Forty years? and not much progress: LGBTQ healthcare options lag

Oct 24, 2018 at 11:12 am

Do a Google search for “LGBTQ-friendly health care providers,” and you’ll find page upon page of organizations, lists and databases devoted to making sure the queer community is able to locate a provider educated on and open to meeting our needs. What a time to be alive!

But not so fast.

If you live in the U.S., it’s likely you don’t have the luxury of shopping around for a doctor or therapist. Even the good health insurance leaves many of us with a sizable copay and limits on which doctors we can visit. In other words, unless we can afford to pay out-of-pocket, we can only cross our fingers that one of those LGBTQ-friendly providers is in our network.

Why is it important for providers to be LGBTQ-friendly?

For one thing, it helps avoid situations like the one I found myself in several years ago when I visited a new doctor.

During intake, the nurse asked if I was sexually active (I was). When she asked what I use for birth control and I said “nothing,” she was horrified by my negligence. Her next question was, of course, about how I expected to avoid pregnancy, but I didn’t want to explain that my girlfriend couldn’t impregnate me, so I sat in silent panic — not because I’m in the closet, but because a healthcare provider who doesn’t expect lesbians to exist has no business treating one.

Had this provider, part of a well-known network, really never treated a queer patient before? How was the onus on me to educate her and come out in the most awkward way possible? Granted, it was Hardin County, a place where Good Gays remain semi-closeted their entire lives to avoid inconveniencing anyone.

The problem with that dynamic is that it allows practices to believe they don’t need to learn about LGBTQ care because it seemingly doesn’t apply to their patients. And the information is out there for providers who care to look. I spoke with Dr. Ryan Combs, an assistant professor in Health Promotion and Behavioral Sciences at UofL, and he explained that there has never been so much information available for providers who care to look for it. Researchers have been studying LGBTQ health for many years, including a 2011 report by the Institute of Medicine, which showed LGBTQ health disparities.

Best practice recommendations focus on how to address patients, how to talk about sexual orientation and gender identity and how to make patients feel more comfortable in the clinical environment, Combs said. “Other best practices cover clinical skills. When providers understand more about LGBTQ health disparities, they can screen their patients much better. This leads to earlier detection of health concerns and translates into better health outcomes.”

So, why don’t practitioners take advantage of all this information?

“Homophobic and transphobic bias can certainly be an issue,” Combs said, adding that a large, national survey showed that a third of transgender people had at least one negative experience in the previous year.

For providers who want to be allies, they may be unfamiliar with the LGBTQ community and afraid of making mistakes, Combs said. “For example, I have heard that some providers worry about fumbling over language. It takes time and energy to build competence. LGBTQ patients are an astute group and can tell whether a provider is supportive or not. Many patients are well networked and will tell their friends about the providers and practices they consider safe. Increasingly, LGBTQ patients expect a high level of knowledge and care.”

My expectations have certainly been raised over the last few years. I’ve adopted the practice of vetting my doctors so I’d never have another awkward office visit like I did back in 2012, so when I discovered my health insurance covers free therapy online — think Skype with a mental health expert, I tried to determine which ones were queer-friendly, with no success. Eventually, I emailed the company to ask for a list of LGBTQ-friendly providers. A few days later, I received this response:

“Hello, All of the providers treat all patients equally. There is no tolerance for discrimination based on race, gender, religion or sexual orientation.”

A sick, worried feeling settled in my stomach. The words are right, but they also don’t answer the question. The American Psychological Association, or APA, has excellent, detailed and research-based guidelines for treating LGBTQ patients, but there’s still a lot of work to be undone, considering that it was only about 40 years ago when the APA decided, per their 1975 resolution, that “homosexuality per se implies no impairment in judgment, stability, reliability or general social or vocational capabilities.”

Added Combs, “Like all of us, medical professionals must examine and challenge their biases. Nondiscrimination statements are important, but those alone set the bar pretty low. Patients want providers to be LGBTQ-friendly, but providing excellent care involves more than that. Providers should affirm patients’ identities and gain the knowledge and skill to deliver appropriate, evidence-based care.”

There were only a handful of providers available, so I tried to vet them one at a time, using Psychology Today profiles, the GLMA database and any other resource I could find. But therapists must list themselves as such on these sites, so I wasn’t even able to find profiles for most of them, much less whether they were open to queer patients.

Ultimately, I resorted to the worst place possible for health care research: Facebook, where memes, profile picture frames and “likes” helped me assess my options.

I think we can do better than that.

For doctors and therapists, it means taking the time to identify and list yourself specifically as an LGBTQ ally so we can find you. For patients, Combs said, “As a member of the LGBTQ community, I would say that learning about our own health is paramount. That way, we can ask the right questions of our providers and not rely as heavily on them to prompt the discussions.”

GLMA has fact sheets of the top-10 issues to discuss with a health provider, he said. Also, if the provider is open to learning, several resources are available, such as The Center for Excellence for Transgender Health and SAGE, an organization advocating for LGBTQ elders. Finally, the National LGBT Health Education Center has some excellent training for providers and laypeople. Providers have a wealth of resources to choose from and people can search for affirming providers by zip code on or the GLMA website.

Combs said Louisville has many affirming providers, which I discovered when I visited my Louisville doctor for the first time. The nurse asked if I was sexually active, and she immediately followed up by asking if it was with men, women or both. What a delight — and a low bar for delight — to be acknowledged. Our rural brothers and sisters deserve the same luxury; let’s hope it doesn’t take another 40 years to get there. •