Being a Good Doctor for ALL of Your Patients: Specific Needs of LGBT Patients

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Presentation from a talk by Dr. Maile O'Hara at SUNY Downstate, given during the 2010 "Sex in Medicine Week". http://www.sexinmedicineweek.org/

Presentation from a talk by Dr. Maile O'Hara at SUNY Downstate, given during the 2010 "Sex in Medicine Week". http://www.sexinmedicineweek.org/

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  • 1. Being a Good Doctor for ALL of Your Patients: Specific Needs of Lesbian, Gay, Bisexual, and Transgender PatientsMaile O’Hara, Ph.D.
  • 2. Homophobic Discrimination in the Medical Field
    Discrimination toward LGBTQ patients:
    Sample: Nursing students, 1998
    Results: 8-12% “despised” LGBTQ people, 5-12% found LGBTQ people “disgusting,” 40-43% stated LGBTQ people should keep their sexuality private
    Discrimination toward LGBTQ medical colleagues
    Sample: Physicians in New Mexico, 1996
    Results: 4% would deny LGBTQ people into medical school, 10% did not support LGBTQ physicians going into OBGYN, 20% of general practitioners said they would discontinue referrals to LGBTQ colleagues
  • 3. Providing Equal Care: Language
    Use term “relationship status” versus “marital status”
    Including relationship status options like “partner”
    When asking for information about significant others include “partner”
    Include “Transgender” as a gender option and providing room for explanation
    * Recommendations from the Gay Lesbian Medical Association (GLMA)
  • 4. Providing Equal Care: In the Patient Interview
    Neutral, respectful, and non-judgmental tone
    Be empathic and recognize that many LGBTQ patients have had negative experiences with providers in the past
    Ask open ended questions
    Address issues of confidentiality in terms of test results, who has access to charts, reporting to insurance companies, right to not answer questions, exceptions to confidentiality, and specifically address documenting sexual orientation
    Make sexual histories routine for all patients
    Make assessment of risk behaviors routine for all patients (only 20% of gay men reported discussing HIV risk factors with providers, and of that 20%, only 21% said their providers initiated the conversation)
    Tell all patients that taking their sexual history and risk assessment is routine for all patients, i.e. “In order to provide the best possible care of you I need to to understand in what ways you are sexually active”
    Ask about behaviors, not sexual orientation, i.e. “Are you sexually active?”, “Do you have sex with men, women, or both?” “How many partners have you had, with what frequency to you use condoms, and what kinds of sexual contact do you have, anal, genital, and/or oral?”
    * GLMA
  • 5. Providing Equal Care: In the Office Environment
    Post confidentiality policy
    Posting nondiscrimination policy that includes LGBTQ people
    Provide pamphlets targeting LBGTQ patients
    Posters targeting LBGTQ patients
    Acknowledging World Aids Day and Gay Pride
    Including LGBTQ magazines in the waiting area
  • 6. Helpful Tips
    Know the difference between transgender (those who’s anatomic sex or perceived gender differ from their gender expression and/or identity) and transsexual (those who consistently identify as the gender other than their congenital reproductive anatomy, and intend to live permanently as this gender), and transvestites (cross-dressing, does not include gender identity)
    *HIV InSite “Exploring Your Patient’s Gender Identity
    Do not equate sexual orientation with gender identity
    Do not equate having children with heterosexuality
    Assess patient knowledge of HIV and STDs
    Give equal access to partners as you would to spouses
    With LGBTQ families include all primary caregivers in discussions
    LBGTQ youth need special assessment of emotional functioning and substance abuse
    Children can understand their sexual orientation and gender
    Sexual orientation and gender identity can change over time
    Many people who identify as having a particular sexual orientation have a range of sexual experiences
    All people born women need pap smears including transgender men and female to male transsexuals unless they have had a full hysterectomy
    Transgender men and female to male transsexuals need breast exams even after breast reconstruction
    Transgender women, and male to female transsexuals need prostate exams
    Individuals receiving hormone replacement therapy need to be monitored by experienced providers
    MSM may need STD screening from the pharynx and rectum depending on sexual behavior
    Lesbians are also at risk for STDs
    Do not ask lesbians about birth control, but rather ask what kinds of protection is used, i.e. dental dam, finger condoms, or gloves
    It is important to screen all people for domestic violence regardless of orientation
    You can always ask questions, for example “Do you prefer to be referred to as he or she?”
    You can always apologize for mistakes or offending
    *From Culturally Competent Care for GLBT People: Recommendation for Healthcare Providers
  • 7. Providing Equal Care: Continued Care
    Networking with LGBTQ referrals
    Community centers
    Counseling services
    Legal resources
    Have colleagues to consult with
  • 8. Resources
    Gay and Lesbian Medical Association
    459 Fulton Street, Suite 107
    San Francisco, CA 94102
    Website www.glma.org
    Phone 415-255-4547
    The Center: The Lesbian, Gay, Bisexual & Transgender Community Center
208 West 13th Street
New York, NY 10011
Website: www.gaycenter.org
Phone: 212-620-7310
    Housing Works
    7 Willoughby St., 2nd Floor
    Brooklyn, NY 11201
    Websitewww.housingworks.org/
    Phone (347) 473-7400
    Gay Men’s Health Crisis
    GMHC, 119 West 24 Street,
    New York, NY 10011
    Website http://www.gmhc.org/
    “Need to talk” help line 1-800-243-7692
    Lambda Legal Defense Fund
    120 Wall St. # 15
    New York, NY 10005-3905
    Website www.lambdalegal.org
    Phone 212-809-8585