7.4: Health Care Providers

The teaching of medical and nursing students about health issues unique to the LGBTQ+ population is inconsistent among education programs for health care providers. An emerging body of research finds a need for more education to better meet the requirements of LGBTQ+ patients. In one study, for example, U.S. medical schools were found to provide only an average of five hours of LGBTQ+ education throughout the curriculum. Baccalaureate nursing programs in another study spent only an average of a little over two hours teaching content about LGBTQ+ health topics. Less is known about the extent to which other health provider education programs cover this content. During a health care clinical experience, LGBTQ+ individuals often encounter health care providers who lack a basic understanding of LGBTQ+ cultures, terminology, and culturally inclusive care.^[44]

Locating a health care facility that affirms LGBTQ+ people can be difficult but is not impossible. Some national organizations provide resources for LGBTQ+ persons and health care providers. For example, the Human Rights Campaign, the largest national LGBTQ+ civil rights organization with over three million members, has a benchmarking tool, the Healthcare Equality Index, to recognize the health care facilities with policies and procedures for equity and inclusion of LGBTQ+ patients, visitors, and employees. Health care facilities evaluated by the index are available in its directory. An agency must reapply every year to demonstrate that it meets the current standards outlined by the Human Rights Campaign.^[45]

Another organization, GLMA (Gay and Lesbian Medical Association), advances health care equality for LGBTQ+ people and has an extensive directory of health care providers across the United States that are LGBTQ+ affirming. The GLMA published guidelines that offer recommendations for practitioners to consider when caring for LGBTQ+ clients. The National LGBT Health Education Center, a program of the Fenway Institute, also has excellent resources to help educate providers.^[46] Both organizations provide valuable resources and are worth mentioning to a provider who lacks sufficient knowledge to provide culturally inclusive care for LGBTQ+ persons. Organizations and coalitions that support LGBTQ+ health are listed in table 7.4. All provide free publications and resources for the LGBTQ+ person and health care providers.

Table 7.4 LGBTQ+ education and advocacy organizations

Organization	URL
GLMA Health Professionals Advancing LGBTQ Equality	http://www.glma.org/
Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies	http://www.nalgap.org/
World Professional Association for Transgender Health	https://www.wpath.org/
Center of Excellence for Transgender Health	http://transhealth.ucsf.edu/
National LGBT Cancer Network	https://cancer-network.org/
Trevor Project	https://www.thetrevorproject.org/
CenterLink: Community of LGBT Centers	https://www.lgbtcenters.org/
Fenway Health	https://fenwayhealth.org/the-fenway-institute/
Howard Brown Health	https://howardbrown.org/
Los Angeles LGBT Center	https://lalgbtcenter.org/
Mazzoni Center LGBTQ Health and Well-Being	https://www.mazzonicenter.org/
Callen-Lorde	https://callen-lorde.org/
LGBT Health Link	https://www.lgbthealthlink.org/

Informed Health Care Consumers

When navigating a system in which not all providers understand or practice care that includes LGBTQ+ people, LGBTQ+ individuals need to know what questions to ask when visiting their provider. Although it is important to be true to yourself and disclose your sexual identity to your provider so you can receive the most holistic care possible, not all LGBTQ+ persons feel comfortable disclosing this information, particularly to a new health care provider with whom they have not yet established a trusting relationship. The Institute of Medicine has recommended including sexual orientation and gender identity data in electronic health records so that more health care facilities will ask patients for this information.^[47] Ultimately, however, LGBTQ+ persons must decide for themselves when and to whom to disclose their LGBTQ+ identity.

Before visiting a provider, consider calling the office to ask if they provide inclusive care for LGBTQ+ patients. Bring a friend or partner to the visit for support if you are uncomfortable meeting with the health care provider. Health care providers must adhere to laws, policies, and ethical codes to keep your information private. Although a health care provider may ask about sexual orientation and gender identity, LGBTQ+ persons also have the right to request that the provider not enter their sexual orientation and gender identity into the medical record.

