June is LGBTQ+ Pride Month. Children and adults who belong to the LGBTQ+ community often times face healthcare discrimination and lack of access to care.
“The impression a patient gets from a doctor’s office starts as soon as they walk in the door,” said Dr. Christopher Drescher, a psychologist and associate professor in the Department of Psychiatry and Health Behavior at Augusta University.
Dr. Drescher helps adolescents by providing outpatient psychotherapy. He became an ally for patients and initially got involved in helping the LGBTQ+ community when he started volunteering at the Equality Clinic as an intern. The Equality clinic is a free primary care health clinic focused on the LGBTQ+ community. The behavioral health team provides screening, interventions, and referrals.
“There are several things physicians can do to provide a more inclusive environment. For instance, do the intake forms have inclusive options around sexual orientation and gender identity? That’s very important. If a physician is not sure about all of the options, they can leave a blank. This can help patients put their own answer. It also helps give providers information about the patient before the clinical encounter, rather than making an assumption that is incorrect. Instead of asking every patient how they identify, the provider already knows how to approach the encounter.”
One way that physician offices can be more accepting is through training the front desk staff, nursing staff, and other support staff to be affirming in how they interact with patients. “They are the first point of contact. If those interactions are negative, the physicians are already at a deficit by the time the patient walks into the exam room.”
Using terminology that the patient uses to refer to themselves is another way to be respectful of patients in the LGBTQ+ community. This can be done by using their pronouns and how they identify their gender and sexual orientation. Using the proper pronouns and nonjudgmental body language provides a safe environment for patients.
It is important for physicians to be educated on these topics. “A lot of LGBTQ+ patients feel like their doctors don’t know what’s really going on around minority sexual health and gender minority issues. They are having to educate their provider on these issues. This is not a good feeling when you are a patient. It is important for physicians to not make assumptions and change their language. For example, instead of asking do you have a husband, ask do you have a spouse or partner. This leaves it open in terms of gender. Small changes to our language allows us to be more inclusive and it doesn’t exclude people that are cisgender or heterosexual.
Sometimes providers have curiosity that aren’t really related to the clinical encounter. For example, if a patient is transgender and comes in for strep throat, knowing if they had a genital surgery is not important to that particular encounter. It is important to not use clinical time with the patient to satisfy our curiosity. There is a lot of great information on the internet, books and articles to understand these issues. It’s important to focus on patient care during our interactions with them.”
Dr. Drescher recommends using the Fenway Institute, an online resource, to physicians who haven’t received much training on transgender, minority health, and gender identity issues.
Tips to find a LGBTQ+ friendly provider
Most people find out who is a LGBTQ+ friendly provider through informal networks. “People talk with their friends to find out if their doctor is accepting. Another way for a patient to find affirming providers is to talk with a physician that has been affirming to see who they would recommend as a primary care physician. There are several concerns among patients including rejection from family members, job discrimination, healthcare discrimination, and housing discrimination.
Mental health concerns are significant and often times that flows from the pervasive experience of discrimination. It can be expressed in different ways. It is difficult for the transgender population to get access to hormone replacement and there is a lack of insurance coverage for this group of individuals.”
When patients have a negative experience, they stop seeking healthcare or they delay seeking healthcare. This can lead to much more significant health problems in the long run. “Feeling blamed for your health problems by your provider is related to suicidal ideation. There are already so many barriers to healthcare, especially amongst the transgender population. If a patient makes it to your door, it is important to have that accepting and nonjudgmental environment when they come in.”