Approximately 10 million people in the U.S. identify as lesbian, gay, or bisexual, and 1.4 million adults identify as transgender. Clinicians who wish to create a welcoming clinical environment and improve access to care for the LGBTQ community must first create an office culture that “encourages patients to be honest with their medical providers about their sexual orientation and behavior,” explains Gal Mayer, MD, president of GLMA: Health Professionals Advancing LGBTQ Equality. “You can only really provide appropriate care for LGBTQ patients after you know who identifies as LGBTQ in your practice.”
Communicate respectfully. Patients receive signals about a practice before they even enter an office. The cultural norm of referring to patients as “sir” or “ma’am” can make transgender and queer patients feel disrespected and alienated, but it’s a hard habit for many people to shake, explains Dane Whicker, PhD, assistant director for Gender and Sexual Diversity Initiatives at Duke. Consider offering sensitivity training for staff so they can understand how to communicate respectfully with LGBTQ patients.
In addition, adding a “transgender” option to the standard male/female checkboxes on intake forms can help transgender patients feel accepted, as stated in GLMA’s Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender (LGBT) Patients (www.glma.org).
Ask the right questions. Gathering accurate information about a patient’s health and sexual history is crucial but can be challenging. An EHR system is a helpful tool for addressing uncomfortable topics. “If a system is prompting you for that information, it’s much easier for staff to ask for it” because it appears in the EHR, Mayer says.
Patients tend to prefer frank questions that are asked in nonjudgmental ways, Whicker adds. It’s also important to explain why you’re asking a particular question, especially with transgender patients who may have had traumatic experiences with past providers.
Conduct appropriate screenings. LGBTQ Americans are particularly vulnerable to social stresses that lead to tobacco, alcohol, and substance use and abuse. Discrimination and harassment related to sexual orientation and gender identity can also contribute to depression, stress, and anxiety. GLMA’s Guidelines for Care of LGBT Patients instructs physicians to conduct depression and mental health screenings when appropriate and offer treatment options for tobacco, alcohol, and drug use.
In addition to refining office culture and increasing provider knowledge about LGBTQ-specific care, listing your practice in the GLMA provider directory will indicate to LGBTQ patients that they can receive respectful medical care from you.
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