Closets Are For Clothes
It’s National Coming Out Day today, and in celebration I thought I’d post some tips and guidelines on how to make yours a LGBT-friendly practice, since the AMA believes that “the physician’s nonjudgmental recognition of sexual orientation and behavior enhances the ability to render optimal patient care in health as well as in illness.” (Note: most of these tips are taken from The ABCs of Sexual Health, in the BMJ, and Creating a Safe Clinical Environment for Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Patients, an excellent guide (pdf) free from GLMA.) These are not monumental, folks. It’s the little stuff that counts. Trust me.
Above all, listen, don’t make assumptions, and always be respectful.
Creating a Welcoming Environment:
- Lesbian, gay, bisexual, transgender, and intersex (LGBTI) patients often “scan” an office for clues to help them determine what information they feel comfortable sharing with their health care provider.
- Post a visible non-descrimination policy.
- Put up a small rainbow or pink triangle. (I know, I hate them too, but seriously, a little goes a long way for LGBT patients.)
- On the intake form, try “partner” instead of “spouse.” And include choices on the “Sex” category besides just “M” and “F.”
On Interviewing:
- Try using gender-neutral words. “Are you currently in a relationship?” as opposed to “Are you married?”
- “Do you have a girlfriend or a boyfriend?”
- “Is there another parent?” as opposed to “Is there a father?”
- If a patient comes out to you, recognize that you are glad they felt comfortable mentioning it, and that it’s not an easy thing to do.
- Assess how the process is going–you may be the first person they’ve ever told.
- Again, listen. Follow the patient’s lead.
- Ask about sexual history honestly and openly. If you’re unsure on what or how to ask, try to let the patient explain–and let them know about your ignorance.
- Just because someone is in a same-sex relationship doesn’t mean violence doesn’t happen.
On Counseling:
- Be honest with yourself; if you are uncomfortable with gay people refer the patient to someone else.
- If an adolescent is confused about his or her sexuality try to help the patient to adjust.
- Do not have preconceived ideas.
- If you don’t know the answer to a question, find out for the patient.
- Know what LGBT resources are available in your area.
If you have questions or comments, please post them here; it’d be great to have an open forum to figure these issues out if you’re unsure about them.
Update: Two more great resources from AMSA: Do Ask, Do Tell, and the June 2001 issues of the AJPH.
Good job, Graham. It looks simple and to the point. If you’d like I also have some info on LGBTI health on a CD, I just need to find it. Hope medical school is coming along; we’re doing anatomy now.
Is there another parent?
“What? Two aren’t enough, already????”
This is great. Happy National Coming Out Day!
Pretty good, but hmm, not sure about the referral process. Referrals should be made on medical issues (opthalmology exam, pap smear, colonoscopy, etc.), not because the provider is uncomfortable. You don’t make referrals to someone based on their race, gender, religion, etc. unless the _patient_ feels uncomfortable and prefers a different provider, not because the _provider_ feels uncomfortable. Similarly I think referral should not be made on the basis of sexual orientation just because the provider feels uncomfortable, unless the patient prefers it. Doctors take CME courses and go to conferences to better their knowledge about health care for ethnic minorities; they should do the same for LGBT health care rather than stay uncomfortable.
I agree Peter–and I was kind of surprised to find that suggestion in the BMJ article. While I’d prefer that doctors just get over themselves and their prejudices, I think I’d rather have LGBT patients with someone open-minded than close-minded and forcing it. But again, I’m conflicted.
good article – the transsexual patient presents an even more challenging “syntactical” dilemma. I got into trouble once b/c I didn’t think to offer “her” a mammogram at a routine physical.
If you’re going to consider modifying the traditional “M” / “F” options for sex on the intake form, can I add something else for consideration? I’d like a place to indicate I’m adopted. Oftentimes there are questions about family history. I’m more than willing to answer those questions, but if the caregiver is trying to assess for familial trends (i.e. genetics), he needs to know I’m adopted.
Although I don’t have any statistics to back me up, I’m guessing there are more people who will check off “Adopted” than those who will have problems with “M/F” for sex. Please don’t misunderstand me, I’m just advocating for my situation; I’m not trying to detract from the discussion at hand.
That’s an excellent idea, Brent.