This past week would have been the Pride March in New York City!

This has gotten me thinking about the care we provide to LGBTQ+ patients. The truth is, we have very little formal training in the care of these patients. And, they are often highly underrepresented in traditional academic studies.

Here are a few barriers I see:

Discrimination

According to a poll conducted by Harvard’s School of Public Health:

• 57% of LGBTQ adults reported that discrimination is a consistent feature in their daily lives.

• 51% reported experiencing violence.

• 57% reported being victims of anti-LGBTQ slurs, and 53% reported offensive comments.

• Even within this community, there were further health disparities based on race.

According to the US Transgender Survey (USTS) conducted in 2015, 33% of those surveyed reported being either harrassed or refused treatment by a healthcare provider.

Discrimination, in fact, is a social determinant of health.

Access to Care

If you don’t feel comfortable and safe going to your doctor or hospital, you won’t go. If you feel discriminated against, belittled, or abused, you are unlikely to ever go back.

This discrimination (or fear of discrimination) may deter LGBTQ+ individuals from seeking timely and high quality health care. This can result in inadequate preventative care, poor management of chronic conditions, delayed treatments, and ultimately worse health outcomes.

If fear of seeking care delays diagnoses such as hypertension, hyperlipidemia, or diabetes, this could present unexpectedly later as a heart attack or stroke. It is imperative that we as healthcare workers create warm, accepting care environments.

Lack of Data

There is a lack of large scale high quality data pertaining to the health outcomes of LGBTQ+ patients. Or frequently, the data on gender identity and orientation is not collected during a study.

The PRIDE study is the first longitudinal study of LGBTQ+ individuals addressing physical, mental, and social health. Hopefully in the coming years this data will assist us in understanding the specific health trends within these communities and more sophisticated, sensitive ways to treat these patients.

From a healthcare worker perspective, it is important to note that this is a heterogenous patient population, with individualized care needs. As always, we must understand our patient’s specific healthcare needs and fears.

Lack of Training

Despite a focus on diversity and inclusion during training, the majority of physicians I know do not feel well equipped to take care of LGBTQ+ patients. Gender/sexual minority training has not historically been part of standard medical training.

LGBTQ+ patients are more likely to suffer poor physical and mental health outcomes. Yet numerous studies have shown that medical students have significant knowledge deficits pertaining to this population. Fortunately, this seems to be changing, and medical school curricula are now becoming more inclusive of LGBTQ+ health.

UCSF, for example, incorporated LGBTQ+ health into their second year medical school curriculum with dedicated sessions, with readings, lectures, patient panels, and small group discussions. And many other medical schools have followed suit and have infused this topic into their existing curricula. For those of us who are already practicing, there are a number of resources available at Stanford, AMA, and AAFP.

Medicine is a “forever learning” career, and hopefully in the upcoming years, we can elucidate the specific health needs and improve care for individuals within the LGBTQ+ community.