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How to improve care for sexual and gender minorities

No one with health concerns should have to worry about receiving inequitable care because of their sexual orientation or gender identity. But studies and surveys show that many lesbian, gay, bisexual and transgender individuals experience discrimination by health care providers — including clinicians who refuse to provide needed care, refuse to touch them or use excessive precautions, are disrespectful or simply blame them for their health status.

Fortunately, health care providers can improve clinical care of their sexual and gender minority patients by taking proactive steps, as outlined in a recent viewpoint in JAMA. In particular, Alexia Torke, MD, and Jennifer Carnahan, MD, professors of medicine at the Indiana University Center for Aging Research, focus in the paper on how to optimize care for older LGBT adults, who are the first generation to be more open about their sexual orientation or gender identity.

The authors recommend that clinicians use inclusive language, such as using a patient’s preferred name and pronoun and asking about a spouse or partner regarding marital status. Forms disclosing sex should also include options for transgender patients, such as “male-to-female,” they say.

In addition, they recommend that physicians learn about the medical concerns specific to sexual and gender minority patients, such as hormone treatment and gender affirming surgery for transgender individuals. They also state that screening and diagnosis for medical conditions should be based on a person’s anatomy rather than their gender identity, giving the example that a female-to-male transgender patient is at risk of gynecologic cancers if he has not had a hysterectomy.

Torke and Carnahan also indicate that clinicians should better understand the unequal treatment that many sexual and gender minority patients face, which can have financial, social and health consequences. For instance, these individuals may not have access to health insurance due to employment discrimination or as an unrecognized spouse.

They also recommend that LGBT-friendly clinicians register as a “safe physician” with organizations like the Gay and Lesbian Medical Association.

A key to improving care for these patients is training, according to the authors and other experts. The Human Rights Campaign has established best practices for health care organizations and provides free online training for health care providers.

The campaign also evaluates the implementation of these best practices and publishes an annual report. In the 2017 report, almost 600 health care facilities participated in the related survey and more than 900 non-participating hospitals were also researched. Over 300 of the participating facilities were rated as a “leader in LGBTQ healthcare equality” with a score of 100 — including Stanford Health Care.

The authors conclude in the paper:

Although lesbian, gay, bisexual, and transgender older adults face barriers to good health and health care, clinicians can take proactive steps to improve the care they deliver. These steps include education about prior discrimination and major health needs, as well as policies that ensure respect for the individual patients and equal treatment in all health care settings.

Previously: “This shouldn’t be the case in 2017”: A call for more research on transgender health, Study finds ER avoidance in transgender individuals needing care and Gay, lesbian, bisexual and transgendered health issues not being taught in medical school
Photo by Gustavb Guanaco

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