Although Pride Month is over, awareness and advocacy for equity among the LGBTQ+ community must continue to be prioritized. This is especially important in health care settings. Many LGBTQ+ people feel uncomfortable and unwelcome in doctors’ offices, and more than 40 percent have experienced discrimination in health care environments. As a result, LGBTQ+ people postpone or avoid care at a rate that is 2-3x greater than the broader U.S. population. Negative experiences seeing a doctor – such as one who does not use a patient’s correct pronouns, does not fully understand why a patient might take pre-exposure prophylaxis (PrEP), or has unconscious biases that favor heterosexual patients – can lead to poorer health outcomes among the community.
There are a few steps health care providers can take to make LGBTQ+ patients feel more comfortable during visits, foster a more inclusive environment, and promote better health outcomes. The following tips are a starting place for practices to create a welcoming experience for the LGBTQ+ community, in-person and virtually.
Demonstrate cultural humility
The lengthy, but inclusive acronym of LGBTQ+ implies that there is breadth and depth to the content a clinician must engage to properly serve the LGBTQ+ community. Clinical professionals can display cultural humility by admitting our own unconscious bias. We start by acknowledging the societal and political barriers our LGBTQ+ patients face and that our health system has marginalized their care. Essentially, we must apologize for our systems, our institutions, and our own lack of training and preparedness.
Adjust paperwork to be LGBTQ+ inclusive
Clinicians should audit their existing patient paperwork and databases to allow for the inclusion of gender-specific information, such as adding spaces for patients to note both their gender identity and sexual orientation. Additionally, make sure electronic medical records document a patient’s pronouns. If there is no designated space to include this detail in the biographical information fields, ask your clinical team to include it in the treatment notes. This can allow for all providers in a practice to be aware of this information and create consistency in communications during patient visits.
Implement training for office staff around LGBTQ+ needs
All staff – including clinicians, front desk, and support staff – should be trained on understanding, acknowledging, and addressing LGBTQ+ patient needs. For example, this should include asking about and using a patient’s preferred name and pronouns. Key learnings from training should be implemented for both in-person and virtual communications with patients, as non-clinical staff often engage directly with patients via phone, email, and video chat to schedule appointments, help with referrals, and answer questions.
Promote continuous clinical training for physicians
A survey of transgender and gender non-conforming people in the U.S. by the National Center for Transgender Equality and the National Gay and Lesbian Task Force found that over 50 percent of respondents reported having to explain aspects of transgender-specific medical needs to their providers. This staggering statistic underscores the urgent need for continuous training. Clinical team leads should ensure that physicians, nurses, physician assistants, and other clinicians receive dedicated training around LGBTQ+ medical needs and keep up to date through continuing education and reviewing timely and relevant peer-reviewed studies. State medical boards often mandate training in specific areas of care. It is time for these boards to require 2 hours of sexual orientation and gender identity (SOGI) continuing education.
Show non-verbal support
To create a truly welcoming environment for LGBTQ+ patients, providers should consistently communicate gentle signals of their support for the community. This could be through the use of LGBTQ+ affirming office décor – such as stickers, flags, and photos – educational handouts, and detail about LGBTQ+ friendly health care on the provider’s website and marketing materials. Providers should also offer the option of sharing virtual or emailed handouts with telehealth patients that highlight LGBTQ+ specific health care information. Those seeing patients in person can also show their support through the accommodations they offer for LGBTQ+ people, such as having gender-inclusive restrooms instead of restrooms designated for men and women only.
Refer patients to LGBTQ+-friendly providers
LGBTQ+ patients are more likely to attend routine doctor’s appointments if they have access to an LGBTQ+ friendly provider with whom they feel comfortable. If a provider feels as though they are unable to appropriately assist or treat an LGBTQ+ patient, they have a responsibility to help the patient navigate to an LGBTQ+ friendly provider who can provide the proper care that they need and deserve.
The health care industry must commit to creating equitable and inclusive environments. Every patient deserves to feel safe and confident knowing their provider is clinically and culturally competent, and has their best interests in mind. To truly prioritize and advocate for their LGBTQ+ patients, health care providers can follow these tips. But they should be just the first step in an ongoing journey to create a welcoming environment that can ultimately help improve health outcomes among the LGBTQ+ community.
Ian Tong is an internal medicine physician.
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