Thousands of Portlanders took to the streets on June 18 to commemorate LGBTQI Pride Month – a tremendous demonstration of support for lesbian, gay, bisexual, transgender, queer and intersex people who still face stigma despite evolving societal attitudes.
As both a health care practitioner and a lesbian, I know that much more needs to be done to improve medical care for people who identify as LGBTQI.
In a 2009 survey, 56 percent of lesbian, gay, and bisexual respondents and 70 percent of transgender respondents reported at least one instance in which they experienced discrimination in the health care setting. Some reported that they were denied care altogether. Others reported that health care professionals refused to touch them, used excessive precautions or even acted with verbal or physical abuse.
I’m proud to work for OHSU, which has established a Transgender Health Program to ensure we provide safe, comprehensive and affirming health care for transgender and gender nonconforming people. Our work has been recognized by the Human Rights Coalition for providing excellent care.
Yet I know that care remains elusive for many patients in Oregon and around the country. That’s why I’ve taken on a leadership role in the American Academy of Neurology to improve care nationwide.
Medical professionals receive little training in cultural competency for these issues. Providers’ discomfort surrounding these topics may lead to inadequate health screening and prevention or missed diagnosis.
Persistent stigma leads to health disparities, fueled by inconsistent access to coverage, inadequate discussion regarding relevant health issues, and an overall underutilization of health care system. Physicians can miss underlying breast cancer in a transmasculine patient with a brain metastasis, or they may not notice dangerous inflammation of the prostate in a transfeminine patient undergoing routine ear, nose and throat surgery.
In 2010, 67 percent of medical students surveyed rated their curriculum as fair or worse in addressing these issues.
A survey of endocrinologists found that only 20 percent said they received training in how to provide hormonal treatment to transgender patients. As one expert points out, “It’s not rocket science, but it is science.”
In February, the American Academy of Neurology established a section designed to improve medical care for LGBTQI patients. Through this new initiative at the AAN, we will provide cultural competency education for our membership and encourage research in order to address disparities in treatment for patients. For neurologists, we will enhance professional development opportunities to foster an inclusive environment in training. We are also partnering with the Fenway Institute in Boston to create neurology-specific education for all providers.
In the meantime, health care practioners can take a few common-sense steps to improve health care for LGBTQI people:
- Avoid making assumptions about gender and behaviors. A patient’s gender identity may not match their gender expression, or a patient may identify as a nonbinary gender.
- Ask the patient for their preferred name and pronouns.
- Take the patient’s lead on language and terminology. If patients refer to their “husband,” then the clinician should also use the term “husband” rather than “partner” or “friend.”
- Explain the medical necessity of personal questions. For example, when treating a transgender patient clinicians may say, “For the purpose of making sure any medications I prescribe do not interact with any medications you may currently be taking, can you please tell me if you are currently taking any hormones?” It is also important to keep in mind that not every transgender person undergoes hormone therapy.
More needs to be done by all of us to ensure that all people, regardless of sexual or gender identity, feel comfortable and confident that their health care practitioner is capable of meeting their health care needs.
Holly Hinson, M.D. M.C.R., is a neurointensivist at OHSU who specializes in caring for patients with life-threatening neurologic emergencies such as stroke, seizures, and traumatic brain injury.