By: Sue Boisvert, BSN, MHSA, CPHRM, FASHRM
Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) individuals are a significant and important segment of our society. Like everyone else, they attend schools, work, and raise families. When LGBTQ individuals seek healthcare, they face a number of obstacles. According to a 2009 study
, more than half of all LGBTQ respondents had been subjected to healthcare discrimination including refusal of care, harsh or abusive treatment, and being blamed for their illness. A 2015 follow-up study
suggests there has been little improvement in care for transgender individuals.
LGBTQ patients face 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, and disparities in health insurance access and coverage. These and other challenges create barriers for LGBTQ patients who are seeking and expecting access to culturally competent care.
Consider the following tips to improve the healthcare experience for LGBTQ patients.
1. Understand LGBTQ Diversity
2. Respect LGBTQ Patients
- Sexual orientation and gender identity are not the same thing. Sexual orientation describes sexual and romantic attraction. Gender identity describes an individual’s self-concept of femaleness or maleness. Both exist on wide spectrums to the point that some individuals may choose not to identify their sexual orientation and/or gender identity. For example, some members of the community may use the term “queer” to identify themselves as someone who is sexual orientation or gender nonconforming without being more specific. Questioning is used to describe children and adolescents who are experimenting with gender identity. For more information, review the PFLAG National Glossary of Terms.
- Sexual orientation and gender identity are not behavioral health disorders. However, some LGBTQ patients experience dysphoria as they become aware of their sexual orientation or gender identity, and this does need to be assessed and treated. This dysphoria is more pronounced in individuals who are rejected by their families, social organizations, and/or healthcare providers.
- Invite members of the LGBTQ community to visit your organization and meet with providers and staff. Provide an opportunity for open and frank conversations. Ask the LGBTQ representatives to share positive and negative healthcare experiences and give staff the opportunity to ask questions.
3. Become Educated About Caring for LGBTQ Patients
- Include sexual orientation and gender identity in nondiscrimination policies.
- Create a welcoming environment. For example, consider providing LGBTQ resource materials in waiting areas, post LGBTQ-friendly materials such as the rainbow and transgender flag symbols, and consider participating in the Healthcare Equality Index.
- Ask transgender patients for their preferred name and pronoun and use them. Apologize if you make a mistake.
- Ensure transgender individuals have reasonable access to restrooms. When possible, identify single-stall restrooms as “family” or “unisex” to provide a safe alternative to gender-specific restrooms for your transgender patients and visitors.
- Permit equal visitation of LGBTQ spouses, families, and support persons.
4. Additional Considerations
- Visit the National LGBTQ Health Education Center for free health education resources. Consider showing a video at a staff meeting or asking staff to review a video and report back.
- Visit the USCF LGBTQ Education and Training Resource Center.
- Peruse a text book, such as The Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health, 2nd, Edition; Lesbian, Gay, Bisexual and Transgende Healthcare: A Clinical Guide to Preventive, Primary, and Specialist Care, 1st Edition
- Collect sexual orientation and gender identity demographics according to the Do Ask Do Tell Guidelines.
- Develop LGBTQ-inclusive policies and procedures.
- Ensure transgender patients receive appropriate primary care cancer screening.
- Work with health insurance providers to reduce the risk that a claim will be rejected because the patient’s gender marker does not match the test conducted. For example, a transgender woman who has a prostate examination.
- Assess LGBTQ patients for depression and intimate partner violence and refer as needed.
- Maintain a current list of appropriate referrals. Identify therapists, psychologists, and psychiatrists with expertise in caring for LGBTQ patients. Identify pediatric endocrinologists with expertise in transgender children and adolescents. Identify reproductive endocrinologists with expertise in caring for adult and geriatric transgender patients. Identify surgeons with expertise in transgender chest reconstruction, facial contouring, and gender reassignment procedures.
LGBTQ patients frequently experience healthcare disparities. You have the opportunity to change the narrative: to reduce fear, exceed expectations, improve patient satisfaction, and change lives for the better. Implement a few or all of the recommendations listed above, and you will be well on your way to providing culturally competent healthcare for your LGBTQ patients.
No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.