Op-Ed: Better LGBT Health Starts With a Conversation 

During the past several years I have given many talks at medical schools, nursing schools, and hospitals on how to end LGBT invisibility in health care, LGBT people often do not overtly demonstrate their sexuality and are reluctant to volunteer the information unless they feel it's a safe enough clinical environment.

I generally begin my sessions by asking attendees if they have ever had a physician take a sexual history, and if they have ever been asked about their sexual orientation or gender identity. Generally the first question elicits positive responses from up to 10% of those attending, and the second question elicits a positive response from a few at most. That rate is consistent with studies, albeit the number of these studies has been few, and the numbers studied relatively small. A CDC report recently quoted a study by the Institute of Medicine: "Ironically, it may require greater intimacy to discuss sex than to engage in it."

In order to begin enhancing the value of prevention and care we provide to LGBT people, it is vital to speak frankly with patients about issues related to sexual identity, behavior and desire, and to be prepared to offer non-judgmental, appropriate, and informed advice. Last week the United States Health Resources and Services Administration of the Department of Health and Human Services awarded The Fenway Institute a grant to create a national LGBT health technical assistance and training center for community health centers. The multi-year, almost $900,000 grant will allow Fenway to train health center providers, administrators and staff in how to better serve and care for LGBT patients. Drawing on material from The Fenway Guide to LGBT Health, this program will seek to train clinicians across the country so that all LGBT people will have access to quality care provided in a welcoming environment. Our hope is that this program becomes an example used by others to teach their colleagues and themselves how to end health disparities for all and ensure that health care is a human right.

While medical technology can take us to great heights, and we spend billions of dollars learning about intricate manipulations of the human genome to cure disease, education of health professionals often avoids some of the simpler skills that can be employed to help keep people healthy.

Several recent reports on health disparities among LGBT people and the necessity for more research on their health care needs, have come from prominent sources such as the Institute of Medicine of the National Academy of Sciences in Washington, D.C. and Healthy People 2020 from the U,S, surgeon general . But beyond the needs for more research, there is a pressing need for clinicians to address known disparities and their impact on the health of sexual minorities. Morbidity from STI's, HIV and behavioral health issues remain alarmingly high and cannot be ignored.

It is incumbent upon clinicians to understand the unique health issues that affect LGBT patients and clients and work with them to help address these issues and live healthy lives. As researchers and clinicians learn more about LGBT people and their cultural diversity, it has become clear there is not a "one size fits all" approach to how any given individual may think about or express their sexual identity, desires, and behavior. Evidence suggests that many do want to discuss their sexual orientation with their physician but don't always feel they have an opportunity, and clinicians may not respond when such personal information is volunteered. At this point, most would find it odd if our doctor did not ask about smoking or exercise, so one might ask what it means to patients if physicians never even ask patients about their sexual identity and desires or discuss issues related to avoiding risk of HIV and STI's as well as encouraging resilience and discussing ways to live feeling healthy and fulfilled. Such discussions can begin and progress from a simple non-judgmental open-ended question like, "tell me about yourself, what you do, and those with whom you are close."

Unfortunately, despite the fact that the latest Census demonstrates that same-sex couples and their families are well distributed across the county, many clinicians say the health of LGBT people is not a concern to them as they have no such patients in their practice. The facts tell a different story, and we will succeed only when clinicians recognize that regardless of where they practice, they will be seeing LGBT people as patients -- even though they may not immediately identify as such.

Harvey Makadon, MD, is the director of Professional Education and Training for The Fenway Institute.