LGBTQ+ Guide for healthcare professionals

Healthcare providers bring their own biases about gender and sexual orientation to work, even if they don’t realize it. It’s important to consider what kind of biases we all carry with us while providing care to this community. Many LGBTQ+ individuals, especially transgender people, avoid seeking both preventative and urgent care due to negative healthcare experiences. The Joint Commission published a field guide for providers, clinicians, and hospitals seeking LGBTQ+ competent healthcare.

How healthcare workers can create a supportive and sensitive care experience

  • Establish trust and rapport with patients. Even when workers know how to ask questions about sexual behavior, identity and attraction, they may not feel comfortable doing so. In this situation, their discomfort may be communicated to LGBTQ+ patients.
  • Normalize and validate – ask the questions as you would to any patient.
  • Ask open-ended questions
    • “Tell me about yourself? Are you involved in a relationship?” Do not assume anything about the relationship, the partner, or the sexual behavior. Don’t assume you know anything about their sexual behavior based on how they identify or with whom they are partnered. Let the information that emerges guide the rest of your interview.
  • Be aware of issues particular to, or different for, the LGBTQ+ population:
  • Coming out
  • Having children—reproduction or adoption
  • Parenting and creating families
  • Adolescence
  • Aging
  • Legal rights as parents and partners

Common barriers to LGBTQ+ Healthcare                                                                      

  • LGBTQ+ individuals are less likely to have health insurance than their heterosexual counterparts. 
  • Insurance plan language may exclude coverage for routine care and for transition-related care (hormones, surgery often not covered)
  • Insurance plan may have a narrow definition of families, and not include “chosen” family of LGBTQ+ people.
  • Previous negative experiences in healthcare settings can discourage LGBTQ+ individuals from obtaining medical care.
  • Lack of provider information and knowledge about LGBTQ+ health needs and risks prevent LGBTQ+ individuals from receiving proper medical care.
  • A lack of LGBTQ+-specific research, policies and procedures can hinder proper medical care and treatment.
  • LGBTQ+ individuals may experience multiple stigmas, including race, class, ability, geographic location, and immigrant status. For example, studies show reduced access among LGBTQ+ people of color.

 Health disparities in the LGBTQ+ community

  • Less access to insurance and health care services, including preventive care (such as cancer screenings)
  • Lower overall health status
  • Higher rates of smoking, alcohol, and substance abuse
  • Higher risk for mental health illnesses, such as anxiety and depression
  • Higher rates of sexually transmitted diseases, including HIV infection
  • Increased incidence of some cancers

Special considerations for LGBTQ+ youth

  • Increased risk for suicide and depression
  • Increased smoking, alcohol and substance use
  • A huge percentage of homeless youth in NYC are LGBTQ+ because they have been kicked out of their homes.
  • Higher levels of violence, victimization and harassment (including bullying in school).

Special considerations for LGBTQ+ older adults

  • Stigma, discrimination and violence, isolation, and lack of family support can affect all LGBTQ+ people, but older adults may have a more limited support system. They are subject to the rules and attitudes of nursing homes, assisted living facilities, where they may experience homophobia/transphobia.
  • There may be Social Security and pension plan exclusions. For example, they may be unable to go on a spouse’s plan if their relationship is not legally recognized.
  • Although recently passed federal regulation seeks to ensure nondiscrimination for hospital visitation rights, this may still be a concern at some hospitals.
  • Community programs and resources which are specific to the needs of LGBTQ+ older adults may be limited.

 Barriers to care for Transgender individuals

  • Denial of healthcare
  • Lack of informed care
  • Lack of insurance coverage for medically necessary gender-related care. For example, a transman needing gynecological care may be denied by the health insurance.
  • Sex segregated services, like homeless shelters, are based on gender
  • Inappropriate name or pronoun use. If this occurs, it is important to acknowledge mistakes and apologize.
  • When asking questions about genitalia or transgender status, explain why you need the information, so it is clear you are not just curious. If you don’t need information about genitalia or transgender status in order to provide care, refrain from asking.
    • If intake forms do not always allow for proper taking of information or if questions are offensive, this creates a barrier.
  • Confidentiality/Privacy are not always respected. You may be the only person in the setting to whom the patient reveals his/her transgender status. Be careful how you treat this information. Ask the patient how they want the information to be treated. For example, information to be put in the computer system or revealed to the healthcare provider.

Additional Resources for Providers and Clinicians:

LGBTQ+ Healthcare

GLAAD LGBTQ Glossary of Terms
National LGBT Health Education Center
The Fenway Institute

Transgender Healthcare

GLAAD Transgender Glossary of Terms
WPATH Standards of Care