10 Tips For Caring For LGBTQ Patients
Ensuring that individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) have access to the care that they need is still an evolving discussion in healthcare.
Recent rulings have put a spotlight on some of the legalities complicating LGBTQ care, as well as protections. The Trump Administration, for instance, just reversed a rule from the Obama administration that included sexual orientation and gender identity within protections against sex discrimination in healthcare and insurance companies. The new rule reversal has raised alarms, as opponents worry it could open the door for a transgender individual to be denied claims or care for procedures or coverage based on their orientation or gender identity. In the workplace, however, the Supreme Court ruled in June that sex discrimination protections do apply towards sexual orientation and gender identity, preventing LGBTQ individuals from being fired or not hired based on their sexual orientation and/or gender identity.
And as the nation in general is moving towards recognizing and reconciling the racial disparities that exist in healthcare, the disparities that the LGBTQ community faces are also being recognized more and more. LGBTQ individuals experience a number of healthcare disparities that are linked to health risks that include higher rates of psychiatric disorders, substance abuse, and suicide.
While the future of healthcare moves towards system-wide awareness and inclusive care, there are plenty of things you can do on a personal level to increase your own LGBTQ sensitivity as you deliver care.
1. Expand your own LGBTQ-care knowledge
To understand the needs of LGBTQ patients, nurses must expand their own knowledge on the subjects of sexual orientation (SO), and gender identity (GI), and how both areas are included in healthcare. For instance, you could seek out Continuing Education on LGBTQ health education, such as those offered by the National LGBT Center for Health Education. Many of the CE modules are even offered for free.
2. Be aware of key LGBTQ definitions
The LGBT Center has a helpful and in-depth guide that breaks down definitions and terms that are used when addressing the LGBTQ community, as well as how those terms may be applied in the clinical sense. Some of the terms you can familiarize yourself with include those referring to gender identity. Gender identity includes transgendered individuals, when a person identifies as a different gender than their biological parts at birth. Gender identity also includes individuals who identify as genderfluid and or have gender expansive identities.
However, the guide notes that not all fit “neatly” into one category, so it’s important to be familiar with terms on SO and GI, while respecting each patient as an individual. The guide also explains that in a healthcare setting, there may be terms that providers or professionals can use terms that describe sexual behavior, rather than focus on orientation, such as MSM (men who have sex with men) or WSM (women who have sex with women) in order to identify any associated risks.
3. Deepen your LGBTQ knowledge
Deepening your knowledge base will enrich your understanding of sexuality in general, and increase your nimbleness in identifying potential health risks for patients seeking your care.
Keep your knowledge up-to-date with ongoing training, reading, and learning from others who are skilled in communicating with and caring for these patients.
Some good websites that can help you further your understanding include:
- Centers for Disease Control and Prevention
- GLBT Health Access Project (Community Standards of Practice Section)
4. Create a welcoming environment for LGBTQ patients
LGBTQ individuals have a long history of discrimination at the individual and institutional levels, including the healthcare system. They may “scan” an environment to determine if it is a safe place to reveal personal information. Some things an individual may watch for and take note of during their time in your reception or waiting room area:
- Is your organization’s nondiscrimination policy in a visible location?
- A rainbow flag, pink triangle, or other symbols of inclusiveness
- Availability of unisex restrooms
- Health education literature with diverse images and inclusive language, including information about LGBTQ health
- Posters announcing days of observance such as World AIDS Day, Pride, and National Transgender Day of Remembrance
5. Use inclusive language
As a healthcare professional providing care for all, it’s important that you use inclusive language. Language matters when discussing and approaching LGBTQ-centered care. Here are some examples of how you can include inclusive language on both intake forms and in speaking with your patients:
For marital status, the form might read, “relationship status: married, partnered, or other,” as well as, of course, any gender identification spaced to include an option outside of male or female.
When asking patients to provide their names, it’s also helpful to include an additional space indicating “Preferred Name,” as a transgender individual may not wish to be called by a name that reflects their gender identity. And including “preferred pronoun” on a form shows understanding that someone may not identify as they appear.
If you feel your hospital or facility needs updated forms with inclusive language, you can approach your administration with some resources on updated forms, such as those from the LGBT center.
6. Use gender-neutral language
Approach each interaction with open-mindedness and a nonjudgmental attitude. For instance, you can use language that changes “nursing mother” to “currently nursing,” indicating that not all who lactate identify as mothers or women, or “menstruating person” instead of “menstruating woman.”
Pronouns are also incredibly important, and starting with a general “they” can be helpful if it’s not clear which pronoun your patient prefers. When in doubt about how to best address a patient, don’t be afraid to simply ask. Asking your patient how they would like to be addressed is a sign of respect and signifies that you are aware that not all individuals identify with she/he pronouns.
7. Ask open-ended questions
For example, asking, “Is there anything else that would help me ensure you get the most out of this visit?” can help patients share relevant health information.
Do not overwhelm patients with questions unrelated to the reason for their visit, or to enhance your own knowledge about transgender health. If caring for LGBTQ patients is new to you, it may also be helpful to practice your responses to questions in advance, such as “Thank you for being open with me; this will help me provide better care for you.” Role-playing your response can increase your own comfort with these situations.
8. Reflect the patient’s language
Avoid applying labels, as some people do not self-identify with any particular descriptive label, and may have sex with partners of more than one sex or gender. Do not presume.
For example, some individuals may have had or have sexual experiences with individuals of the opposite sex, and bisexual individuals may have long periods of monogamy; keep in mind that sexuality can change over time.
9. Be aware of mental and physical health risks for LGBTQ patients
Be aware of the unique social pressures and health risks of LBGTQ patients. Societal phobias, violence, and hate crimes – and the fear of them -- are all too real. Along with the potential for being ostracized by family and other social groups, this can contribute to chronic anxiety and depression. Additionally, LGBTQ individuals who are members of minority populations often face a double burden of discrimination.
It’s also important to build your awareness of the specific physical health problems LGBTQ individuals face. For instance, some specific healthcare risks in the LGBTQ community as compared to the non-LGBT population, and especially for youth, include
- Higher risk of substance abuse
- Higher risk of STDs
- Higher risk of cancers
- Higher risk of cardiovascular diseases
- Higher risk of bullying
- Higher risk of mental health issues, such as anxiety, depression, and suicide
Familiarize yourself, whenever possible, with the specific risks of the population that you will be caring for so you can appropriately screen for any associated health conditions and offer resources as appropriate.
10. Convey respect
Always remember that the LGBTQ patient in front of you has taken a courageous step to be in your office and disclose some of the most personal information about their lives. Having as positive and affirming an experience as possible will make it more likely the individual will seek future care in a timely manner.
Becoming aware of resources specifically designed for LGBTQ individuals and making referrals as appropriate will convey that you care enough to become informed about their particular needs. The quality of your interaction can truly make a difference in someone’s health -- and life.
More healthcare facilities across the nation are also turning their focus specifically to welcome LGBTQ patients, and train healthcare professionals on LGBTQ-focused care.
For instance, the first Nurse Practitioner fellowship training for LFBTQ+ care was announced last year, directories for LGBTQ care are being built, such as this LGBTQ+ Directory of Clinical Care Services (DoCCS), and more medical centers are moving in the direction to offer specific LGBTQ healthcare centers.
The CDC also has a comprehensive state-by-state guide, with LGBTQ facilities in each state, along with other resources, such as hotlines and referral services. OutCare also partners with the LGBTQ center to provide a list of state LGBT healthcare centers and resources.