Eliminating the Health Disparities Faced By the LGBTQ+ Community

Strategies we can use to understand and treat people in the LGBTQ+ population


Theme: Ethics and Controversy


Zuairia Shahrin

Until 1973, homosexuality was listed as a disorder in the Diagnostic and Statistical Manual of Mental Disorders. Although the evolution of our society has led to some understanding of the importance of protecting people from discrimination in healthcare settings, some clinicians still harbour anti-LGBT attitudes. In her article about Health Disparities Within the Transgender Community, Venaya raises an important issue, “Should we have the right to treat anyone, if we’re not treating everyone?” This becomes all the more important to consider after Trump’s movement with a rule that rolls back healthcare rights for the transgender community, even though the States Supreme Court barred sex discrimination against LGBT individuals. If healthcare professionals do not oppose this rule, should they even practice medicine at all? Creating an affirming and inclusive environment for the LGBTQ+ community requires a combination of understanding them as a population, whilst treating every LGBTQ+ person as a unique individual. This article highlights some strategies we can use to ensure that.    


Practical Thinking

  • Many LGBT people do not have health insurance, with 11% of them not understanding it’s coverage.[1][3] When this happens, it’s important to address the issue whilst trying to make them feel as comfortable as possible. Helping them with enrolling for care, or helping them deal with billing might calm them down if not solve all of the problems. 

  • They may be reluctant to open up about the true nature of their health issues due to lack of trust. It’s crucial to put yourself in their shoes to gain an understanding of why the trust issues might exist. In a 2018 survey, it was discovered among LGBQ people who had visited a doctor, 8% said that the doctor refused consultation because of their actual or perceived sexual orientation. 6% said that doctors denied them healthcare that was linked to their actual or perceived sexual orientation and an unfortunate 7% said that they experienced unwanted physical contact from a doctor or other healthcare provider. Among transgender people who had visited a doctor, 29% said that the doctor refused consultation due to their sexual orientation, 12% said that healthcare linked to their sexual orientation was denied, 29% said that they experienced unwanted physical contact from a doctor.[4] Happenings like these might have caused the LGBT people to lose faith from the medical system, or doubt its ethical standards. 

  • They might be unaware of how to manage their care. This might happen for various reasons, but if it does, we must provide good information about healthcare options and how they might want to access medical care.[7] This becomes all the more important for a doctor because patient safety is the foremost responsibility. 


Communication Basics

Using the right words and tone of voice is fundamental when wanting to develop a good rapport with the LGBT individual. At the most basic level, we should avoid making any assumptions about gender identity and sexual orientation when interacting with LGBT people. In the 2018 survey, 9% of the LGBQ people responded by saying that the healthcare provider used harsh and abusive language when treating them. Simultaneously, 21% of the transgender people admitted that the healthcare provider had used harsh and abusive language when treating them. To stop this, we need to pay extra attention to how LGBT individuals might address themselves and their partners. If somebody calls themselves “gay,” we must not use the term “homosexual.” If a woman refers to her “wife,” we must not address her as a “friend.” Instead of asking “Do you have a boyfriend/girlfriend?” it is much more mature to ask “Are you in a relationship?” Using open-ended questions will allow clinicians to initiate discussions about relationships and sexual behaviour without assuming heterosexuality.[5]


Pronouns and Preferred Names

In the 2018 survery, 23% of the transgender people said that the healthcare provider intentionally misgendered them or used the wrong name. It is not possible to guess someone’s gender identity based on the person’s name, looks and sounds. Therefore, when addressing somebody for the first time, instead of asking “How may I help you, sir?” we should avoid using pronouns and simply ask, “How may I help you?” When unsure of what name to use when addressing the individual, it’s helpful to make eye contact or lightly tapping on their shoulder. Or, if you want to be straightforward, a simple “I would like to be respectful. How would you like to be addressed?” is perfect.[3]


