As health providers, we like to help anyone that walks through our door, regardless of background or identity. Sometimes, though, it’s not enough to simply be open-minded, or accepting. With certain populations it is imperative to not only be “open,” but also competent. All minority populations have their own unique needs, backgrounds, influences, and struggles. LGBT individuals are no different. This post is a brief overview, though it is important to keep in mind that each letter of that acronym is unique with its own needs, especially trans*gender individuals.
LGBT individuals face a myriad of health disparities. A recent study found that many gay men, for instance, exhibit psychological symptoms of severe PTSD, and display the concomitant health risks, even if they have never been in a life-threatening situation. Over 70% of trans*gender individuals report at least one instance of overt discrimination in a healthcare setting, ranging from everything to deliberate misgendering to outright physical abuse. Lesbian women have significantly higher rates of obesity, smoking, and are far less likely to receive preventative care, such as mammograms, than their heterosexual peers, but also tend to have better mental health outcomes and more stable relationships than gay men. In order for any healthcare setting to be affirmative and competent, education, consultation, research, and ongoing awareness are necessary. Following are a few steps to help facilitate more open discussion.
Many individuals will not feel comfortable disclosing what may be one of the most important aspects of their identity to someone they don’t know and don’t yet trust, so providers should get in the habit of asking about identity and lifestyle characteristics of patients. A great place to start is with new patient paperwork. Having multiple options for relationship status and gender identity, and overtly asking about sexual orientation can go a long way to opening the door to conversations about identity and health risks and disparities. What this conveys to your new client is that you are aware they exist (in a broad sense), it’s something you have thought about, and it is something that you are probably (hopefully) knowledgeable about. For LGB individuals, even the assumption of heterosexuality by their provider can be alienating and invalidating. For trans*gender individuals, a disclosure of trans*gender identity might be met with skepticism and invasive questions at best, or outright hostility or medical harm at worst.
Next most important is simply asking. It should not be incumbent upon the patient to disclose information to a new provider that could potentially be used against them. We can help ease that anxiety by taking the first step and overtly offering a safe and supportive space for disclosure. Because being LGB, and often T, is an invisible status, meaning it cannot be gleaned just by looking at someone, it is easy for the patient to stay quiet, let the clinician make assumptions, and move on. But that isn’t good healthcare. Understanding what is most relevant to our patients not only helps build rapport and trust, it provides us with a fuller picture of habits and behaviors, risks, disparities, and protective factors.
Third most important is self-learning and continuing education. Research in trans*gender health especially is moving at a rapid pace, and it is important to stay informed and updated. Consulting with other professionals who have experience with these populations, attending continuing education workshops, and going to conferences are all excellent ways to keep abreast of the latest developments in the field, but also to network. See if you can bring in specialists to your organization to conduct trainings and seminars. Even seeking out clinical supervision while you begin working with this population might be helpful and a good idea.
The key to all successful relationships is adequate communication, and it is no different with our patients. The better we can learn to communicate, and the better we can learn to listen, the more likely clients and patients are to open up to us, confide in us, and let us give them the most competent and comprehensive care we can. And we can only speak as experts if we have expert knowledge, which includes not only education, but experience.
Dr. Ryan Cox earned his Bachelor's in Psychology at St. Edward's University in Austin, Texas, his Master's in Counseling at Pacific University in Forest Grove, Oregon, and his PhD in Counseling Psychology at the University of Memphis in Tennessee. His primary clinical interests are LGBT health, integrated healthcare, holistic health and wellness, HIV/AIDS, and masculinity and gender issues. He currently works as an integrated psychologist in Oncology, Sleep Health, and Pain Management at Truman Medical Center in Kansas City, Missouri. Dr. Cox also teaches graduate courses at Avila University, and sits on the board of the Good Samaritan Project, a non-profit dedicated to ending the impact of HIV in Kansas City.