Did you know that people of the lesbian, gay, bisexual, transgender, questioning, two-spirit, intersex, asexual, plus (LGBTQ2SIA+) community make up 8% of the total U.S. adult population and 4% of the Canadian population? (13)(22) LGBTQ2SIA+ individuals experience interpersonal, structural, institutional, and internalized discrimination at significantly higher rates compared to the general population. As a result, they’re more likely to experience a range of disparities such as mental health issues, substance abuse, sexually transmitted infections, bullying, isolation, self-harm, and suicide. (10) They don’t only face these adversities in their daily lives; many report inequities and discrimination in the healthcare system. It’s common for LGBTQ2SIA+ patients to feel fearful or mistrustful of healthcare providers. (15) In fact, 18% of LGBTQ2SIA+ adults report avoiding or delaying care out of fear or hesitation of anticipated discrimination from their healthcare provider, and 16% report experiencing discrimination in healthcare settings. (7)
Did you know? Many states have little to no LGBTQ2SIA+-inclusive health insurance protections. As a result, insurance providers can deny coverage to transgender youth and adults seeking gender-affirming care. (16)
The LGBTQ2SIA+ community often receives low-quality healthcare due to multiple factors such as stigma, insensitivity, or poor practitioner cultural competency and awareness of the unique healthcare needs of LGBTQ2SIA+ populations. (10) Furthermore, the prejudices, personal beliefs, religious beliefs, and attitudes held by providers can worsen quality of care. (21)
As a healthcare provider, what can you do to help current and future patients feel safe, accepted, and respected in your practice? Keep reading to learn some practical tips for fostering a welcoming environment and caring for LGBTQ+ patients.
Tips for creating a welcoming clinical environment for LGBTQ+ patients
Dr. Cyndi Gilbert, ND, a naturopathic doctor and educator committed to an anti-oppression model of care explains, “Health and wellness providers can curate welcoming practices for patients who identify as LGBTQ2SIA+ in many ways. Client interactions are complex, and every part of that experience needs to be addressed to create an inclusive, responsive, affirming, and anti-oppressive space. Often, practitioners know they need to take more meaningful action than “love is love” images and Pride flags but don’t know how.”
“Reflecting and challenging personal bias is a great place to start,” explains Dr. Gilbert. “Unlearning cisnormative, heteronormative, allonormative, and other beliefs about gender, sex, and sexuality is vital. Conducting a quick practice audit helps to identify areas for improvements (e.g., space, signage, media, communication, policies, clinical skills, etc.) and any additional training desired to upgrade knowledge, skills, and language. Throughout this process, it’s critical to consider intersectionality, how other social determinants such as racism and ableism converge to impact accessibility and inclusion. During clinical encounters, the key is providing triple-A care: affirmation, allyship, and advocacy.”
Refer to the tips below to help create a hospitable environment and provide the best care for your patients who are part of the LGBTQ2SIA+ community.
1. Complete cultural competency care training
The American Psychological Association defines cultural competency as the “ability to understand, appreciate, and interact with people from cultures or belief systems different from one’s own.” (2) A solid understanding of cultural competency is essential for building practitioner-patient relationships and enhancing the quality of care. Pursuing training and continuing education for yourself and your staff can help ensure that you’re delivering the best possible care to your patients of the LGBTQ2SIA+ community.
Not sure where to start? Thankfully, there are various online continuing education courses and resources available, such as:
- Gay and Lesbian Medical Association (GLMA)
- Gay, Lesbian, Bisexual and Transgender (GLBT) Health Access Project
- Heal All Consulting
- National LGBT Center for Health Education
- Nurses Health Education About LGBTQ Elders (HEALE)
- Rainbow Health Ontario
- Rainbow Resource Centre
- The 519
- Think Cultural Health
“As a queer ND, I rarely saw myself or my community represented, so I co-founded Heal All, an educational and consulting hub to help health and wellness practitioners create safer and more welcoming spaces for LGBTQ2SIA+ clients,” says Dr. Gilbert.
