Anna Chiara Corriero
Anglia Ruskin Medical School
Being out and proud is hard. Despite the efforts made from the UK government such as anti-discrimination laws and same-sex marriage laws, negative attitudes towards LGBT people still exists (1). This makes it hard to live life as oneself for many people that do not feel safe enough to come out, possibly due to religious or cultural reasons. Alongside racist and islamophobic hate crimes, which have increased massively in numbers over the last few years, homophobic and transphobic attacks have also increased dramatically, reaching a 147% increase in 2016 (2).
LGBTQ+ people do not feel safe in the streets, they are scared of holding hands, face bullying at school (3), and are afraid to come out at work (4). Many might also be scared of attending the doctor’s practice or the hospital, due to fear of discrimination, even if inadvertent and many report that they feel that the specific needs of LGBTQ+ patients are often overlooked when providing healthcare (5), particularly for what concerns mental and sexual health services (6). However, healthcare professionals have a duty to care for all patients and make their practice as inclusive and welcoming as possible for everyone. Often it is believe that healthcare professionals should carry out this duty of care even more when looking after patients belonging to minority groups, as they are bound to suffer relatively more psychologically. So, what can we do to care for LGBTQ+ patients as well as possible?
1) Educate ourselves: Stonewall has reported that the needs of LGBTQ+ patients are often overlooked and unmet (5) and this is possibly due to the lack of knowledge of the above mentioned needs. Educating ourselves by reading books and guidance, as well as listening to podcasts are all valuable options that we can choose to enhance our understanding of the varied LGBTQ+ needs; having a good grasp of laws and policies and of words and definitions, including the difference between sex and gender and terms such as “gender transition” or “sexual orientation” can really make a difference to a patient. With better education, healthcare professionals will be able to provide care that is better tailored for LGBTQ+ patients.
2) Create an inclusive environment: the aforementioned Stonewall report states that Lesbian and bisexual women are twice as likely to never have attended their cervical smear test to screen for cervical cancers, compared to heterosexual women. The same report also states that half of lesbian and bisexual women are also not out to their General Practitioner; LGBTQ+ women are more likely to harm themselves compared to the general population and 3% of gay men are reported to have attempted to take their lives every year (5).
Having posters up the practice’s or clinic walls with rainbow flags and accepting slogans can be small visual cues that reassure LGBTQ+ patients that they will not be treated differently for who they are. You can also conduct patients experience surveys and audit policies to understand the impact they have on your LGBTQ+ patients (5). This will overall ensure that you are promoting health and healthy behaviour in your patients, as they will be encouraged to attend clinics and hospitals more (5), if they feel safe.
3) Never assume (7): if in doubt, or if you do not know the patients, when opening a consultation or taking a history, alongside patient’s name and date of brith, you can confirm their preferred pronouns. Never assume how they identify or the gender of their partner, as this can make patients feel very uncomfortable and lead them to avoid seeking hep when in need.
For example, when asking about their sexual and reproductive history, you can always ask patients if they are having sex with a sperm-producing partner, rather than with a man, as not all men produce sperm and not all sperm-producing people are men!
4) Validating people’s experiences and perceptions: ask the questions you would ask to any patient (7) and do not express any views that could be conflicting to those of your patients. After all, the General Medical Council reports that doctors “must not unfairly discriminate against patients or colleagues by allowing their personal views to affect their professional relationships or the treatment they provide or arrange” (8). This is true for all healthcare professionals and is only in line with the ethical principles of beneficence, non-maleficence, and justice.
5) Remember to build a rapport of confidence and trust: this is based on ensuring confidentiality, something that many LGBTQ+ fear might be broken when they come out to their doctors (5), as well as being comfortable with asking questions and receiving any type of answer from our patients, regarding their gender identify, orientation, and much more. Trust will be built if you educate yourself, create an inclusive environment, if you never assume, and you validate people’s experience and perceptions. All of these small actions will mean a lot for your patients who will not only feel more comfortable attending your practice, but they will also feel more understood and welcome.
6) Lastly, but probably most importantly, if you make a mistake, apologise, learn, and move on. However, do not over-apologise, as that can make somebody quite uncomfortable!
For many sociological reasons, LGTBQ+ individuals have faced adversities in every aspect of life, even with regards to medicine and their doctor-patient relationship. Meeting every patient’s demands and needs should be the utmost goal for physicians, and this can be done through empathizing with this group of people, learning, and establishing a healthy dynamic. With respect, education and inclusivity, you will be able to make such a difference when caring for LGBTQ+ patients, and they will appreciate that their physician has taken the next step in order for them to be treated equally. Remember that we never stop learning, there will always be an oppressed or marginalized group that needs understanding, support, and care, and as physicians, inclusivity and care for all comes above all else.
Sources
(6) https://www.bmj.com/content/366/bmj.l5374
(8)https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/domain-4---maintaining-trust#paragraph-56