The need for LGBT-friendly healthcare is clear and urgent. Dr. Evan Goldstein, Founder and CEO of Bespoke Surgical, explains how providers can ensure their practices meet the specific needs of a diverse LGBTQ population and become better LGBT-friendly doctors.

“Love and compassion are necessities, not luxuries. Without them, humanity cannot survive.”
—Dalai Lama XIV

Let’s face it: the desire for nonjudgmental, thoughtful communication that fosters open and honest deliverance of healthcare is not specific to the LGBT community. It’s a basic human need — a right — and yet there is a clear and continued divide as to how it is orchestrated and executed.

When you analyze any subset or community, the patients within not only demand a basic
understanding of their values and ethics, but also tend to surround themselves with others like them. This is purely second nature, and it’s comforting. For that reason, it’s essential for medical providers to understand the intricacies and nuances of gender, sex, and all aspects of sexual relationships — so that every patient, especially those in the LGBT community, feels comfortable and understood.

Where to Begin: Subject Matter Expertise

Asking the right questions, spending quality and well-deserved time immersed in the subject matter, and leading the discussion with a high-level awareness of continued sensitivity is crucial to properly caring for LGBT patients. In a recent survey, 80 percent of healthcare providers said they felt uncomfortable asking a patient about their sexual orientation, but only 10 percent of LGBTQ patients said they would choose not to disclose it.

Specifically, it’s imperative for physicians and specialists to have an understanding of:

  • The myriad types of relationships and the inherent risks of each, i.e. polyamory and open relationships.
  • The best methods to approach safe sexual encounters of all kinds:
    • STI prevention, screening, and treatment for all patients
    • The intricacies of anal intercourse and how to minimize injury or harm
    • Utilization and management of PrEP, along with a diverse knowledge of its appropriate use cases
  • The intricacies related to gender transition:
    • Transgender identities
    • Hormone replacement therapy
    • Gender-affirmation surgery
    • Use of anatomic inventory to ensure appropriate screening tests
  • The unique mental health risks of LBGTQ patients
    • Depression
    • Suicidal thoughts
    • Substance abuse

A clear conception of these topics (among others) leads to a coherent and expansive discussion when caring for LGBT patients. And yet, these are just a few of the important sensitivities and just some of the niche knowledge that is necessary in order to serve the LGBTQ community’s needs to the fullest.

Cultivating Patient Empathy when Caring for LGBT Patients

Since this is an ever evolving and changing field, the commitment to constant re-evaluation and education on all levels is imperative. You can’t provide sensitive care without making your share of mistakes, but analyzing knowledge gaps and addressing the issues that cause them allows for the human side of the elevated doctor-patient relationship to develop. Studies have long linked physician empathy to greater patient satisfaction, better outcomes, decreased physician burnout, and a lower risk of malpractice suits and errors. So how can we cultivate empathy in the exam room? When caring for LGBT patients, don’t be afraid to respectfully ask questions, request feedback, communicate clearly and honestly, and make a concerted effort to fill gaps in your own experience. Consider that many LGBT patients have experienced healthcare discrimination and may approach a doctor’s visit with hesitation.

Accommodating Cost Barriers

High-quality care paired with thoughtful patient communication often equals elevated costs. But with decreasing levels of insurance, the potential repeal of the Affordable Care Act, and the loss of government funding, how does one continue to provide much-needed services to the LGBTQ community?

When you deliver care using a volume-based model, that delivery becomes clinic-oriented, including single-pathology office visits that only allow for a snippet of time and corrective, mostly reactive planning. Inside the operations of these clinics, there are a huge number of moving parts. That’s a big problem, because the more parts involved, the more errors; the more errors, the more patients who come to receive subordinate care. How can providers do what’s practical while still adhering to the aforementioned model of quality care — the one that hits all the marks?

The fact is that only a small subset of people can actually afford that model. It is, of course, the standard of care that everyone desires and deserves, but current political and socioeconomic realities leave us subject to ongoing affordability issues and the argument of class wars.

It begs the question: Can you deliver appropriate, elevated community care at all levels with the sensitivities and understanding we all need? It’s a question that still needs answering, but education continues to be of utmost importance to everyone involved in delivering healthcare, and it’s imperative that it go further than just the provider.

Starting with Sensitivity

We talk so much about these sensitivities, but it needs to be understood that the process of providing care starts from the second someone attempts to make an appointment with the receptionist, to the way they are greeted and addressed when arriving at the office, to the time they receive their test results or diagnosis.

To that end, being sensitive to and understanding of all the LGBT community has to offer doesn’t have to be based on monetary value. Setting the appropriate tone of mutual respect with complete understanding allows for comfortable communications to be fostered. With comfort comes honesty and with honesty comes respect and positive change. There needs to be a clear line delineated between sensitive and community-specific care, with all providers and physicians developing a greater awareness and becoming more educated in order to offer the best care — not just in major cities, but everywhere in the U.S. We need that more than ever in this unforgiving chapter in the history of American healthcare.

Change starts now. It starts with us.


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