The Need for More Inclusive Healthcare
This is going to be a lengthy one. So sit down, strap in, and read carefully.
It took me having to experience it myself (during my transition from female to male) to recognize that there is a major problem with our healthcare system with regards to the treatment and care of members of the LGBTQ community — particularly transgender and gender non-conforming individuals.
From the patient intake forms to the office staff to nurses and doctors, a safe and inclusive healthcare environment should be top of mind for everyone — and it hasn’t been for the LGBTQ community for a very long time. To put it bluntly, they are mostly ignored by modern medicine. That desperately needs to change. Members of the LGBTQ community face many barriers in the healthcare system — from intake forms with non-inclusive language to challenges finding knowledgeable providers who genuinely care about their healthcare needs.
The act of simply going to the doctor can be nerve-wracking for anyone. It can be a very stressful experience for most people — but LGBTQ patients often experience additional stress and fear. According to a recent article from Health Nexus, a survey of more than 27,000 transgender people showed that 33% reported having at least one negative experience with a healthcare provider related to their gender identity, which included having to actually educate the provider about being transgender. Most nurses and doctors do not have the proper training to fully understand what it means to be transgender or non-binary.
This recent BBC Article provides a detailed experience of Cameron Whitley, his need for a kidney transplant, and the terrible experience he had — which could have been prevented. Though this took place in the UK, similar experiences happen around the world all the time.
Though I won’t address all of the challenges here, I do want to cover some of the more significant ones. Let’s start with patient intake forms.
Here is an example of a good New Patient Intake Form. Notice the section under “Sexuality/Gender Identity”. Some healthcare facilities are getting it right — or at least trying.
I absolutely love this Intake From Best Practices for LGBTQ Patients from the University of Colorado Anschutz Medical Campus.
Unfortunately, the vast majority of patient intake forms look something like this:
The way gender, sexuality, and relationships are treated on the forms patients are asked to complete is critical to a patient getting the very best care. The easier it is for LGBTQ patients to complete the forms with answers that truly reflect who they are, the better they will feel and the more likely they will be to provide complete and accurate information.
With regards to gender, many forms offer only two options: male and female. There are many people for whom neither of these options is accurate. Individuals who identify as transgender, genderqueer, etc. may find that neither of these options really applies. Some transgender individuals may choose the gender with which they currently identify, without indicating that this does not correspond to the sex they were assigned at birth.
Every patient intake form should include detailed sections for:
- Gender Identity
- Sex
- Pronouns
- Sexual Orientation
- Sexual Behavior/Activity
- Relationship Status
Let’s talk about bias and discrimination and how members of the LGBTQ community are often treated when trying to get necessary medical care. No matter how much education and training is provided, nothing is going to change if medical providers continue to employ and ignore the behavior of those who treat members of the LGBTQ community as less than or second-class citizens. How people are treated when seeking medical advice and treatment is of the utmost importance.
Every employee should be aware of the inclusive policy. You know…the one that goes a little something like “Equal care will be provided to all patients, regardless of age, race, ethnicity, physical ability or attributes, religion, sexual orientation, gender identity or gender expression.” Every medical facility should have one, but more importantly, every member of their staff should be in 100% agreement with it and treat LGBTQ patients with genuine care and compassion. Unfortunately, that is often not the case.
Making a point of sharing this policy with staff and patients is critical. This makes it clear that a medical provider wants LGBTQ patients (and all patients) to feel comfortable and expects them to be treated with respect and courtesy. Including a non-discrimination policy in promotional literature and advertising also helps prospective patients feel comfortable and welcome.
Want to know more about this topic? Take a moment to read How Bias May Affect Providers’ Knowledge of Transgender Health.
I also want to touch on the importance of “what people see”. There is a major lack of inclusivity in medical offices. No one should feel uncomfortable or unsafe going into a restroom to do what comes naturally to every human being. Something as simple as single-stall bathrooms marked as gender-neutral help to make transgender and non-binary patients feel more comfortable and safe.
If a medical practice is truly welcoming and inclusive, it should “advertise” it on their website, in their offices, in pamphlets, etc. I can’t tell you how difficult it was for me to find a trans-friendly primary healthcare provider, a female-to-male top surgeon, and a trans-friendly physical therapist. It was literally equal to searching for a needle in a haystack. Wanna know how many plastic surgeons specializing in transgender surgeries are located within 4 hours of my home? Two! And neither of them accept insurance. Oh…and I could go on and on about health insurance providers and the changes that need to be made. Wow! That would have to be a separate article.
Because many LGBTQ people have experienced rejection and stigmatization, they are often sensitive to subtle signs in the environment that can be interpreted as indications of whether they will are welcomed or not. Making a few simple adjustments can communicate to LGBTQ patients that they are welcome and safe.
Last but not least, medical providers need much more education and training — and more research needs to be done. For example, most doctors have no idea how hormone therapy affects the risk of disease in transgender patients. For example, long-term exposure to hormone therapy can increase the risk of cancer. Currently, there are no standardized cancer screening guidelines for transgender patients. Proper guidelines need to be established. And then this information needs to be shared with medical providers and patients to make sure there is clear messaging.
Disparities affecting the LBGTQ community are complex. They intersect with race, ethnicity, age, and gender. A staggering 70% of trans and gender non-conforming people reporting experiences with discrimination in care, such as being refused necessary care. And despite being at higher risk for HIV, 56% of gay and bisexual men say that a doctor has never recommended they get tested for HIV.
It is 2021. This is just a small number of the issues that the LGBTQ community still face when it comes to healthcare. Healthcare isn’t the only challenge that we face on a regular basis. BUT it is one of the major ones…considering it can be the difference between treatment or constant illness and/or pain…and sometimes the difference between life and death.
As a trans man who has:
- Been on testosterone since March of 2020
- Had female-to-male top surgery in September
- Recently changed primary healthcare providers
I am happy to speak with any medical provider who wants to have a serious discussion about this. I’m happy to share my experience and recommendations. Feel free to also read my blog, where I have tracked my journey since I started my transition last year. Disclaimer: there are pictures on my blog that some may find difficult to look at. I questioned whether to even share my blog, as it is very personal. But it has helped quite a few people in their own journeys. And if it helps others, that’s all that matters.
“Openness may not completely disarm prejudice, but it’s a good place to start.”
#Transgender #LGBTQ #Doctors #Nurses #Medical #Healthcare #Diversity #Inclusion #Belonging #Bias #Discrimination #Equality
