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Breaking Down Barriers to Healthcare for the LGBTQ+ Community

A Practitioner’s Perspective

Jennifer Sugden, ND

It will come as no surprise that healthcare disparities among the LGBTQ+ community are unfortunately well-documented, and they have some pretty profound implications for this community’s health and well-being.

As a healthcare provider, I feel it is our responsibility to educate ourselves, recognize, and address the barriers that prevent LGBTQ+ individuals from accessing the quality healthcare services they deserve.

There are simple strategies that practitioners can use to break down the barriers, promote inclusivity, equity, and ultimately improve health outcomes for everyone.

In working with chronic complex illness for the last 15 years, there is often a trigger, be it hormones, big life changes, surgeries, emotional distress, just to name a few. Many LGBTQ+ patients have worked very hard to find the right PCP and specialist for their specific healthcare needs and now are faced with a chronic, sometimes unlabeled, illness that requires yet another specialist to help them through it. Due to the unique life circumstances and medical insults they have faced in the past they may come into the clinic with their guard already up.

This is true for any patient with a chronic complex illness honestly. Many of my patients have seen 20+ doctors with no answers and have been told it’s all in their head. This experience is magnified even further for the LGBTQ+ community. We, as practitioners, need to be more sensitive to their needs that are unique to them. This frustrating process can be further complicated if the trigger to the chronic complex illness was hormonally related.

Imagine if the very thing that finally began the journey to becoming your true self set off a cascade of events that has left you with reactivated infection, chronic fatigue, mast cell activation, joint pain, or an array of other symptoms. It can feel incredibly unfair.

As with any patient, a detailed history is key.

Treatment starts with a good detailed history as we would with any chronic case. Trying to put all the puzzle pieces together, and understanding the cascade of events that broke it apart to begin with. As with any patient that is seen, honesty between the provider and patient is key. There is no subject that should be taboo or difficult to discuss with a patient. However, often the first mistake we make as practitioners is avoidance of certain subject matters within the case, and this can have serious implications for our patients’ healthcare needs.

Do not assume. Simply ask.

For example, if you have a transgender male as a patient, AFAB (Assigned female at birth), at some point in the intake there needs to be a discussion on their last gynecological exam or if they have already had gender-affirming surgery. This is an example of “first-do-no-harm” and can be and should be something that is visited within the discussion for the whole health of any patient.

With every patient, at some point in the initial intake find a comfortable time to ask about sexual preferences, habits, or lack thereof. This is important because your perception of a patient’s sexual habits may not be as they appear on the surface. It is a question that allows us to understand a patient’s risk factors and to be able to give them the best healthcare possible.

If you do not know, you cannot help, and you certainly cannot prevent future disease.

Let’s not forget mental health!

LGBTQ+ individuals are at higher risk of experiencing mental issues due to stigma, discrimination, and social isolation. Again don’t be afraid to broach this subject, talking about and discussing suicidal thoughts does not create suicide attempts. If you have a patient admitting suicidal ideations, you need to discuss access to guns and pills in the home. Come up with a plan and have a list of resources and options for these patients to support them through this crisis. By addressing mental health needs we can help patients cope with stressors and improve their quality of life.

This is especially true in our younger patients who may be struggling with gender identity and acceptance within their family unit. According to research by The Trevor Project, “While little research has specifically examined gender identity outness, outness of ones’ LGBTQ+ identity more broadly is associated with mixed mental health outcomes among young people. Sexual orientation outness is associated with high levels of suicide risk among LGBTQ+ young people.”

Education and awareness are absolute game-changers.

When it comes to addressing misconceptions and biases surrounding LGBTQ+ health, we can do better to educate ourselves and our colleagues about LGBTQ+ health disparities, cultural competence, and best practices for providing inclusive care.

Hopefully this will spark some good conversations within your clinic and with all of your patients. Getting familiar with the right terminology, understanding the unique healthcare needs for LGBTQ+ individuals and providing care that’s respectful and affirming. Plus, raising awareness among the general public can help reduce the stigma and discrimination, fostering acceptance and support for the LGBTQ+ community.

RESOURCES

If you are thinking about harming yourself
Get immediate 24/7 crisis support via text, chat, or phone. The Trevor Project is 100% confidential and 100% free.

Explore the research on this topic: https://www.thetrevorproject.org/research/

Educational resources for allies of LGBTQ+ individuals:
https://www.thetrevorproject.org/public-education/
https://pflag.org/find-resources/

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