Common Issues and Disparities in Healthcare for LGBTQ Patients
August 08, 2017
This blog post is based on a recent Webinar with Sarah Bender, Health Equity Strategist and Consultant.
The patient experience is not necessarily the same for everyone. The social and institutional inequalities facing the LGBTQ communities extend to healthcare settings as well.
Social Factors and Structural Inequalities Help Create Health and Healthcare Disparities
Members of LGBTQ communities have historically lacked certain legal protections which, in many cases, lead to higher rates of unemployment, homelessness, poverty, and a lack of family support. These issues can create barriers to both wellness and access to healthcare. It may also lead to a reluctance on the part of members of LGBTQ communities to seek preventative healthcare. The fear of discrimination or a previous difficult or uncomfortable healthcare experience may also contribute to these disparities.
Be Particularly Aware of the Youngest and Oldest Amongst This Patient Population
If an LGBTQ teen is estranged from their family because their family is unwilling to accept them, it can lead to a cycle that may result in some significant health issues. The cycle may start with homelessness, which can result in lower educational levels. This in turn can lead to higher levels of unemployment and may also lead to other high-risk behaviors including a much higher than average rate of suicide.
At the opposite end of the spectrum are the frequently-overlooked LGBTQ elders. A lack of culturally competent providers can create unique barriers for this group. Bender also shared reports of LGBTQ elders having to “go back into the closet” in some healthcare settings such as assisted living facilities. “This can result in the LGBTQ elder community experiencing severe isolation, anxiety, and depression.”
Missed Opportunities – Inequities in Health Screenings and Access
The fear of having a negative experience may keep many people out of the doctor’s office, but this appears to be a somewhat larger issue for the LGBTQ communities. For example, lesbian and bisexual women are considerably less likely than their heterosexual counterparts to get basic and potentially life-saving cancer screenings. There is also evidence that gay and bisexual men have a higher risk of HIV and other STDs than heterosexual men. These numbers are even higher for men of color. A recent study (2015) from The National Center for Transgender Equality and National Gay and Lesbian Taskforce reports that 19 percent of respondents reported being denied healthcare due to their gender identity.
How Do LGBTQ Patients Describe Their Patient Experience?
Once a member of the LGBTQ community overcomes their concerns about discrimination or their reluctance based on a bad previous experience, what do they encounter in the healthcare setting? Are healthcare providers really providing an affirming experience or is the experience itself creating a barrier to good health? It appears that the answer may be a difficult one for us to acknowledge based on the following perceptions. LGBTQ patients report that they:
- May experience longer wait times
- May perceive a judgmental or “short” tone from healthcare staff
- May experience staff walking out or refusing to provide care
- A spouse or partner may be denied visitation or accompaniment
- May feel that their privacy has been violated by staff gossip
These Problems May Be Somewhat More Acute for Transgender Patients
Transgender patients may report all of the above experiences, but perhaps have an even steeper hill to climb than other members of these communities. They may be called by the wrong name or hear staff using an incorrect pronoun, they may be denied access to a room that is appropriate to their gender, they may be asked to “prove” their gender, and they may simply be refused medical care. In many cases, they will need to educate providers on their unique healthcare needs and have difficulty obtaining life-saving, sex-specific screenings.
Watch and Listen to the full Webinar here.