While rainbow-colored flags may wave proudly from hotel balconies and sports arenas, LGBTQ+ patients may still feel some discrimination in the medical space, according to a Center for American Progress survey.
"Despite healthcare being considered a basic human right by the World Health Organization, it's common for LGBTQ+ folks to not only face difficulties when trying to access care but also within the walls of the doctor's office or hospital," says Samantha Estevez, MD, a reproductive endocrinology and infertility fellow in New York.
In Medscape's Physicians' Views on LGBTQ+ Rights Issues Report 2022: Strong Emotions, Contrary Opinions, we asked physicians whether they see disparities in the care LGBTQ+ patients receive in comparison with the care that non-LGBTQ+ patients receive. About 35% of physicians said LGBTQ+ patients receive a different level of care; 52% of respondents younger than 45 were more likely to say so.
It's an issue unlikely to be resolved without the medical community's awareness. With insights from four LGBTQ+ clinicians, here are several steps physicians can take to close the disparity gap.
Update Intake Forms
Many patient medical forms are populated with checkboxes. These forms may make it easier for patients to share their medical information and for practices to collect data. But unfortunately, they don't allow for patients to fill in contextual information.
"It's extremely important for healthcare professionals to understand the people they are serving," says Nicholas Grant, PhD, ABPP, president of GLMA: Health Professionals Advancing LGBTQ+ Equality. Grant is a board-certified clinical psychologist in Hawaii. "The more accurate we are with our information gathering and paperwork, the more accurate we will be at serving our LGBTQ+ communities."
Grant recommends asking open-ended questions, such as the following:
What is your gender identity?
What was your assigned sex at birth?
What pronouns do you prefer?
What gender(s) are your sexual partners?
However, Frances Grimstad, MD, a Boston-based ob/gyn and GLMA board member, adds this advice: before revising intake forms, consider their purpose.
"As an ob/gyn, information about a patient's sexual orientation and their sexual activity is beneficial for my care," says Grimstad. "But that information may not be relevant for a physical therapy clinic where most patients are coming in with knee injuries. So, you shouldn't just place items on your intake forms by default. Instead, clinicians should consider what is relevant to the encounter you're having and how you are going to use the information."
Take stock of posters and brochures in the office and signs outside restrooms. If they communicate traditional gender roles, then it may be time for a change.
"It's important to ensure representation of all types of people and families in your office," says Chase Anderson, MD, an assistant professor of child and adolescent psychiatry in San Francisco.
Hang posters with images of diverse families. Display brochures that address LGBTQ+ health concerns when warranted. And for restrooms, replace traditional binary images with gender-neutral ones. You can also add signage about each bathroom's purpose, suggests Grimstad.
"Let's not just de-gender bathrooms," she says. "Let's hang signs that tell if the bathroom has multiple stalls, urinals, or handicap access. Let signage focus on the functions of each bathroom, not gender."
Ask for Feedback
Feedback forms give LBGTQ+ patients a platform to share concerns. For example, consider an email with a linked document that all patients can fill out anonymously. Ask questions such as the following:
Did you feel affirmed during your appointment? If so, how? If not, how can we improve?
Did we use the proper pronouns?
Did signage make you feel like you were in a safe space? What didn't make you feel safe?
Set up a system with team members to process feedback and implement changes.
Also, if you have a large-scale practice, consider forming an LGBTQ+ community advisory board. "They can offer feedback about your practice's clinical structure," Grimstad tells Medscape.
Hire Diverse Employees
Building a diverse and inclusive workforce is critical to serving the LBGTQ+ community. Team members should reflect your patient population.
"Diversity isn't a monolith," says Grimstad. "It isn't just racial diversity, or sexual or gender diversity. Even in a town which appears homogeneous in one area of diversity, such as a majority White town, it's important to remember all the other facets of diversity that exist, such as gender, sexual orientation, cultural diversity."
A diverse team may offer a surprising boost to your practice. According to a study published in the Journal of the National Medical Association, patient outcomes improve when a more diverse team provides care. In fact, diverse teams fare better in innovation, communication, risk assessment, and financial performance.
Anderson also recommends allowing team members "to be themselves." For example, let employees wear their hair in whatever way they prefer or display their tattoos.
"This signals to patients that if staff members can be themselves here, patients can be themselves here, too," says Anderson.
Medical staff may sometimes feel uncomfortable serving LBGTQ+ patients because of their own biases, attitudes, or lack of knowledge about the community. Regular training can ease their discomfort.
"Make sure all health professionals are trained and educated on the needs of LGBTQ+ patients," says Grant. "Understanding their health needs is the provider's responsibility."
For basic information, Anderson recommends visiting The Trevor Project, an organization that serves LGBTQ+ youth. "They're really good at keeping up with changing verbiage and trends," says Anderson.
To strengthen community connections, Grimstad recommends using trainers from your local area if possible. Do a Google search to find an LGBTQ+ center nearby or in the closest major city. Invite them to staff meetings or ask them to organize a workshop.
By implementing these strategies, you can start building a bridge between your practice and the LGBTQ+ community and provide better care for them as patients.
"Whether it's knowing about PrEP...or ensuring staff members are trained in caring for patients with any general or sexual identity, we as doctors and medical professionals must continue to move forward and serve our LGBTQ+ patients in big and small ways," says Estevez.
For in-depth training, check the following organizations:
National LGBTQIA+ Health Education Center at the Fenway Institute provides educational programs and resources to healthcare organizations.
GLMA has a top 10 health issues webpage that doctors can use to educate themselves and staff members on the LGBTQ+ community's most urgent health needs.
Alliance for Full Acceptance offers LGBTQ cultural competency training, including a 1-hour awareness class and a 3-hour inclusivity workshop for clinicians.
The Substance Abuse and Mental Health Services Administration has compiled a list of training curricula for behavioral health counselors and primary care providers.
UCSF's Lesbian, Gay, Bisexual, and Transgender Resource Center has a list of training and educational materials for medical professionals.
Equality California Institute offers both in-person and virtual training covering basic terminology, data on LGBTQ+ health issues, and how to create an inclusive environment.
Ana Gascon Ivey is a health and medical writer based in Savannah. She also teaches creative writing at a men's correctional facility.
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Cite this: Best Practices for an LGBTQ+ Friendly Medical Space - Medscape - Oct 13, 2022.