An RX for Better Treatment of LGBT Patients

As health care providers, we must open the door to allow all patients to express their identity. In order for providers to provide competent care, they must know whether patients are straight, lesbian, gay, bisexual or transgender.
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It is hardly uncommon for a visit to the doctor to inspire anxiety, whether it be from fear of bad news or fear of a scolding for one's weight or tobacco use. Yet many lesbian, gay, bisexual and transgender (LGBT) patients have far greater reasons to dread a visit to the doctor. They face the fear of discrimination, moral condemnation or outright rejection from medical providers, and that fear is enough to keep many LGBT people from ever entering a healthcare professional's office, except in a dire emergency.

This fear is not unwarranted. Most doctors' offices remain institutions where one is presumed heterosexual until proven otherwise, and where, if so proven, there is no guarantee of acceptance. In this environment, LGBT patients lack what their straight counterparts take for granted -- the freedom to discuss their families and their means of emotional support.

This is why I am so excited about a new training program, Reexamining LGBT Healthcare, being released for healthcare facilities, schools and other institutions. A joint effort by the National LGBT Cancer Network and NYC's Health and Hospitals Corporation, this program delivers a message from LGBT patients that we all need to heed: "To Treat Me, You Have To Know Who I Am." The highlight of the program is a ten-minute video featuring the voices of LGBT patients relating their experiences with medical providers who all too often did not respect their identities, as well as those who did. Our hope is this tremendous first partnership will spur others to action as the video and training materials will be available to any healthcare facility, social service agency or university that is committed to making a difference in the health of the LGBT people they serve.

I am proud to be in the latter group. As I say in the video: "I think the LGBT community has a specific special need, which is to be treated the way non-LGBT people have been treated forever." That means asking the same, basic, fundamental questions to LGBT patients that we ask all patients: about their sexuality, their living situations and what support they have from their family and friends, without being afraid to hear the answers.

As a primary care physician for the last 18 years, I know that primary care medicine cannot be practiced in a social vacuum. To care for a patient with significant medical conditions, a provider must be able to freely discuss a patient's family and support system. And the patient's sexual orientation and gender identity are crucial information. To treat a patient, provide appropriate medical care and schedule necessary screenings, a provider needs to know where he or she works, if she has children, if he is partnered, who he or she takes meals with and with whom he or she sleeps. A patient cannot be expected to adhere perfectly to his or her treatment regimen without a certain modicum of trust in the provider -- and if the provider does not make the patient comfortable discussing the most fundamental details of his or her personal life, this trust cannot be established.

This does not mean that providers should be afraid to make mistakes, such as using the incorrect pronouns or using the wrong language for a patient's gender identity. A simple apology and a willingness to learn how to do it or say it better next time go a long way with all patients.

Nonetheless, as health care providers, we must consciously and deliberately open the door to allow all patients to express their identity, in full confidentiality. In order for these providers -- from the triage nurse, to the physical therapist, to the internist, to the surgeon to the palliative care provider -- to provide competent care, they must know whether their patients are straight, lesbian, gay, bisexual or transgender.

I know firsthand that the patient is far less likely to fear disclosure when the doctor makes it clear that he is not afraid of or uncomfortable with hearing the answers. And the benefits of an open and honest patient-doctor dialogue are immense. When a provider is aware of a patient's sexual orientation and gender identity, he or she knows that the patient may be at greater risk for certain medical conditions, and can recommend screenings accordingly. When a provider knows the extent of a patient's support system, he can determine who needs to be consulted on the patient's behalf, and who can see to caring for the patient outside a medical setting. And when a patient knows that he or she can trust a medical provider, the patient is far less likely to avoid medical care altogether -- a decision that far too many make today.

I am aware that no one provider can be all things to all patients; not every doctor, nurse or other professional will be perfectly suited to dealing with the unique problems faced by each LGBT patient. But medical providers have to start somewhere when it comes to ending the vast disparities in quality of care that the LGBT community experiences, and treating patients as they wish to be treated is a significant step towards both better care and better health for the patient.

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