Paying Attention to Special Health Issues

Providers must understand health care issues common in the LGBTQ+ population and explore whether their patients have any of these risk factors. GLMA has created ten resource sheets for LGBTQ+ persons, each one addressing one of the top health concerns to discuss with a health care provider. Although not all these health issues apply to every person, it is essential to be aware that these health topics are more common among LGBTQ+ people. Several health topics are relevant to all LGBTQ+ groups, and others pertain more to one group. For example, research has identified that depression, tobacco and alcohol use, sexually transmitted diseases (including human papillomavirus and HIV/AIDS), and certain cancers are greater health risks in the LGBTQ+ population. Moreover, the risk of illicit use of injectable silicone is a more significant concern among transgender women. Other health issues are more common within certain groups, such as breast and gynecological cancers among lesbians and male-to-female transgender persons. In addition to the risk of HIV/AIDS among men who have sex with men, they also have a higher incidence of and mortality from prostate, anal, and colon cancer.^[48]

Minimizing risk factors for these acute and chronic illnesses is essential to maintaining health. The LGBT Health Link is a network for health equity and offers very practical advice for things that LGBTQ+ people can do to improve their wellness. Recommendations include how to search for insurance options, practice preventive care, seek mental health support, adopt a healthier lifestyle, and practice safer sex.^[49] The resources provided in this section support LGBTQ+ individuals to advocate for themselves when seeking health care services, particularly from providers who are not well educated about LGBTQ+ health issues or who do not demonstrate culturally inclusive and affirming behaviors. Although health care providers are responsible for establishing a trusting relationship with their patients, this does not consistently occur in every health care setting. When a health care provider demonstrates genuine concern and respect for an LGBTQ+ individual in a practice not restricted to a fifteen-minute office visit, then there is greater opportunity for individualized, holistic, patient-centered care. Becoming a smarter LGBTQ+ health consumer requires being aware of the community’s complex history with medicine, understanding the unique health issues involved, and recognizing health risks and changes that occur over the course of life.

Check Your Knowledge

Contributed by Has Arakelyan, Rio Hondo College

Multiple-Choice Questions

1. On average, how many hours do U.S. medical schools devote to LGBTQ+ health education in their curriculum?
A) Less than 1 hour
B) 20 hours
C) About 5 hours
D) 50 hours

2. Which organization publishes the Healthcare Equality Index to benchmark health care facilities for LGBTQ+ inclusion?
A) American Medical Association
B) Human Rights Campaign
C) Centers for Disease Control and Prevention
D) World Health Organization

3. What is a common challenge LGBTQ+ individuals face when seeking health care?
A) Too many providers to choose from
B) Overly long office visits
C) Excessive insurance coverage
D) Providers lacking basic understanding of LGBTQ+ cultures and terminology

4. What is the main purpose of the GLMA directory?
A) To provide a list of LGBTQ+-affirming health care providers
B) To list all hospitals in the U.S.
C) To offer legal advice
D) To sell health insurance

5. Why must health care facilities reapply each year to the Healthcare Equality Index?
A) To pay annual dues
B) To update their insurance policies
C) To demonstrate they meet current standards for LGBTQ+ equity and inclusion
D) To renew their medical licenses

Discussion Questions

1. Why would it be important for a health care professional to understand a patient’s identity from an intersectional perspective?
2. How has LGBTQ+ activism influenced health care systems and medical practice?
3. What steps can LGBTQ+ individuals take to find affirming and inclusive health care providers?
4. Why would it be important for a health care professional to understand a patient’s identity from an intersectional perspective?
5. What additional changes would you recommend to health care education programs to better serve LGBTQ+ communities?

Multiple-Choice Questions - Answers

1. C) About 5 hours
2. B) Human Rights Campaign
3. D) Providers lacking basic understanding of LGBTQ+ cultures and terminology
4. A) To provide a list of LGBTQ+-affirming health care providers
5. C) To demonstrate they meet current standards for LGBTQ+ equity and inclusion