At Eden Health, patients spend more time with their providers. We believe that longer-than-usual appointment times allow clinicians to really listen to patient concerns and form ongoing, trusted relationships.
And those trusted relationships aren’t just nice-to-haves, for LGBTQ+ individuals, having access to trusted and inclusive primary care is critical to avoiding the elevated health risks associated with the structural discrimination they can encounter in any area of their life — including their relationship with a primary care provider. LGBTQ+ individuals who live in communities that harbor strong prejudices against them lose, on average, twelve years of life. They are at a higher risk of early death by suicide, cardiovascular disease, and other life-shortening health conditions.
Though the Affordable Care Act (ACA) prohibited healthcare providers and insurance companies from discriminating against patients based on gender identity and sexual orientation, research reveals that LGBTQ+ individuals routinely experience discrimination in healthcare settings.
According to a 2017 CAP survey that included participants who visited a doctor or healthcare provider the year before revealed:
- 8% of lesbian, gay, bisexual, and queer respondents reported that a doctor or other healthcare provider refused to see them because of their actual or perceived sexual orientation
- 6% said providers refused to give them care related to their actual or perceived sexual orientation
- 7% said providers refused to recognize their family, including a child or same-sex spouse or partner
- 9% reported harsh or abusive language from their providers
- 7% experienced unwanted physical contact from their providers, including fondling, sexual assault, and rape
Similar data points were even more harrowing among transgender respondents:
- 29% reported that a doctor or other healthcare provider refused to see them because of their actual or perceived sexual orientation
- 12% said their provider refused to give them healthcare related to gender transition
- 23% were misgendered or called the wrong name by their providers
- 21% reported harsh or abusive language from their providers
- 29% experienced unwanted physical contact from their providers, including fondling, sexual assault, and rape
Unsurprisingly, discrimination (or even the potential for experiencing discrimination) can deter LGBTQ+ people from seeking care at all.
Culturally sensitive and clinically specific LGBTQ+ healthcare is an intentional and genuine decision to respect all aspects of what makes each patient unique. Equitable access to this kind of inclusive healthcare allows members of the LGBTQ+ community the opportunity to live healthier lives.
WHAT KIND OF CARE IS CRITICAL FOR LGBTQ+ INCLUSIVE PATIENTS?
- Gender affirming services: Nonsurgical affirming services can include everything from hormone therapy and monitoring to voice care (speech therapy) and mental health needs that support social transitions, exploration of gender identity, support systems, and more.
- PEP/PrEP: PrEP (or Pre-Exposure Prophylaxis) is a prevention method used by people who are HIV-negative and who are at high risk of being exposed to HIV through sexual contact or injection drug use. These medicines can work to keep the virus from establishing an infection in the body. PEP (or Post-Exposure Prophylaxis) refers to the use of antiretroviral drugs for people who are HIV-negative after a single, high-risk exposure to stop HIV infection.
- STI testing and treatment: LGBTQ+ people are both at higher risk for contracting STIs and less likely to have access to testing and treatment. LGBTQ+ people, especially men who have sex with men and transgender women, are at higher risk for contracting sexually transmitted infections (STIs) like HIV, chlamydia, herpes, HPV, and trichomonaisis.
- Sexual and reproductive healthcare: Sexual and reproductive healthcare are crucial to offering a full spectrum of care for LGBTQ+ individuals. People who are capable of becoming pregnant — including queer women, transmasculine people, and nonbinary people — deserve equitable access to pregnancy, family planning, and abortion care.
So, how are providers able to practice LGBTQ+ inclusive care? Here are some tips on fostering LGBTQ+ inclusive healthcare settings:
MASTER THE BASICS OF COMMUNICATION
- Avoid making any assumptions about gender identity and sexual orientation
- Use the terms that patients use to describe themselves and their partners
- When taking a personal history, don’t use words that assume patients have an opposite-sex partner (or even parents). Instead of saying “Do you have a boyfriend?” instead ask “Are you in a relationship?”
- Remember it’s never possible to guess someone’s pronouns based on their name, how they appear, or how they sound, so always ask!
CREATE A COMFORTABLE ENVIRONMENT
- Check your facial expressions — showing disapproval or surprise can make patients feel uncomfortable or unsafe
- Drop gendered terms like “sir” or “ma’am”, especially when meeting patients for the first time
- Don’t be afraid to correct your colleagues if you overhear them misgendering patients or issuing insensitive comments
USE VISUAL CUES TO ESTABLISH A SAFE SPACE FOR PATIENTS
- Display brochures or pamphlets that address LGBTQ+ health concerns
- Create and post a nondiscrimination statement in a place that is visible to all patients
- Hang posters or artwork promoting non-profit LGBTQ+ organizations
LIST YOUR PRACTICE
Make sure LGBTQ+ patients know how to find you. The Gay and Lesbian Medical Association (GLMA) has a directory that lists LGBTQ+ friendly providers and is free to the general public. You can also use the Human Rights Campaign Healthcare Equality Index, which measures the equity and inclusion of healthcare facilities in the United States, to see how you’re rated.