LGBT: An Underserved Demographic. What can we do?

When you think of medically underserved communities, what comes to mind?  Ethnic minorities?  The uninsured?  The poor?  How about the LGBT community?


The LGBT community is an oft overlooked demographic that has been historically quite medically underserved.  There are a number of reasons why this might be the case, but one that most can agree on is the fact that a disproportionate number of LGBT-identified individuals have had negative experiences with medical care in the past.  According to this report from Lambda Legal based on a survey of almost 5,000 LGBT and/or HIV-positive patients nationwide,

• 27% of transgender respondents have experienced an outright refusal of health care services
• 11% of gay respondents reported health care professionals who refused to touch them or used excessive precautions
• 12% of gay respondents and 20% of transgender respondents were personally blamed for their health problems

Scary, isn't it?

There are some resources out there to help connect LGBT patients with competent care and avoid these horror stories.  The Gay and Lesbian Medical Association (GLMA) hosts a Provider Directory where providers (both LGBT and allies) can register as LGBT-welcoming and committed to the health of LGBT patients.  As I've said before, it is unfortunate that the queer community has to depend on word of mouth and directories like this to find someone who is gay-friendly.  But the only way to change this culture of subpar care for LGBT patients is by creating a sea change in how we are inclusive and supportive of ALL patients, regardless of sexual orientation or gender identity.  Obviously this is a complex problem that requires a multi-pronged approach, but some simple initiatives could include:

1. Encouraging more medical schools to amp up LGBT health curriculum
2. Holding cultural sensitivity training workshops with staff 
3. Including LGBT-inclusive literature and forms in your clinic
4. What ideas do YOU have?

Joe Kort, a therapist and champion of gay affirmative therapy, implores clinicians to take the next step to be competent providers for their LGBT patients.  It is not enough to be gay-friendly, he says, one should strive to be gay-informed.  That means becoming educated about the health issues that disproportionately affect the LGBT community, learning appropriate language and inclusive forms of interviewing (for example, asking "Who is important to you in your life?" rather than "Are you married?"), and being aware of important management and harm reduction strategies to care for your LGBT patients.

Now, no matter how hard we try, we can't be expected to know everything to be a perfect provider for LGBT patients (or for any of our patients, for that matter!).  But I implore any of you medical students, physicians, and other clinicians who may be reading this-- even if you do not feel 100% equipped to effectively handle the health care needs of your LGBT patients, always cultivate an attitude of learning.  Don't be afraid to say "I don't know, but I will find out" or "I'm sorry, this is new to me and I want to be supportive, please help me understand."  Listen to your patients.  The more sensitive you are to understanding their needs, the better you can connect with and care for them.

I was at a committee meeting recently regarding LGBT mental health issues, and everyone was so incredibly welcoming and grateful and excited for a soon-to-be doc to be on board with LGBT health issues.  I spoke with many clients at that meeting, and they all said the same thing-- all they want is for their doctor to treat them like a normal person, with respect, and an open mind.  They begged me to spread the word.  So here I am with this message.  Will you pass this on?

In conclusion, here is a pretty exciting piece that recently came through the pipeline via the Joint Commission: 

At this debriefing meeting, we were familiarized with this field guide which is intended to be not only a resource to promote more LGBT-competent providers, but also to identify a number of requirements that are becoming a part of the accreditation process for hospitals.  This is a HUGE step in LGBT advocacy in the health care field.  No longer are we simply paying lip service to the idea that we need to do a better job with our LGBT patients-- hospitals are going to be held to a high standard to ensure that this actually takes place.  

So exciting!  Whether it's small steps mentioned in the suggestions above, or major initiatives like this one, let's continue to move in the direction of doing a better job caring for the LGBT community, so those scary statistics can eventually be history.