2. Be aware of the unique health risks facing LGBTQ+ patients
To provide optimal care to the LGBTQ2SIA+ community, it’s important to acknowledge the significant health challenges facing this population. The LGBTQ2SIA+ community experiences higher rates of various health concerns, including:
- Elderly LGBTQ2SIA+ patients experience isolation and poor access to social services and/or culturally competent healthcare providers. (11)
- LGBTQ2SIA+ people are more likely to experience physical, emotional, and sexual abuse than heterosexual individuals. (3)(12)
- Men who have sex with men and transgender men and women are at a greater risk of contracting human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). (4)(11)(23)
- Lesbian and bisexual women, as well as transgender men, are less likely to receive routine Pap tests. (11)
- Lesbians and bisexual women are more likely to be overweight or obese compared to heterosexual women. (11)
- LGBTQ2SIA+ people have a higher risk of developing cardiovascular disease. (6)
- LGBTQ2SIA+ populations are more likely to use tobacco, alcohol, and other drugs than the general population. (11)
- Transgender individuals are at a higher risk of experiencing victimization, mental health issues, and suicide. (11)
- Transgender patients are less likely to have health insurance compared to heterosexual and lesbian, gay, and bisexual patients. (11)
“Health risks and inequities for LGBTQ2SIA+ people primarily stem from stigma, discrimination, and barriers to care. These risks are amplified for LGBTQ2SIA+ folks who are Black, Indigenous, and People of Color (BIPOC), those living with disabilities, young and old individuals, and others who face discrimination on the basis of multiple socially constructed categories,” explains Dr. Gilbert.
“Widespread structural, institutional, and interpersonal discrimination increases many specific health risks from cardiovascular disease and cancer to mental health conditions, all associated with reduced access to quality healthcare, underutilization of services, lack of representation in health research and public health policies, and social isolation due to discrimination at work, school, and home. The good news is many of these increased risks decrease or even disappear when people feel connected, when their identities are affirmed, and when they are supported by their families, workplaces, schools, and neighborhoods.”
Did you know? A staggering 40% of young people experiencing homelessness are part of the LGBTQ2SIA+ community. (10)
3. Use welcoming visuals and share online
Visuals on the inside and outside of your clinic can help patients feel welcome in your practice. You can also post relevant information on your website and/or social media accounts to help spread the word about the inclusivity of your practice. Examples include:
- Acknowledging Pride Month every June and days of observance such as World AIDS Day and National Transgender Day of Remembrance
- Displaying brochures, posters, and educational materials related to LGBTQ2SIA+ health concerns; consider using visuals that depict racially and ethnically diverse same-sex/gender couples or transgender people
- Displaying posters from non-profit LGBTQ2SIA+ organizations
- Participating in provider referral programs and online directories of LGBTQ2SIA+-friendly practices, such as the Gay and Lesbian Medical Association (GLMA) in the United States or the Rainbow Health Ontario website if you’re located in Ontario, Canada
- Posting a non-discrimination statement on your website and in your office stating that your practice provides equal care to all patients, regardless of age, race, ethnicity, religion, physical ability, sexual orientation, or gender identity/expression
- Posting a rainbow flag, all gender bathroom signs, or other LGBTQ2SIA+-friendly symbols or stickers in your practice (1)(20)
4. Use inclusive language on intake forms
LGBTQ2SIA+ patients may be hesitant to disclose information related to their sexual orientation or gender identity due to privacy and confidentiality concerns. The experience a patient has while filling out intake forms is one of their first glimpses into how your practice operates. Set the tone by following these guidelines:
- Avoid gendered terms such as husband, wife, father, or mother. Instead, use spouse, partner, parent, or biological relative. For questions that require detailed responses, such as family health history, include a “specify who” instruction that prompts the patient to provide further identifying information about their relationship.
- Provide training to front desk staff who are often the first point of contact for patients. Instruct your administrative staff to avoid using gendered terms. For example, ask “How may I help you?” instead of “How may I help you, sir?” and state “Your patient is ready to see you now” instead of “She is ready to see you.”
- If required by your regulatory body or for insurance purposes, ask about a patient’s “sex assigned at birth” or “legal sex.” When asking about gender, use a blank space for patients to write in their identitiy or include multiple options, including “non-binary,” “Two-Spirit,” “questioning,” and “transgender” in addition to “female” and “male.”
- Use the term “relationship status” instead of “marital status” and include options such as “partnered.”
- Use terms such as “sexual orientation,” “gender identity,” and “gender expression” when requesting demographic information on intake forms, and request that patients share their pronouns and preferred name. (5)(9)(17)
5. Refer to your patients by their pronouns and chosen name
A simple way to build rapport and show your respect to your LGBTQ2SIA+ patients is to refer to them by their pronouns and chosen name. You can request information regarding their pronouns and chosen name on their intake forms, or you can also ask them directly by saying, “What name and pronouns would you like me to use?” or “Hello, I’m Dr. Smith. My pronouns are she/her. How would you like to be addressed?”
Make sure to note your patients’ pronouns and chosen name in their chart so that staff are aware. Once a patient has given this information, staff should note it in the chart and use this name during all interactions.
