LGBTQ+ Inclusion in Health Care Goes Beyond Non-Discrimination.

Last year during Pride month, President Trump issued a rule that took away health protections for transgender people, which were previously included in the Affordable Care Act. That rule essentially allowed health care providers to deny services to transgender individuals, solely based on the fact that they are transgender.  In May of 2021, President Biden reversed that policy. While the policy reversal is certainly a victory, it is the responsibility of health care providers not only to accept this policy but to implement the policy in their practice and provoke real change for the LGBTQ+ community in health care.  Further, discrimination cannot simply be defined as refusing to treat LGBTQ+ patients— discrimination also involves doctors being visibly uncomfortable around patients due to their gender identity, misgendering patients, and not having knowledge on the LGBTQ+ community and their health needs (American Progress Center). Health care providers need to remove all discriminatory practices from their office space. What exactly does that mean? Health disparities, as defined by the CDC, are “preventable differences in the burden of disease, injury, violence, or opportunities to reach your best health that are experienced by socially disadvantaged populations.” The LGBTQ+ community faces many health disparities, including higher rates of mental health conditions, obesity, eating disorders, sexually transmitted infections, substance use and abuse, breast cancer, cervical cancer, and heart disease.  The LGBTQ+ community has also been disproportionately impacted by the COVID-19 pandemic. According to the Kaiser Family Foundation, “Three-fourths of LGBT people (74%) say worry and stress from the pandemic has had a negative impact on their mental health, compared to 49% of those who are not LGBT.” This Pride month, coming off of an incredibly difficult year, it is imperative for health care providers to support the needs of their LGBTQ+ patients.  According to the American Progress Center, “More than 10% of LGBTQ Americans faced mistreatment by a health care provider.” The same study shows that “Thirty-eight percent of transgender Americans said that their doctors or other providers have been visibly uncomfortable with them because of their gender identity.”  A doctor’s office should be a safe place for patients to communicate with their health care providers— especially for transgender individuals who face health disparities and unique health challenges.  Health care discrimination can lead to worse outcomes for patients. Aside from receiving insufficient medical care, discrimination in the health care setting may lead LGBTQ+ patients to delay care, avoid preventative screenings, or not seek out treatment at all.  There needs to be clear communication of acceptance in doctor’s offices, whether through face-to-face conversations, signage, office policies, or inclusive language on medical forms. Health care provider organizations also should require training for staff members on the unique medical needs of the LGBTQ+ community, and the use of inclusive language when speaking with patients. A study from the American Progress Center also showed that “Sixty-eight percent of LGBTQ respondents said that it is very important to them that health care providers they see have nondiscrimination policies and specific training in working with LGBTQ people.” Acceptance of the LGBTQ+ community in the health care setting needs to be communicated throughout the entire space, and it needs to be incredibly clear to patients.  All of this is to say that Biden’s policy needs to extend beyond doctors and other health care providers merely “not discriminating against” LGBTQ+ patients. It even needs to extend beyond health care providers accepting LGBTQ patients. LGBTQ+ patients shouldn’t just feel like they are allowed in a doctor’s office. This policy calls for the implementation of proper communication to ensure patients feel completely safe, welcomed, and supported by their health care providers. They need to feel fully confident that their health care providers will listen to them and understand their unique needs. There needs to be a change in the entire culture, and that requires care and effort on the part of providers and everyone hoping to make a difference.  Our health systems must move beyond the current conception of equitable treatment for LGBTQ+ patients (non-discrimination) and toward a model that embraces the unique needs of the community. It is the responsibility of all health care professionals to implement practices that support and improve the health of the LGBTQ+ community.  Further, it’s up to all of us — not just health care providers — to talk about and advocate for these changes. The next time you’re in a doctor’s office, look out for some of these discriminatory practices. You can suggest that your doctor change the language on intake forms to be more inclusive, or that the office have gender-neutral bathrooms. These small changes can have a big impact, and speaking up could be the difference in a patient’s experience. If you haven’t already, Pride month is a great time to start advocating for change.