their behalf during their stay in a hospital or other medical facility. They further call for research on LGBT health disparities and approaches for reducing them, and recommend that medical training programs incorporate LGBT health issues into their curricula.

Finally, the ACP opposes the use of conversion, reorientation, or reparative therapy for the treatment of LGBT persons. They note that this therapy has no evidence of benefit, as well as some evidence of harm, especially among youth. Two states (California and New Jersey) and Washington, DC, have banned its use for minors.

Jack Drescher, MD, a psychiatrist and psychoanalyst in private practice in New York City, applauded the ACP's opposition to conversion therapy, noting that the American Psychiatric Association first expressed a stance against this therapy in 1998 and reaffirmed that stance in 2000.

Only "fringe groups" continue to endorse conversion therapy, he said in an interview. It is unknown how commonly it is used because those data are not being collected.

"We don't teach it in psychiatric residency training programs, it's not taught in psychology or social work training programs," Dr Drescher elaborated. "And the people practicing it, many of them are not even licensed mental health professionals.... People who call themselves life coaches, people who are counselors and religious groups are doing it.

"Pretty much, it's a mainstream view that conversion therapies don't work, and that they can be harmful," he concluded.

The ACP's Dr Riley noted that the new policy position paper complements the recently updated Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, which he described as "sort of a primer on providing culturally competent care to LGBT communities."

"We look upon this as a two-pronged thing: one, to provide a medical textbook specific to LGBT care in the Fenway Guide, and also in terms of our health and public policy position, to really make a statement that LGBT care is important," he explained.

Financial support for development of the policy position paper came exclusively from the ACP operating budget.

Ann Intern Med. Published online May 11, 2015. Full text

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