Did you know? According to a 2017 survey, 8% of LGBTQ2SIA+ respondents reported that a healthcare provider refused to see them due to their actual or perceived sexual orientation, and 9% reported that their practitioner used harsh or abusive language when providing care. (8)
6. Establish trust
The practitioner-patient relationship is built on trust, which can make or break a patient’s experience and even influence their health outcomes. (24) Tips for building trust with your LGBTQ2SIA+ patients include:
- Assure confidentiality.
- Account for, honor, and respect the breadth of your patient’s identity and lived experience.
- Apologize when you make a mistake, such as using the incorrect pronoun.
- Ask open-ended questions such as “Do you have any concerns that you’d like to discuss today?” and avoid questions unrelated to the purpose of their visit.
- Be non-judgmental and have an open mind.
- Use neutralized clinical language.
- Screen for impacts of stigma and discrimination.
- Correct other staff members when they make insensitive comments or incorrectly refer to a patient by the wrong pronoun or name.
- Avoid making assumptions based on a patient’s name, appearance, or anatomy.
- Familiarize yourself with LGBTQ2SIA+ terminology and avoid using antiquated and offensive language.
- Develop a referral network of LGBTQ2SIA+-inclusive healthcare providers. (14)(18)(19)
The bottom line
As a practitioner, you have the potential to help reduce the barriers to healthcare access for members of the LGBTQ2SIA+ community and create an inclusive, welcoming environment in your practice.
In Dr. Gilbert’s words, “Practitioners can make a difference by working to create inclusive clinical environments as well as advocating for supports and positive change in their larger communities. Inclusive care isn’t a one-and-done activity–engage in ongoing allyship, affirmative care, and advocacy. Take opportunities to expand and update your knowledge and skills.”
Help your patients feel safe, accepted, and valued, and improve the quality of care afforded to LGBTQ2SIA+ patients by pursuing cultural competency training and continuing education, using inclusive language, referring to patients by their pronouns and chosen name, and establishing trust.
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- Andersen, J. P., & Blosnich, J. (2013). Disparities in adverse childhood experiences among sexual minority and heterosexual adults: Results from a Multi-State Probability-Based sample. PLoS ONE, 8(1), e54691.
- Bass B, Nagy H. Cultural Competence in the Care of LGBTQ Patients. (2022). In: StatPearls . Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563176/
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- Caceres, B. A., Streed, C. G., Corliss, H. L., Lloyd-Jones, D. M., Matthews, P. A., Mukherjee, M., Poteat, T., Rosendale, N., & Ross, L. M. (2020). Assessing and addressing cardiovascular health in LGBTQ adults: A scientific statement from the American Heart Association. Circulation, 142(19), e321–e332.
- Casey, L. S., Reisner, S. L., Findling, M. G., Blendon, R. J., Benson, J. M., Sayde, J. M., & Miller, C. (2019). Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Services Research, 54(S2), 1454–1466.
- Center for American Progress. (2018). Discrimination prevents LGBTQ people from accessing health care. https://www.americanprogress.org/article/discrimination-prevents-lgbtq-people-accessing-health-care/
- Gay & Lesbian Medical Association. (n.d.). Guidelines for care of lesbian, gay, bisexual, and transgender patients. https://www.glma.org/_data/n_0001/resources/live/GLMA%20guidelines%202006%20FINAL.pdf
- Hafeez, H., Zeshan, M., Tahir, M. A., Jahan, N., & Naveed, S. (2017). Health care disparities among lesbian, gay, bisexual, and transgender youth: A literature review. Cureus, 9(4).
- Healthy People 2020. (2020). Lesbian, gay, bisexual, and transgender health. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health
- Human Rights Campaign. (n.d.). Sexual assault and the LGBTQ community. https://www.hrc.org/resources/sexual-assault-and-the-lgbt-community
- Human Rights Campaign. (2021). We are here: At least 20 million LGBTQ+ adults in U.S. https://www.hrc.org/press-releases/we-are-here-lgbtq-adult-population-in-united-states-reaches-at-least-20-million-according-to-human-rights-campaign-foundation-report
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- Medina-Martínez, J., Saus-Ortega, C., Sánchez-Lorente, M. M., Sosa-Palanca, E. M., García-Martínez, P., & Mármol-López, M. I. (2021). Health inequities in LGBT people and nursing interventions to reduce them: A systematic review. International Journal of Environmental Research and Public Health, 18(22), 11801.
- Movement Advancement Project. (2022). Healthcare laws and policies. https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies
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