How can healthcare providers provide a safe space for LGBTQ+ patients?
During the month of June, many businesses show their support of the Lesbian, Gay, Bisexual, Transgender and Queer community by flying rainbow flags in solidarity with the LGBTQ+ community, but what happens during the rest of the year? How can healthcare providers demonstrate their allyship by providing a safe and welcoming space for LGBTQ+ patients to seek care and receive care without judgement?
According to a Gallop poll, about 6% of US adults identify as lesbian, gay, bisexual, or transgender. This estimate is up from 4.5% in a previous Gallup’s update based on 2017 data. Gallup’s research also shows that younger generations are more likely to identify as LGBTQ+, with more than one in six Gen Z respondents identifying as something other than heterosexual.
This population is growing, and it’s important for healthcare providers to be prepared to create an LGBTQ+ friendly practice to respond to an expanding need for care.
Many LGBTQ+ patients have faced a lifetime of discrimination; in healthcare settings, this leads many people in this population to delay seeking treatment. According to a 2018 UCLA Study, 29% of lesbian and bisexual women reported that they delayed seeking healthcare. The same study found that lesbian, gay, and bisexual populations have poorer health status and more barriers to accessing health care relative to straight women and men. So how can healthcare providers help to create a more welcoming practice?
One of the easiest things practitioners can do to create an LGBTQ+ friendly practice is wear something with a rainbow on it or have something in your office with a rainbow on it - even something as small as a pen, poster or a sticker. Letting your patients know that you are supportive of them, that you are willing to listen to them, and you won't judge or reject them is critical. Fear of rejection is a big hurdle for this population. If they know that their doctor is LGBTQ+ friendly and is open to them talking to them and open to giving care to them, that's half the battle.
As this population ages, they face the same health comorbidities as heterosexual people including cancer, osteoporosis, and diabetes. By creating a welcoming practice, this population will be more likely to seek healthcare and access treatment, leading to better health outcomes.
Healthcare delivery doesn't change too much with the LGBTQ+ population, but a lot of healthcare providers either don't know or are intimidated by the cultural competency behind it. Treating this population begins with how to address these patients properly.
One example is the use of pronouns. You can introduce yourself with your preferred pronouns so your patients feel comfortable using theirs. Update your intake paperwork. Provide a space for patients to include their preferred name and pronouns. Being more inclusive of gender identity is an easy way to update your paperwork to help somebody feel more confident.
While LGBTQ+ patients have the same healthcare issues as the general population, there are some special considerations when treating these patients. And certain groups within this population have specific healthcare needs. For example, lesbian women are 200% more likely to use tobacco than the general population. Bisexual patients are at a greater risk of depression and self-harm. All LGBTQ+ patients should be screened regularly for depression. In my work as a family healthcare provider specializing in LGBTQ+ medicine, I’ve created a chart that identifies some clinical pearls and helps practitioners be proactive in providing care.
Whenever possible, include brochures in your office that don’t just feature a heterosexual, cisgender couple on them, but also showcase diversity. Look for materials that include interracial couples. Show same-sex couples. Show couples that are intersex, that look different. A lot of people think, “I want to be LGBTQ+ friendly with my office, so I'll put up an AIDS brochure or an HIV brochure.” This is great if you're an infectious disease practitioner, but there's more to this population than one particular disease.
Hiring diverse people for your front office staff is another great way to let people know that you're open minded and interested in caring for all sorts of people. Train your staff how to treat LGBTQ+ patients respectfully and learn how to become more culturally competent. By creating a welcoming environment, you will improve the patient experience, which will ultimately lead to better health outcomes.
An excellent resource for healthcare practitioners is glma.org, the Gay Lesbian Medical Association. GLMA is a national organization committed to ensuring health equity for lesbian, gay, bisexual, transgender, queer, and all other sexual and gender minority individuals, as well as equality for LGBTQ/SGM health professionals in their work and learning environments. GLMA’s website offers a wealth of resources for healthcare providers and features an LGBTQ+ provider directory that you can register with so patients can find you when they are looking for the nearest provider.
For LGBTQ+ patients looking for additional support, The Trevor Project is an excellent resource. They also offer a provider resource, research, volunteer/advocacy opportunities and educational resources to help physicians learn to be better allies to the LGBTQ+ community.
SAGE is a national advocacy and services organization for older LGBTQ+ adults and is one of the premier resources for treating this largely underserved population within the LGBTQ+ community.
While largely underserved, the LGBTQ+ community is growing. Healthcare practitioners who create an LGBTQ+ friendly practice can help to improve health outcomes for populations who are reluctant to seek healthcare. And there’s a financial bonus to creating a more welcoming practice as well—research from McKinsey has shown that the business case for diversity and inclusion is strong, with companies that embrace diversity and inclusion outperforming their less diverse peers in profitability.
I’ve also witnessed firsthand the positive impact of creating an LGBTQ+ friendly practice. My mom is an OB/GYN in Montana. She took the simple step of putting a rainbow flag sticker in her office. The word-of-mouth impact from that small gesture led to her treating new LGBTQ+ patients. She also began training her staff to be more friendly and create an atmosphere of respect. Now she has expanded the population for her clinic. If you are willing to make small changes, educate yourself and treat LGBTQ+ patients with care and respect it will benefit your practice.
Søren Estvold, MD, MPH is a 2018 graduate of the University of Medicine and Health Sciences and is currently working in a Family Medicine residency at Augusta University Medical Center in Georgia. Dr. Estvold specializes in LBGTQ+ medicine and serves on the board of the Equality Clinic, an interdisciplinary team of healthcare providers serving the under- and uninsured LGBTQIA+ community of Augusta, Georgia and the surrounding areas.
