Gay, lesbian, bisexual and transgender (GLBT) individuals have unique healthcare access issues. Seeing the doctor can be even more stressful for GLBT patients than it is for the population at large, because there is always the risk that a doctor will be uncomfortable or even hostile toward them because of their sexuality or gender identity. Furthermore, even when a physician is well-meaning, discomfort may affect his or her ability to provide effective care for GLBT patients.
Fortunately, there are some very simple ways that doctors can improve their medical care of GLBT teens and adults, and make their offices into safer spaces for everyone who needs care.
1. Be Aware of Prejudices
Sitting down in a quiet place and making an inventory of their assumptions about GLBT people is a good way for doctors to catch potential biases before they affect patient care. When physicians have certain beliefs about GLBT patients or their relationships, it’s important to make an effort to find out if they’re based on fact. When they have prejudices, they need to examine them carefully and try to see where they come from. While it may not be easy to get rid of prejudices and problematic beliefs, awareness means that doctors can at least make an effort to avoid having them affect their patient care.
2. Ask About Partners, Not Boy/Girlfriends
When a doctor asks a patient whether they have a romantic partner or are romantically involved – rather than saying to men, “Do you have a girlfriend?” or to women, “Do you have a husband?” – it gives these patients a safer space in which to discuss their romantic relationships, including disclosing whether their partner is a person of the same sex.
Similarly, printing intake forms that ask for a patient’s gender with a write-in line, instead of just including check boxes for “male” and “female,” can be more accurate and welcoming for transgender and gender-queer patients.
3. Don’t Assume Who A Patient Is Sleeping With
Just because a patient identifies as a lesbian doesn’t mean she has never slept with a man. Doctors also can’t be certain that a man who identifies as heterosexual has never had sex with another man.
When doctors require an accurate sexual history in order to provide appropriate care, they need to ask about the number of partners a person has had in the past year as well as their gender. The answers may not always be what they expect.
4. Keep In Mind That There Are Infinite Ways For People To Have Sex
Not all gay men have anal sex. Not all lesbians practice fisting. The sex lives of GLBT individuals are, if anything, even more varied than those of their heterosexual, cisgender counterparts. There’s no way to tell what sexual practices a person is engaging in by the gender of their partner.
5. Watch Out for Heterosexism
It’s easy for straight people to assume that heterosexual relationship styles are the norm. However, every relationship is unique, and asking a gay couple “which of you is the man?” is incredibly offensive. Not every relationship can be described by masculine and feminine roles. While some same-sex relationships follow heterosexual scripts, others forge pathways all their own.
This is important because when patients perceive a doctor as homophobic or even simply uncomfortable with their sexuality, they may withhold information that is important to their medical care. For example, when a doctor does a smoking history, if the patient doesn’t smoke, but lives with a same sex partner who does, the patient may not disclose that relationship or mention the risk factor of second-hand smoke.
6. Look Beneath the Surface
Not everyone who looks like a woman was born in a female body. It’s important to keep this in mind, since transgender patients who are on hormones or who have had gender reassignment surgery may not always be comfortable disclosing their full health history. Their gender identity is critical to their self image, and they may not want to discuss health problems that occurred before transition.
That said, respecting the person’s gender identity, and not phrasing questions in a way that disputes it, will make it much easier for the person to disclose For example, if you have questions about what happened before the patient transitioned, ask about it that way rather than saying “back when you were a (wo)man.” People’s gender identity doesn’t change just because they transition their bodies, they transition their bodies to better express their gender identity.
Conversely, it’s also important to realize that a person’s body may not tell the whole story. If a patient identifies as a woman and asks her doctor to use the female pronoun, it is important for that doctor to respect her identity whether or not her body appears to match it. There are many reasons why a transgender patient may have decided not to undergo gender reassignment surgery, or not to undergo it yet. It is a very difficult and personal decision.
7. Be Aware of Special Needs
When doctors have a GLBT patient base, they need to be aware of specific health issues that affect those populations. Lesbians, gay men and transgender individuals may have medical concerns and needs that are different from the needs of heterosexual patients. Doctors need to stay on top of these needs, even if doing so requires additional research.
8. Listen to Patients’ Priorities
A doctor’s expectations of a patient’s healthcare priorities may not reflect the realities of their life. For example, some transgender patients will avoid going to the doctor even when they’re having symptoms of a heart attack, if they fear that the doctor will tell them to stop their hormones. Such concerns can often be managed in a reasonably healthy way, but not if their doctors don’t listen to what they need and want.
9. Treat GLBT Patients Like Other Patients
Much of the time, medical treatment for GLBT individuals isn’t significantly different from that of heterosexual and cisgendered adults. They too have problems with obesity, second-hand smoke and cholesterol. Doctors have to remember not to focus on sexual health just because someone is part of a sexual or gender minority – it may be no greater concern for such a patient than it is for anyone else.
10. Resist the Desire to Label
Just because a woman is in a relationship with another woman doesn’t mean that she identifies as a lesbian. Similarly, a man who was born in a female body may not call himself transgendered or transsexual. These labels can have very powerful meanings to individuals. The patients alone can decide whether they wish to identify themselves with a particular word – or label themselves at all.
In general, it’s best if doctors resist the desire to label their patients as anything other than fellow human beings.
Primary Care Protocol for Transgender Patient Care , Center of Excellence for Transgender Health, University of California, San Francisco, Department of Family and Community Medicine, April 2011
Bernstein A.C. (2000) “Straight Therapists Working with Lesbians and Gays in Family Thearpy” Journal of Marital and Family Therapy 26(4)443-54
Bjorkman R. & Malterud K. (2009) “Lesbian women’s experiences with health care: A qualitative study” Scandinavian Journal of Primary Health Care. 27:238–243