Lesbian, gay, bisexual, transgender, and queer individuals are an important and significant part of our society. Like everybody else, they go to school, go to work, and raise families. When LGBTQ individuals need to seek healthcare, however, they can face several obstacles and inequality. A huge proportion of LGBTQ patients have experience discrimination in healthcare, including being refused care, harsh or abusive treatment, or being blamed for being ill. Care has not improved much in recent years for transgender individuals.
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LGBTQ patients often have to face healthcare providers who are not familiar with their unique needs, electronic medical record systems that don’t have the ability to accurately represent sexual orientation and gender identity (unlike https://www.intellectsoft.net/blog/electronic-medical-records-software-solutions/), and disparities in access to health insurance and coverage. These barriers create barriers for LGBTQ patients who seek and expect access to competent care. As a healthcare provider, consider these tips to offer a better healthcare experience for your patients.
Understand LGBTQ Diversity
Remember that sexual orientation and gender identity are not the same things. Sexual orientation describes sexual and romantic attraction, whereas gender identity describes an individual’s self-concept of gender. Both of these exist on wide spectrums, and some may prefer not to identify their orientation or identity at all. For example, some members of the community are very comfortable with the term ‘queer’ for identifying themselves as someone who is sexual orientation or gender nonconforming, and won’t want to be more specific. Others prefer to be more specific and feel the term ‘queer’ is offensive and inappropriate, so always ask and be ready to adapt. PFLAG has a good glossary of terms that can help.
Sexual orientation and gender identity are not behavioral health disorders and should never be treated as such. Some LGBTQ patients will experience dysphoria as they question their orientation or identity, and this does need to be properly assessed and treated. Dysphoria like this is often more pronounced in individuals who have been rejected by their families, social organizations, and healthcare providers.
Invite members of the LGBTQ community to visit your organization and meet your staff and healthcare providers. Offer an opportunity for open conversation. Ask your representatives to share positive and negative experiences, and let staff ask questions so they can better understand.
Respect LGBTQ Patients
Respect all your patients and make sure you are being inclusive. Put in place non-discrimination policies that include sexual orientation and gender identity.
Make sure you have created an environment that is welcoming to all. For example, you could provide LGBTQ resource materials in your waiting areas, display LGBTQ-friendly materials, such as a rainbow or other flag symbols, and participate in the Healthcare Equality Index.
Be sensitive to transgender patients. Always ask for their preferred name and pronouns. Use them. If you make a mistake, apologize, and move on, making sure to get it right next time. Make sure transgender patients have access to restrooms. If you can, use single-stall restrooms and label them as unisex to offer a safe alternative to gender-specific restrooms for any transgender or non-binary patients or visitors.
Be sure to allow equal visitation of LGBTQ spouses, families, and support people.
Other Considerations
- Make sure you are collecting sexual orientation and gender identity demographics according to Do Ask Do Tell guidelines.
- Develop LGBTQ-inclusive procedures and policies
- Make sure that your transgender patients receive appropriate primary care cancer screening
- Work with providers of health insurance to reduce the risk that a claim will be rejected because the patient’s gender marker does not match the test that was conducted. For example, if your patient is a transgender woman who has to claim for a prostate exam.
- Assess your LGBTQ patients for depression and intimate partner violence. Refer when needed.
- Keep an up-to-date list of appropriate referrals. Find therapists, psychologists, and psychiatrists who have experience and expertise in caring for LGBTQ patients. You should also know pediatric endocrinologists who have experience working with transgender children and adolescents. Identify reproductive endocrinologists who have expertise in caring for adult and geriatric transgender patients. Find surgeons with expertise in transgender chest reconstruction, facial contouring, and gender reassignment procedures. By keeping these contacts up-to-date, you know you can refer any patient to someone suitable with the knowledge to help them, and who will provide correct, sensitive, and respectful care.
- Work to establish trust and rapport with your patients. Even when your staff knows how to ask questions in an appropriate manner about sexual behavior, identity, and attraction, they may not always feel comfortable doing so. In this situation, they may need to communicate this to their LGBTQ patients.
- Work to normalize and validate all patients. Ask any questions in the same way as you would to any other patient.
- Ask open-ended questions. Ask things like, “Tell me about yourself?” or “Are you involved in a relationship?” Use terms like partner or spouse, instead of girlfriend or husband. Never make any assumptions about someone’s relationship, their partner, or their sexual behavior. Do not assume that you know anything about someone’s sexual behavior based only on how they identify or who they are partnered with. As you talk to your patient, let the information that they are willing to give you guide the rest of your interview.
- Be sensitive in your use of language. Ask for pronouns, how someone identifies their gender, and the terms they prefer to use for their body parts. Do this for all your patients, not just the ones that you think might be LGBTQ.
Unfortunately, LGBTQ patients often experience disparities in healthcare that is available to them. As a healthcare provider, you have the opportunity to change these negative experiences. You can put in the work to reduce fear, exceed patient expectations, improve patient satisfaction, and change lives for the better. By implementing a few or all of these recommendations into the way you run your organizations, you can get a long way to providing healthcare that is comfortable and culturally competent for your LGBTQ patients.
