According to a recent survey from the Center for American Progress, 8% of gay, lesbian and bisexual patients have had a medical provider refuse to see them because of their sexual orientation, and 6% were refused health care services for the same reason. Transgender individuals experienced the worse discrimination: 29% were refused to be seen and 12% were refused care.
Along with reporting that they had received unwanted physical contact from a health care provider, LBGTQ patients have experienced providers not recognizing a same-sex partner as a family member, using harsh or abusive language, and intentionally using the wrong gender or name during treatment. “This can affect someone’s ability to access care,” said Timothy Wang, MPH, Senior Policy Analyst at The Fenway Institute in Boston, which conducts research affecting LGBTQ health, HIV policy, and other issues. “It’s not pleasant if they are already dealing with a health issue and then they feel like have to educate a doctor or office’s staff [about their gender or sexuality] on top of that.”
As a result of these episodes, LBGTQ patients are more likely to experience microaggressions, Wang said. Understanding what these are and how to prevent them in a practice can go a long way toward making LGBTQ patients feel safer and well-treated. Developing skills that make for comfortable interactions with LGBTQ patients would be valuable to any practice. Providers who are at ease in this space can be leaders in educating and training colleagues.
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First steps
The first few minutes of an office visit are the most important part of any medical encounter, according to Jane van Dis, MD, Medical Director for Business Development for Greenville, South Carolina’s OB Hospitalist Group. Doctors tend to think they are better listeners than they actually are, she said. During medical encounters, providers should ask LBGTQ patients what they consider to be their gender, what sex they were assigned at birth, and which pronouns apply to them.
Providers should not make assumptions based on what patients look like or how they talk or dress. A lesbian might be having, or have had, sex with men, so it should not be assumed she does not need pregnancy prevention or to be tested for sexually transmitted diseases. Gender and sexual practices can impact mental health, cancer screenings, and routine care.
Clinicians should not feel uncomfortable asking questions about sexuality. A study from Johns Hopkins Medicine in Baltimore published in JAMA Internal Medicine in 2017 found that 80% of physicians surveyed thought patients would not want to talk about their sexual orientation, but only 10% of patients said they would refuse to answer that question.
“As patients, we are used to answering sensitive questions,” Wang said. “It’s valid to feel uncomfortable asking those questions as a doctor, but they can practice, and it will become more natural.”
Standardizing treatment
Practices should post non-discrimination notices at various locations in the office making clear they do not discriminate on the basis of sexual orientation or gender identity. “This way people don’t have to guess about it,” Wang said. “It’s important to have it in the waiting areas and clinic rooms so staff and patients can easily see and identify their policies and know they are protected.”
Practices also should attempt to collect information about sexual orientation and gender identity from patients. This can be done during the intake process or through a patient portal, where the process may feel more private. Having these data helps providers during medical encounters and can be used for quality improvement. By analyzing these data, practices can evaluate the effectiveness of their interventions and identify disparities in outcomes or access. Wang said it is important to let patients know they do not have to provide this information if doing so makes them uncomfortable.
