AMA Stands Up to Stop 'Fraud, Harm, Trauma' in LGBTQ Patients

Pauline Anderson

November 20, 2019

The American Medical Association (AMA) has announced several new and updated policies to better support and protect transgender patients and other members of the LGBTQ community.

On November 19, at the Interim Meeting of its House of Delegates, the AMA announced it would advocate for federal legislation to ban conversion therapy, which is aimed at changing the sexual orientation or gender identity of members of the gay and transgender communities.

During the AMA meeting, it was also announced that its House of Delegates has directed the AMA to develop model state legislation and to advocate for federal legislation to ban "reparative" or conversion therapy for sexual orientation or gender identity.

The AMA has long been opposed to conversion therapy because of evidence that it causes significant harms, including depression, posttraumatic stress disorder, and suicidal thoughts and attempts. In addition, there is no scientific evidence to support the premise that it's possible to change an individual's sexual orientation.

"It is clear to the AMA that the conversion therapy needs to end in the United States given the risk of deliberate harm to LGBTQ people," AMA board member William E. Kobler, MD, said in a statement.

"Conversion therapy has no foundation as scientifically valid medical care and lacks credible evidence to support its efficacy or safety. The newly amended policy reinforces the importance of EHRs [electronic health records] that contain inclusive information on transgender patients," Kobler added.

Data cited by the AMA suggest that as of 2018, almost 700,000 LGBTQ adults in the United States had received conversion therapy. In addition, an estimated "57,000 youths will receive change efforts from religious or health care providers before they turn 18 years old."

"Harm, Fraud, Trauma"

To date, 18 states and the District of Columbia have banned licensed healthcare practitioners from subjecting minors to conversion therapy. No states have banned conversion therapy for adults. The AMA said it "agrees with medical experts that the lack of regulation on conversion therapy opens the door to fraud, harm and trauma for many adults and children in the US."

The AMA also strengthened its existing policy promoting inclusive gender, sex, and sexual orientation options in medical documentation for LGBTQ patients, and it called for the creation of EHRs that are "fully inclusive of transgender patients."

The amended policy aligns with the recommendations of the World Professional Association for Transgender Health that medical documentation include a patient's preferred name, preferred gender identity, and pronoun preference, along with a means to maintain an inventory of a patient's medical transition history and current anatomy.

"Without this information, transgender patients and their specific health care needs cannot be identified or documented, the health disparities they experience cannot be addressed, and the provision of important health care services may not be delivered," said Kobler.

The AMA also adopted a policy aimed at medical training so that students and residents have a better understanding of the health issues related to sexual orientation and gender identity.

"With research showing significant disparities among patients facing health issues related to sexual orientation and gender identity, it is important that our future physicians have the training they need to recognize these health issues and better treat their patients," said AMA board member Grayson W. Armstrong, MD, MPH.

Not Far Enough?

Although these new and amended AMA policies are a step in the right direction, more needs to be done, Jack Drescher, MD, clinical professor of psychiatry, Columbia University, New York City, and distinguished life fellow of the American Psychiatric Association (APA), told Medscape Medical News.

A member of the APA's sexual- and gender-identity work group for the DSM-5, he has worked for more than 20 years to eliminate conversion therapy and has authored briefs in support of legislation banning it in several states. He noted that although a ban on conversion therapy sends a signal, it may not be entirely effective.

"The problem with bans is they don't go far enough. There are only bans on minors and only bans for licensed professionals, but the majority of the clients are not minors, and the majority of practitioners are not licensed professionals," he said.

Opponents of banning conversion therapy typically come from "social conservative religious organizations that disapprove of homosexuality," he added.

Drescher applauded the AMA's move to boost awareness of health issues related to sexual orientation and gender identity in basic science, clinical care, and cultural competency curricula in medical school and residency training.

He noted that clinicians are not always aware of the sexual orientation of patients.

"By asking certain questions, you're letting patients know you're comfortable with who they are and that they're not an outlier," he said.

Some physicians wonder what to do about patients during transitioning, said Drescher. "I often get asked: 'What do we do if their legal name is male but they're presenting as female? How are we supposed to chart this?' "

He suggested that it's simply a matter of writing this information in the first paragraph of the patient's chart. When it comes to healthcare of LGBTQ patients, the AMA "is becoming increasingly supportive" of updating policies.

"That's not only good for patients but for those who treat them," he said.

Although this is a positive move, it remains to be seen whether medical schools will pay attention to the policy and implement it.

Drescher, who frequently lectures to professionals on sexual orientation and gender identity issues, said he often begins his talk by asking how many in the audience think they had adequate training in this area.

"Very few people raise their hands," he said.

He noted that this gap applies not only to physicians but also to other healthcare professionals, including nurses and psychologists.

He added that the APA offers "a lot of LGBTQ-oriented training" at its meetings. "I think the APA is taking a leadership role in this area," he said.

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