By Tammie Smeltz
In New York State, over one million adults identify as LGBTQ+. Statistically, that is 7.9% of the overall adult population, with 3.4% identifying as bisexual, 2.2% identifying as lesbian or gay, 2.2% identifying as other orientation and 0.5% identifying as transgender or gender non-conforming.
Current literature shows that many people who depart from traditional heterosexual norms feel disrespected and marginalized in the healthcare setting. This stigma may result in an increase in substance abuse, mental health disorders, risky sexual behaviors and suicide attempts — all of which can lead to chronic long-term illness. Compound these feelings of discrimination and limited access to quality healthcare with the difficulties of maintaining health insurance and income inequalities, this population remains very vulnerable.
For providers, there are several things to consider when treating the LGBTQ+ population. For one, it is difficult for many LGBTQ+ patients to reveal their sexual orientation to healthcare providers. As a result, they may not feel comfortable sharing an accurate medical history. Furthermore, some healthcare providers may feel uncomfortable asking questions about sexual orientation. It is situations like these that can lead to delays in care, inappropriate care or even avoidance of care all together.
For physicians in New York, there are many things to consider when addressing the needs of the LGBTQ+ population. Becoming aware of this vulnerable population is a step in the right direction. The American Medical Association recommends creating an environment where all patients feel welcome. Simple ways to create an inclusive environment include displaying posters from a nonprofit LGBTQ+ organization or providing brochures or educational materials that address health concerns for this population.
When caring for the LGBTQ+ population, MLMIC recommends the following:
Patient Relations: Ensure your website uses inclusive language and features LGBTQ+ friendly information. Consider displaying images of same sex couples or rainbow flags. Offer unisex bathrooms and incorporate neutral medical terminology into your office culture.
Create intake forms that include the full range of sexual and gender identity and expression. The forms should include an option for “domestic partnership,” as well as single, married, widowed and divorced. Office staff must be trained to use patients’ preferred names and pronouns. Also, it is imperative that confidentiality be ensured on all forms.
Communication: Regarding communication, follow your patients’ lead. Be curious and ask questions that are pertinent to caring for the patient. If you inadvertently offend the patient, simply apologize. Patients will appreciate your sincerity and good intentions.
Documentation: It is imperative to document any transition history including any surgeries performed, as well as hormones that are prescribed. For those patients who are transitioning, it is important to update any new procedures performed or new hormones prescribed since the previous visit. It will also be essential to note what anatomy still exists. For example, a transgender man may still have a cervix and therefore will still require a pap smear.
Medical Management: Tailor the physical exam to address specific health risks and challenges associated with this population. Become familiar with collecting information pertaining to sexual history, orientation, identity, gender and anatomy. Be cognizant of cancer screenings, such as a mammogram for a transgender male patient or a prostate exam or PSA test for a transgender woman. Include mental health and suicide screenings at all visits and discuss immunizations such as PrEP for HIV. Become educated on medical issues that are not typical of your current scope of practice that you may encounter and are capable of treating.
Staff Education: Caring for the LGBTQ+ patient should be part of every new employee orientation. Ensure that your staff is comfortable communicating with this population and offer educational sessions when necessary. Discuss with your staff the importance of having a no- tolerance policy for inappropriate behaviors such as laughing, joking and negative comments. Address any issues that arise with the use of improper names/pronouns, inappropriate room assignments or challenges to bathroom use.
Policies and Procedures: Modify your Patient’s Bill of Rights to include information for LGBTQ+ patients. Implement changes to your nondiscrimination policy to include gender identity and gender expression, as well as sex/gender, sexual identity or orientation.
Medical Insurance: Keep in mind that several insurance companies continue to deny coverage for transgender patients. This challenge may require extra time and effort from both you and your staff, as this struggle can increase the risk of depression, suicide, self-medication and self-surgery in the LGBTQ+ population.
Risk Management Tips: Do not assume that all patients are heterosexual or that sexual orientation is based on appearance. Modify your EHR to address the LGBTQ+ patient and implement practice guidelines for treating this population. Involve the patient in the decision-making process and always remain cognizant of your own bias.
For a more in-depth look at addressing the needs of your LGBTQ+ patient population, register for our online CME+ educational program here. To schedule an online seminar or live educational program for your office staff, contact Matthew Lamb, Esq., at 518-786-2762.
MLMIC policyholders can reach our 24/7 emergency support services for questions regarding caring for the LGBTQ+ population by calling (844)-MMS-LAW1. You can also submit a specific question by sending an email request here.
Photo by Cottonbro Studio.