Maintaining a Non-Judgemental Attitude

It is fundamental to avoid showing disapproval or surprise when you discover their gender identity or sexual orientation. We should constantly be aware of our facial expressions and body language to ensure that we don’t send off unintended messages, and are maintaining eye contact with the individual. In this way, we can keep an open mind whilst helping them feel a sense of safety.[1][3]


Accepting Your Mistakes

It is not always possible to avoid making errors, and as humans, it is natural to make mistakes. Apologising if you have addressed them using the wrong pronoun/name/terms will let them know that you did not mean to disrespect them. This also helps when trying to initiate discussions.[4]


Healthcare is one of our most basic human rights, and not something we should be deprived of. As someone who strongly believes that every individual in our community should have their rights protected, I felt the need to familiarise people with these strategies. The success of healthcare organisations of all types - ranging from academic medical centres to community hospitals - depends on providing care to patients that optimizes quality and clinical effectiveness. As with all patient populations, effectively serving the LGBTQ+ patient population requires clinicians to understand the cultural context of patients’ lives, modify the environment and its policies to be inclusive, take detailed and non-judgemental histories, educating themselves about the health issues of importance to their patients and reflecting upon attitudes that might prevent them from providing affirmative care to the LGBTQ+ community. By doing so, clinicians can ensure that LGBTQ+ patients, and all of their patients, are getting the highest possible level of healthcare. 


GLOSSARY:

  1. LGBTQ+: An abbreviation used to refer to all of the communities included in the LGBTTTQQIAA, which means Lesbian, Gay, Bisexual, Transgender, Transsexual, Queer, Questioning, Intersex, Asexual, Ally. 

  2. Sexual Orientation: A person’s sexual identity in relation to the gender to which they are attracted

  3. Rapport: A close or harmonious relationship where people or groups concerned understand each other’s feelings or ideas and communicate well. 

REFERENCES:

  1. Ard, K., Makadon, H. Improving The Healthcare of Lesbian, Gay, Bisexual and Transgender People. The Fenway Institute. Retrieved 8 June 2020. [Online] Available from: <https://www.lgbthealtheducation.org/wp-content/uploads/Improving-the-Health-of-LGBT-People.pdf>

  2. The Fenway Institute. Providing Inclusive Services And Care For LGBT People. National LGBT Health Education Centre. Retrieved 8 June 2020. [Online] Available from: <https://www.lgbthealtheducation.org/wp-content/uploads/Providing-Inclusive-Services-and-Care-for-LGBT-People.pdf>

  3. Mirza, S., Rooney, C. (18 January 2018). Discrimination Prevents LGBTQ People From Accessing Health Care. Center for American Progress. Retrieved 8 June 2020. [Online] Available from: <https://www.americanprogress.org/issues/lgbtq-rights/news/2018/01/18/445130/discrimination-prevents-lgbtq-people-accessing-health-care/>

  4. Powell, A. (23 March 2018). The Problems With LGBTQ Health Care. The Harvard Gazette - Health & Medicine. Retrieved 8 June 2020. [Online] Available from: <https://news.harvard.edu/gazette/story/2018/03/health-care-providers-need-better-understanding-of-lgbtq-patients-harvard-forum-says/>

  5. Cigna. (February 2017). LGBT Health Disparities. Cigna Individuals and Families. Retrieved 8 June 2020. [Online] Available from: <https://www.cigna.com/individuals-families/health-wellness/lgbt-disparities>

  6. Centres for Disease Control and Prevention. (28 March 2018). Lesbian, Gay, Bisexual, and Transgender Health. Centres for Disease Control and Prevention. Retrieved 8 June 2020. [Online] Available from: <https://www.cdc.gov/lgbthealth/index.htm>

  7. Krehely, J. (21 December 2009). How To Close LGBT Health Disparities Gap. Centre for American Progress. Retrieved 8 June 2020. [Online] Available from: <https://www.americanprogress.org/issues/lgbtq-rights/reports/2009/12/21/7048/how-to-close-the-lgbt-health-disparities-gap/>



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