LGBT health care equality: Be your patient’s advocate

The fight for equality for lesbian, gay, bisexual, and transgender citizens has been a long and storied one. We have fought for rights related to family, marriage, anti-discrimination and service to our country.  We have reveled in the freedom to be openly ourselves in public and have cheered as the fight for equality became a priority not only for ourselves but also for our straight allies.  As Rhode Island recently joined the fight for marriage equality, I couldn’t help but think about where we stand in the realm of healthcare equality for LGBT patients.

In 2007, the Human Rights Campaign (HRC) instituted a way of measuring quality, safety, and satisfaction of LGBT patients treated at both inpatient and outpatient facilities across the United States. The measurement was called the Healthcare Equality Index (HEI), a skillfully designed survey helping healthcare organizations to provide quality care to the LGBT community. The survey focused on 4 core measures: patient non-discrimination, equal visitation, employment non-discrimination, and training in LGBT patient-centered care.  Hospitals across the nation began to adopt the HEI and the Joint Commission recognized the growing need of advancing effective communication to this patient population.

The HEI was originally drafted as an improvement marker to address healthcare inequality towards the LGBT population. In a recent study from the HRC, When Health Care Isn’t Caring, 73% of transgender patients and29% of lesbian, gay and bisexual patients reported that they believed they would betreated differently by medical personnel because of their sexual orientation.  These numbers, though disconcerting, are not surprising. Even more disconcerting is the feeling of discrimination that some LGBT physicians describe from within their respective fields.

As an openly gay physician-in-training, I feel compelled to address the issues of modern-day medicine and the emotionality behind being both a member and provider of the LGBT community. Though much of what I see in my colleagues is encouraging, there still remains a lack of knowledge of the how-to of LGBT patient-centered care on the part of the providers. So where are we going wrong?

During my medical school basic science training, our LGBT health education consisted of a 5-minute blurb about sensitivity in history taking when questioning a homosexual male patient. This hardly constituted an “education” and left me confused and angry about why LGBT health wasn’t in focus. What about me wasn’t important? As I entered my clinical years, it became even more apparent that many health-care providers and fellow medical students lacked the cultural sensitivity that I innately expected from them.  What I later recognized was the culprit was a disparity in dialogue between LGBT patients and their physicians. But where was this disparity coming from? Was it simply a lack of knowledge of the patient population or was this hinting to a larger issue of an unspoken but well understood homophobia within the field of medicine?

A recent article by Dr. Mark Schuster (professor of pediatrics at Harvard Medical School and chief of general pediatrics at Children’s Hospital Boston) elucidated some of the sentiments that I sometimes am hesitant to say I agree with.   Medicine is a noble profession. We as providers chose to treat patients regardless of race, creed, political background, and undoubtedly sexual orientation. We are supposed to be selfless in intention and show the same amount of compassion to the CEO as we do to his janitor. To me, saying that homophobia exists in medicine is completely counterintuitive to what our profession stands for. They may both exist, but they simply cannot coexist.

As a resident in internal medicine, I’ve grown to embrace my role as health-care provider and more importantly my role as advocate for my patients.  After coming out to family and friends in medical school, I was scared about living openly and being judged by strangers. I realized that every time I asked my patients about their personal lives, I was putting myself at risk of being judged if they reversed the questioning.  It was in those moments that I learned the most about myself and about my patients.  Those moments allowed me to feel the vulnerability that my LGBT patients feel every time they enter a hospital front door.

The Healthcare Equality Index will continue to be a step in the right direction in helping close the gap between patient and provider.  Ultimately, medical school curriculum as well as residency awareness of LGBT patient-centered care will be relevant and necessary to further the dialogue. As physicians, we must realize that our role in caring for LGBT patients and families extends beyond our role as provider. In the political climate that we live in, progress will continue in every realm if we continue to voice our support of equality in our realm.  I’ve chosen to be an advocate for my LGBT patients and to stand on the right side of history.

Rashmee Patil is an internal medicine resident.

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