Featured Resource: National LGBTQIA+ Health Education Center Learning Resources
4 - 5 Minutes
Author: Julpohng “JP” Vilai, MD, FAAP
As we reflect on Pride month, we recognize LGBTQIA+ people as a medically underserved population who often endure discrimination and mistreatment within healthcare systems, which can lead to adverse outcomes.(1) These inequities result partly from lack of knowledge about LGBTQIA+ healthcare needs, misconceptions regarding the community, and personal and religious beliefs of healthcare professionals.(2) The barriers facing LGBTQIA+ people became most evident to me when I practiced in a rural community, where it was a polarizing issue even within my own clinic.
Creating inclusivity and providing appropriate care for LGBTQIA+ patients can be challenging, particularly when many clinicians lack formal training in LGBTQIA+ health. The National LGBTQIA+ Health Education Center was created in an effort to advance health equity for LGBTQIA+ people, address and eliminate health disparities, optimize access to cost-effective healthcare, and improve the quality of care by providing training and technical assistance to health care providers and staff.(3) The Center provides a robust collection of learning resources.
As an example, we would like to highlight the Health Education Center’s “Ten Strategies for Creating Inclusive Healthcare Environments for LGBTQIA+ People.”(4)
1. Leadership is Actively Engaged
Ideally, a “champion” from the management team helps to set the tone. In my rural private practice, many of my partners privately supported or were at least neutral toward LGBTQIA+ issues, and I effectively became an advocate. However, one shareholder and a founding clinician was religiously opposed, resulting in our inability to publicly support the LGBTQIA+ community as a united practice.
2. Organizational Policies Protect LGBTQIA+ People
While my practice struggled with organizational policies, notably in refusing to create unisex bathrooms even though the bathrooms were all single user, the competing Pediatrics practice in town displayed a pride flag on their organization’s website and incorporated unisex bathrooms among other institutional policies demonstrating a high-level of organizational support. Potential policy areas include non-discrimination policies, restroom policies, and family/support person policies.
3. The Physical and Virtual Environment Welcomes LGBTQIA+ People
“Upon entering a health care facility, patients look for signs and clues of diversity and openenss to LGBTQIA+ identities.”(4) To signify inclusivity, I attached a Human Rights Campaign (HRC) pin to my ID badge. While inconspicuous to many, it was an indication of a welcoming space to those for whom it mattered. Additionally, we hired individuals from the LGBTQIA+ community; the nurse on my team, a lesbian and leader in the LGBTQIA+ community, told me that she was excited to take the job because of my HRC pin. Other ideas for creating a welcoming environment include providing health education materials specific for LGBTQIA+ people, carrying brochures for local LGBTQIA+ organizations, and incorporating magazines directed to the LGBTQIA+ community.
4. Forms Reflect LGBTQIA+ People & Their Environment
I helped to redesign my clinic’s registration and intake forms to be more inclusive, using gender inclusive items such as spouse/partner instead of wife/husband and asking for names of caregivers instead of mother/father. My team used medical history forms that avoided specifying sections as only applicable to men or women.
5. Partnerships with the LGBTQIA+ Community
My nurse, my wife, and a group of local activists founded an LGBTQIA+ 501(c)(3) and opened an LGBTIA+ resource center and safe space for LGBTQIA+. I was able to make a $10,000 donation from my clinic to start the organization; however, the donation only came from my productivity and was not acknowledged as coming from the clinic as a whole (i.e., we could not advertise that the clinic was supportive because of a reluctant shareholder). This was a creative solution to support a fledgling local organization. To counter the lack of shareholder support, I worked with pediatricians across the city to participate in the annual Pride parade.
6. All Staff Receive Training on Affirming Communication and Care
Although we did not conduct formal training, I did informally educate staff and set a standard for how to interact and communicate with LGBTQIA+ patients and families. I would occasionally overhear discriminatory comments from some staff and providers, but they were aware that I did not tolerate it. The National LGBTQIA+ Health Education Center is the premier resource for training clinicians and staff.
7. Sexual Orientation and Gender Identity Data are Collected and Used to Improve Health Outcomes
Asking about sexual orientation and gender identity (SOGI) can enhance patient-clinician communication and facilitate appropriate screening and counseling. It can also help monitor clinical care quality, inform disparities, and improve patient satisfaction.
8. All Patients Receive Routine and Inclusive Sexual Health Histories
Particularly with adolescent patients, I spent additional time on the sexual health history and found that patients commonly questioned their sexuality, preferences, and gender identity. I tried to help guide them, provide resources, and create a protected and confidential space for them. Inclusive sexual health histories also include not assuming that every patient is heterosexual; lesbians often complain about being asked pregnancy questions repeatedly. The assumption that any woman could become accidentally pregnant is not applicable to women who only have sex with women. The operative question in this instance is, “Do you have sex with men, women, or both?”
9. Clinical Care and Services Meet LGBTQIA+ Health Needs
Rural communities struggle with access to subspecialty care, particularly mental health resources. We made note of local LGBTQIA+ friendly providers and businesses and would refer and make recommendations to patients accordingly. Despite this, I would often need to take primary responsibility for providing affirming care or refer, occasionally out of state.
10. LGBTQIA+ People are Recruited and Retained
My nurse was a lesbian woman, and one of my scribes was a gay man who was a drag performer. Others on my team were largely allies. As a shareholder, I had the luxury of having wide latitude and influence on hiring practices and retention.■
References
(1) Ayhan C, Bilgin H, Uluman O, et al. A systematic review of the discrimination against sexual and gender minority in health care settings. Int J Health Serv. 2019;50(1):44-61. https://pubmed.ncbi.nlm.nih.gov/31684808/
(2) Clark K, Lunn M, Bosse J, et al. Societal stigma and mistreatment in healthcare among gender minority people: a cross-sectional study. Int J Equity Health. 2023;22(1):162. https://pubmed.ncbi.nlm.nih.gov/37620832/
(3) National LGBTQIA+ Health Education Center: A Program of the Fenway Institute. Accessed May 28, 2024 from https://www.lgbtqiahealtheducation.org/
(4) National LGBTQIA+ Health Education Center. Ten Strategies for Creating Inclusive Health Care Environments for LGBTQIA+ People. April 2021. Accessed on May 28, 2024 from https://www.lgbtqiahealtheducation.org/publication/ten-strategies-for-creating-inclusive-health-care-environments-for-lgbtqia-people-2021/download/.