Being a Good Doctor for ALL of Your Patients: Specific Needs of Lesbian, Gay, Bisexual, and Transgender PatientsMaile O’Hara, Ph.D.
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
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)
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
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
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
Providing Equal Care: Continued Care Networking with LGBTQ referrals Community centers Counseling services Legal resources Have colleagues to consult with
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