Best Practices in Providing Affirming Care for LGBTQ Patients
July 26, 2017
This blog post is based on a recent Webinar with Sarah Bender, Health Equity Strategist and Consultant
While LGBTQ people experience the same diseases, injuries, and other health issues experienced by members of non-LGBTQ communities, we know that LGBTQ people experience these things differently. They have a higher risk of certain diseases and have historically faced discrimination within healthcare settings, which can create barriers to receiving appropriate care. In addition, clinical and non-clinical training frequently overlooks information on how to provide affirming care to the LGBTQ community.
Get On the Same Page – Start with Definitions
The LGBTQ community is not homogeneous. The term LGBTQ represents a diverse group. It is important that both clinical and non-clinical staff understand the differences between the groups. The three very distinct aspects of sexual orientation–behavior, identity, and attraction are a good place to start. Bender states, “It’s really crucial that we’re able to differentiate these aspects of our patients’ identity and not lump them together and make assumptions about one based on the other. We want to be careful to not assume that someone who is transgender for example, also identifies as lesbian or gay. Knowing someone’s sexual orientation doesn’t tell us their gender identity or vice versa.” It is also important to understand that even the term LGBTQ is not inclusive of all members of this community, so we may hear patients using terms outside of these designations to describe themselves.
Resist the Temptation to Make Assumptions about LBGTQ Patients
As a threshold, do not assume that everyone is heterosexual. In addition, not all patients will use traditional labels to define their identities. Take the time to talk to patients about their anatomy, how they would like to be addressed, and their specific healthcare needs. Bender cautions providers against making assumptions about gender identity based on the patient’s appearance, the gender of their partner, or any other clues we think that we may have. She also encourages us to remember that gender identity and sexual orientation may be somewhat fluid and could change from one visit to the next.
Setting the Stage for Open and Honest Discussions
Bender starts off with what she describes as the “low-hanging fruit.” Are there non-verbal cues that LGBTQ patients might see that would help them feel more comfortable? Bender recommends that staff wear buttons or nametags that announce their own gender pronoun to help start the discussion. Also, have brochures that address LGBTQ health issues available for patients and visitors. Make gender-inclusive restrooms available and easy to access.
An Accurate Electronic Health Record Can Be the Foundation
Bender recommends that as organizations begin to identify the ways in which to best lay the foundation for affirming care for LGBTQ patients, that the medical record is the logical place to start, as it has implications for both the clinical and non-clinical patient experience.
- Use it to ensure that the patient will be communicated with using the proper pronoun.
- Consider having an organ inventory as part of the EHR that is not related to a patient’s assigned gender at birth or their gender identity.
- Use this information to ensure that the patient receives the appropriate health screenings.
The Legal Framework for Providing Affirming Care
Providing affirming care to the LGBTQ community is the right thing to do and failing to do so may put healthcare providers in the crosshairs of regulatory agencies and insurers. Section 1557 of the Affordable Care Act prohibits discrimination in both health coverage and health care on the basis of race, color, national origin, sex, age or disability. Health and Human Services defines “sex,” in this case, as inclusive of gender identity. In addition, certain states have health insurance protections for transgender patients.
Learn more about creating a welcoming environment for LGBTQ patients here.