Every doctor – patient relationship requires some degree of trust. The best ones — for both parties — are built on a foundation of openness and understanding.
Establishing that kind of rapport with a doctor can be difficult for anyone, and even more challenging for members of the LGBT community.
“In speaking with members of the LGBT community, I’m still hearing that many of them don’t come out to their doctors unless their doctors are gay, so there’s work to be done,” says Dr. Rhonda Johnson, senior medical director of health equity and quality services at Highmark Inc.
Doctors take an oath when they graduate from medical school, promising to treat everyone fairly. But, as Dr. Johnson points out, medical professionals are all human — and being human means being influenced by our experiences.
“Our traditional medical education does not adequately deal with biases,” Dr. Johnson says, “and we all have them. Patients can detect our biases fairly quickly. In some cases, physicians and their office staff may unconsciously demonstrate biases which members of the LGBT community can perceive as less than welcoming. It is important to treat LGBT patients with respect and be compassionate and non-judgmental in their care.”
Dr. Johnson recalls many years ago,“There was a young, gay patient who refused to be seen by me,” she says. “And that was a wake-up call for me because there was something about my demeanor toward him that caused him to just walk out. I felt very badly; I apologized to him and tried to get him to see another provider, but for that particular day, he did not get any kind of care. That was years ago, but I’ve never forgotten that.”
In the years since, Dr. Johnson has taken additional training on LGBT and gender identity health care, unconscious bias training, and participated in LGBT community events like Pittsburgh’s Pride Festival.
“Even as open-minded as I thought I was, I had a lot more to learn,” says Dr. Johnson.
“I can’t imagine doing it any other way,” says Allegheny Health Network breast surgeon Dr. Charis Venditti. “I am here to take care of patients and all people should be treated with respect, kindness and generosity irrespective of anything related to a person’s background.”
Dr. Venditti adds that today’s medical education programs are considered incomplete without the inclusion of cultural sensitivity training. “I was very fortunate to be trained by a program that devoted a lot of time and effort to teaching the importance of cultural awareness and sensitivity. And this included keeping in mind the needs of the LGBT community,” she says.
Dr. Venditti was inspired to become a doctor — first an OB-GYN and then a breast surgeon — because she knew women who would have been more comfortable seeing a female physician, but who couldn’t find one. That career-guiding passion helped her establish a practice that’s open and welcoming to patients from a range of backgrounds.
“Any community that feels different from the majority tends to be a little more shy about sharing things that could be on their mind, things that might be bothering them, things they have questions about,” Dr. Venditti says. “These are the patients who are at the highest risk for having problems that go unnoticed, and precisely the patients who need our compassion the most.”
“We have to be comfortable talking to patients about their sexual history, whether they’re gay, lesbian, bisexual or transgender,” Dr. Johnson adds. “We have to be comfortable working with all patients and their sexuality, not just the LGBT community.”
It’s particularly important for LGBT patients to find friendly health care providers because research has shown that encountering an insensitive provider can lead members of the community to simply forego medical care.
“If members of the LGBT community don’t find open and welcoming providers, there’s a real danger they’ll become disengaged,” says Dr. Johnson. “There are health disparities that are prevalent in the LGBT community and avoidance of going to the doctor only serves to perpetuate these differences. When you don’t feel welcome, you don’t want to go back.”
“Disease doesn’t discriminate,” says Dr. Venditti, “neither should we.”
In her work with the LGBT community, Dr. Johnson says she’s found that many members rely on word-of-mouth referrals when they need to find a doctor or specialist. She cautions providers against assuming they’d be able to tell if a patient was lesbian, gay, bisexual, transgender or a member of any other group.
“An estimated 3 to 10 percent of the population is LGBT,” she says. “So if you don’t have 3 to 10 percent of the people seen in your practice identified as LGBT, it’s probably because they’re not telling you. And more importantly, are you asking?”
Even if doctors aren’t sure about their patients’ sexual preferences, there are ways to show they’re open and willing to meet the needs of LGBT community members. Dr. Venditti suggests it can be as subtle as the waiting room reading material.
“I’ve seen different types of reading magazines in the waiting room that are targeted to different communities,” Dr. Venditti says. “You’ll have your standard Vogue magazine and then Out magazine will be put in there as well. When patients see different types of reading material in the waiting room, they may be comforted and feel that the doctor or practice is more open-minded.”
Dr. Johnson encourages providers to post — and be sure everyone in the office follows — a nondiscrimination policy.
“You have to have a no-tolerance policy for homophobia, transphobia or any type of discrimination by your office staff,” she says. “Patients may interact with several people before they ever get to see the doctor, so everybody has to be on board. Your office staff have to be welcoming and you have to be the role model.”
To make sure they’re doing all they can to be LGBT-friendly, doctors may also value in resources from the Gay and Lesbian Medical Association (GLMA), including suggestions like these:
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