Treating LGBT Patients

Given the broad spectrum of human sexuality, most clinicians can safely assume that they currently care for patients who are lesbian or gay. Practitioners must recognize that lesbians, gay men, and bisexuals need standard primary care, that sexual behavior can have psychologic and psychosocial impacts on a patient’s health, and that homophobia and heterosexism are barriers to healthcare. Clinicians also must realize the need to create a trusting relationship if they are to ensure optimal healthcare for all patients.

Barriers to openness and trust may be overcome with nonjudgmental attitudes from clinicians and support staff, complete confidentiality, and resources for support and information....

Practitioners who are uncomfortable working with lesbian and gay clients may want to seek further continuing education to lessen communication barriers. Those clinicians who find themselves unable to overcome social taboos regarding homosexuality should recognize how their personal attitude compromises the care they offer, and be prepared to refer lesbian, gay, and bisexual patients to other providers.

—Margaret A. Lynch, MSN, FNP, and Richard S. Ferri, PhD, ANP, ACRN.

As a provider, perhaps you wonder why we decided to create a lesbian health resource guide. Why single out specific providers as being more sensitive than others? Shouldn’t all physicians be considered sensitive to the needs of their patients?

Indeed they should, but the reality is that they are not.

• Lesbians may experience dilemmas about how much information to disclose to health care providers, especially if questions are phrased in heterosexual language on intake forms or health histories.
  
• Many lesbians feel that most health promotion messages don’t address their concerns.
  
• Homophobic practitioners and staff have displayed behaviors such as hostility, breach of confidentiality, denial of care, and inappropriate questions about sexual behavior.
  
• Partners are often excluded from discussions.
  

As lesbians, our concerns about health care run from the seemingly mundane to the potentially deadly. Being asked, “What kind of birth control are you using?” may seem like a benign mistake; however, it puts the patient in the awkward position of addressing your assumption of her heterosexuality. The physician-patient relationship is one of power, and your lesbian patients’ health is in your hands. It is your role to facilitate their sense of comfort with you, not their role to correct your assumptions.

We are all homophobic by virtue of being brought up in this culture. The difference is in the degree of our homophobia and whether we have taken the time to examine our own biases and heterosexism. Homophobia can run strong and deep. A lesbian patient may wonder how you will treat her if she comes out—and even if you treat her the same, what will you think of her? Unless you actively let her know you respect and value her coming out to you, she may remain worried about what you really think about her sexual orientation.

Be especially careful about confidentiality. Don’t assume that a patient is “out” to her family or the other medical office staff. Avoid discussing a patient’s sexual orientation with anyone other than the patient.

Ask your lesbian patients how they prefer you address their partners and the terms you use to describe their sexual orientation. Give a lesbian patient’s relationship and family the same value you would give those of a heterosexual patient. Ask about her partner, if she is in a relationship. If she has kids, ask about them. If she doesn’t have kids, ask if she is considering having them. Examine your attitudes about women who fit the stereotype of what a “dyke” is—those who are "butch" or blur gender lines. They may feel the least comfortable going to the doctor, particularly for female concerns. Take steps to educate yourself about transgender and transsexual people, who may be most likely to avoid seeking health care.

The little things matter: they may mean the difference between a lesbian patient coming back to you every year for her necessary health care—or never coming back again. Together, we can improve health care for all lesbian, gay, bisexual, and transgender people.