The Fear of Discrimination in LGBT Healthcare
by Brett Tortelli, MD/PhD candidate, Washington University in St. Louis School of Medicine
For many people talking about their sex life with their doctor can be uncomfortable. When someone reveals something so intimate about his or her personal life there is a fear of judgment.
We as physicians are trained to ask our patients about their sexual practices in order to develop a complete patient history; but many physicians find this topic uncomfortable and shy away. For LGBT patients these feelings of vulnerability and fears of judgment are often exacerbated. If he knows I’m gay, trans, bi, etc., will the doctor treat me differently? Will they think of me differently? Will I be outed?
These thoughts are not uncommon among LGBT individuals when interacting with healthcare professionals and their fears are not unwarranted. Studies have shown both implicit and explicit bias among heterosexual healthcare providers against LGBT patients.1
The fear of discrimination in the clinic is toxic to proper healthcare and can even prevent some individuals from seeking medical attention. In an environment where the patient fears interacting with their physician, there is an inevitable breakdown in communication and subsequent failures to fully address the medical needs of that individual are likely. This fear of discrimination represents a major barrier that exists between LGBT patients and healthcare environment and perpetuates the very real health disparities that have been documented in numerous studies. But how do we as medical professionals help bring down these barriers? I would argue that the first step is to educate current and future healthcare providers.
LGBT Specific Training
Throughout the four year U.S. medical school education, a student will receive, on average, a mere five hours of LGBT specific training.2 If I were to ask a group of graduating medical students what comes to mind when they hear the term LGBT health disparities, I would probably hear about elevated rates of HIV and other STIs. This notion is of course in part true. Men who have sex with men are indeed at increased risk for acquiring HIV or another STI.
However, LGBT health disparities cannot universally be grouped in terms of sexually transmitted diseases. The factors contributing to an LGBT patient’s susceptibility to various diseases is complex and requires a thorough evaluation of the patient’s behavior and history. Considering the complex nature of LGBT health, more than five hours of LGBT specific training over the course of four years should be advocated. In addition to teaching students about the risks facing LGBT patients, they need to be trained on how to discuss issues of sexuality and sexual practices with their patients in a sensitive manner.
Acquiring the necessary information to complete a patient’s social and sexual history can be difficult and many physicians are uncomfortable bringing up matters of sexuality or sexual practices with their patients, preferring to wait for the patient to initiate the dialog. However, it should not be the patient’s responsibility to introduce the topic of conversation. It is the physician’s job to inquire about all attributes of the patient’s life that could have a bearing on their medical care. Knowing that members of the LGBT community are at elevated risk for various diseases, it is our job to bring up the pertinent topics with our patients.
Beyond teaching future medical doctors how to best interact with their LGBT patients, we must promote LGBT specific education and training among current physicians. Part of the responsibility here lies on institutions. Universities, medical centers and hospital groups need to make addressing LGBT health disparities a priority and provide frequent and readily available training to their staff. Furthermore those of us aware of the health needs of the LGBT community need to advocate education amongst our peers. It is through education and open communication that we can begin to break down the healthcare barriers that exist for the LGBT community and fight ignorance and discrimination in the clinic.
- Health Care Providers’ Implicit and Explicit Attitudes Toward Lesbian Women and Gay Men. Janice A. Sabin, Rachel G. Riskind, Brian A. Nosek. Am J Public Health. 2015 Sep; 105(9): 1831–1841. Published online 2015 Sep. doi: 10.2105/AJPH.2015.302631
- Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, Gay, Bisexual, and Transgender–Related Content in Undergraduate Medical Education. JAMA.2011;306(9):971-977. doi:10.1001/jama.2011.1255.