A Prescription for Healthcare Equality

If there's any place where lesbian, gay, bisexual, and transgender people ought to be treated with dignity, it's in their doctor's office, clinic, or the local emergency room. But we all know this still is often not the case.

Fortunately, there have been several recent developments that give us hope for big changes for the health of LGBT patients. A report released weeks ago by the Institutes of Medicine found that there are vast gaps in the existing research into LGBT health and that the challenges LGBT people face in virtually every area of health and mental health must be addressed. The report was quickly followed by a strong set of recommendations from the Department of Health and Human Services. The healthcare world and the federal government are taking some major steps in the right direction. But these kinds of words require action to make any real difference in the health or healthcare experiences of LGBT people.

One example of how this change can work in practice is a new partnership between the National LGBT Cancer Network and New York City's Health and Hospital Corporation -- the largest municipal hospital group in the country, with 39,000 staff. Together, we've created a very real and practical tool to improve the healthcare experiences of LGBT patients.

This month, we are rolling out a program that we hope will be used across the country or simply inspire others to do similar work in their communities. The goal is educating healthcare professionals by telling the stories of LGBT patients and providers, putting a face on these issues, and pairing it with information and simple practical guidelines for increasing cultural competency. This new powerful tool is exactly what the Institutes of Medicine and Health and Human Services were talking about.

But what is all of this really about?

Take the case of Rosemary Lopez, who was visiting Florida with her family when one of her daughters had to be taken to the emergency room. There, the staff were insensitive and vocally expressed their disbelief that a child could have two mothers. Right in front of their daughter. A stressful situation quickly became a traumatic one. This is simply wrong and goes against every principle of healthcare practice.

Rosemary is just one of the voices featured in our video, "To Treat Me, You Have To Know Who I Am." The video is part of the Network's comprehensive new Reexamining LGBT Healthcare program for training medical professionals in working with LGBT patients, developed initially for HHC use. Her story is one of many patients in the video. We also hear from providers about the challenges they face in treating LGBT patients. (You can see an excerpt of the video here.)

And, as I have seen firsthand, this problem isn't always born out of outright bigotry against LGBT people, but rather widespread and pervasive ignorance on the part of medical staff on how to recognize and treat diverse patients. If we don't educate them, who will?

I've trained medical personnel for years, and most of them have their hearts in the right place. But they believe that the best and most respectful approach is to treat all their patients the same. For our community, that axiom hinges on a number of myths: that LGBT patients are responsible for coming out, that they feel safe to come out, and that our health risks and needs are no different from those of non-LGBT people, so that it isn't essential for medical providers to ask about our sexuality. None of these assumptions are fair or accurate.

It is the healthcare provider's responsibility to ensure that patients feel safe to come out. Providers need to be aware of the health risks that are greater for LGBT patients, including chronic health disorders, cancer, HIV, and other STIs. And they absolutely need to know the sexual orientation and gender identity of their patients.

Why? Because it's good clinical practice. If medical providers treat sexual orientation as irrelevant to their patients' health, they have no way of knowing their health risks and the appropriate screenings to recommend. Nor will they be aware of the patient's support system, which determines who should be included in consultations and who will be involved in aftercare. And if patients aren't comfortable discussing the most fundamental aspects of their personal lives, they cannot trust their medical providers and avoid engaging the health care system altogether. This forms the basis of the healthcare disparities that plague the LGBT community.

Finally, if LGBT patients are made to feel stigmatized, as they often already are in society, that stigma poses significant health risks. There is a strong correlation between stigmatization and rates of alcohol use, tobacco use, drug use, mental health problems, and other issues.

So rather than following the Golden Rule, I suggest that medical providers follow what has been called the "Platinum Rule": Treat patients as they want to be treated. This means learning and respecting whatever language they use for their partners and body parts. It means asking the questions that need to be asked, even if the provider feels awkward at first, and not being afraid to hear the answers. This enhances care rather than damaging it, as in Rosemary's case.

The Department of Health and Human Services made clear in its recent set of recommendations for LGBT healthcare that this lack of cultural competence in the medical field is a critical problem that must be solved. The well-meaning approach of ostensibly "treating all people the same" has led to invisibility, disregard for our families, and, worse, inadequate health care for LGBT people everywhere. In order to combat the health disparities in our community, we need to be respectfully and safely invited to bring our whole selves into the healthcare setting, including our gender identity and sexual orientation. We are proud to have helped the NYC Health and Hospital Corporation take the lead in working towards these important changes.

For more information, go to www.cancer-network.org