By Cori McMahon, Psy.D, NCCE, Vice President for Clinical Services
More than 11 million individuals in the United States identify as LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other genders and identities), and this population has a shorter life expectancy compared to the population overall. What’s just as concerning are the health disparities that LGBTQIA+ individuals face, including the higher likelihood of alcohol and illicit drug use, suicide, HIV, and other sexually transmitted infections.
Unfortunately, more than half of LGBTQIA+ individuals also report experiencing discrimination, and one-third of transgendered individuals have reported experiencing prejudice during a medical appointment. Center For American Progress Survey data reveal that discrimination plays a significant role in preventing LGBTQIA+ from seeking healthcare, noting that 8 percent of all LGBTQIA+ people, and 14 percent of those who had experienced discrimination on the basis of sexual orientation or gender identity in the past year either avoided or postponed necessary medical care because of perceived disrespect or discrimination from the medical staff.
Among trans patients, 22% reported avoiding care. This data is consistent with other research, including the 2015 U.S. Transgender Survey, which found that 1 in 4 (25 percent) trans people had avoided seeking needed healthcare in the prior year due to fear of discrimination or mistreatment based on gender identity.
LGBTQIA+ individuals experience complex barriers to care
Most would agree that a visit to the doctor’s office is rarely without at least some sense of apprehension or discomfort. Whether it’s a specific health concern, talking about private or sensitive topics, or having a physical exam, it’s not uncommon to find oneself feeling vulnerable, worried, or downright scared. It’s part of a health professional’s job to make all patients feel welcome, comfortable, and deserving of excellent treatment.
However, according to BMC Medical Education, when it comes to the LGBTQIA+ population, biases in the medical community may result in patients receiving a lower standard of care or restricted access to services as compared to the general population. That means LGBTQIA+ individuals experience significant disparities in physical and mental health outcomes on top of discrimination, which comes on top of understandable apprehension when interacting with the healthcare system.
Justin Schweitzer, DO, Medical Director for LGBTQ+ Health & Primary Care for Cooper Care Alliance in New Jersey, agrees that there are complex barriers for the population when engaging in healthcare services. Patients might experience any of a number of discriminatory actions, including:
- Implicit and explicit bias, such as poor communication or refusing to see LGBTQIA+ patients
- Misgendering, when a provider refers to the patient as a gender that does not align with their affirmed gender
- Deadnaming, when a medical professional refers to a trans patient by their birth name even though they have changed their name as part of their transition
Remember that patients may lack family support and have potential for constant vigilance related to worry over being accepted by loved ones, by medical providers, even by strangers on the street, which can create underlying stress. It is common for individuals to be cautious, and providers should exercise patience when asking questions or suggesting behavioral health screenings, for example.
Make your practice friendlier for LGBTQIA+
When it comes to creating an LGBGTQIA+ friendly medical practice, Dr. Schweitzer recommends that care providers “meet patients where they are.” Don’t make assumptions. Look to mirror the patient’s language, such as their preferred pronouns and words used when talking about their partner.
Dr. Schweitzer highlights the need for practices to make it clear that the environment is safe and welcoming by:
- Wearing pride flags or displaying them in the office or on your website
- Including signage in the waiting room for the LGBTQIA+ population
- Advertising what services are available
- Including the underserved populations in marketing or advertising campaigns
- Communicating the good work being done in the community to support the LGBTQIA+ population
These suggestions are echoed in an AMA article, where it is recommended that providers display brochures and educational materials about LGBTQIA+ health concerns, visibly post a nondiscrimination statement, and display posters from supportive LGBTQIA+ or HIV/AIDS nonprofit organizations.
There are a variety of resources available to providers who seek to enhance their knowledge and skills in LGBTQIA+ healthcare. For example, the University of California, San Francisco, provides guidelines for the primary and gender-affirming care of transgender and nonbinary people. WPATH has free digital downloads and virtual courses, and the Philadelphia Trans Wellness Conference offers both professional and consumer tracks for learning on a variety of topics that impact the LGBTQIA+ population.
Dr. Schweitzer notes there is a lack of appropriately trained providers, and everyone in the behavioral health care community should aim to serve this population with dignity, quality, and competency. All people in need of healthcare should be able to experience safe, comfortable access with providers who are well-prepared to meet their needs.