WSMA Guidance: LGBT Health
At the 2014 WSMA Annual Meeting, the House of Delegates adopted Resolution B-14 – Health Care Access and Inequities in Persons Who Are Lesbian, Gay, Bisexual, and Transgender. This resolution was introduced to identify ways to address disparities faced by individuals who are, or may be, LGBT, or who may have issues concerning gender identity or sex development. Such disparities may include "decreased access to needed care, bias and discrimination … lack of [health care] provider knowledge and/or comfort in providing care, absent or suboptimal risk factor assessment, and medical management that is not grounded in the current best evidence." (See AAMC paper described below, p. 55.) Such disparities create the potential for "preventable harm."
At the 2019 WSMA Annual Meeting, the House of Delegates adopted Resolution C-24 – Improving Health Care Experiences for Transgender and Gender Nonconforming Patients. This resolution declares WSMA's strong support for the rights of transgender and gender nonconforming patients, and recommends that all Washington state health care facilities that provide direct patient care adopt gender-affirming practices, including but not limited to the following:
- Ensure appropriate documentation of a patient's preferred name and pronouns as part of new patient registration processes.
- Establish and publicize protocol for documenting a change in a patient's gender.
- Provide a write-in option for sex and gender on all forms and avoid binary identifiers.
- Offer gender sensitivity training by an expert trainer for all medical providers, administrators, and support staff.
- Develop guidelines for providing appropriate preventative health care screenings for all patients regardless of gender identity and according to their physical needs.
- Ensure the availability of gender-neutral bathrooms.
- Develop a patient referral plan when one's health care facility is unable to provide gender-affirming services, including hormone replacement therapy, gender-affirming surgical procedures, and routine preventative health screening.
The WSMA is committed to helping physicians offer care that is complete and welcoming for all patients. In reviewing information related to this important topic, we have identified several of the most effective, yet easy to institute, ways for physicians to welcome their LGBT patients. As such, and at the directive of the Resolution B-14 from 2014 and C-24 from 2019, the WSMA is providing resources for physicians to make their practice more responsive to the needs of LGBT patients. This includes materials on concise terminology regarding LGBT individuals, the unique medical needs of LBGT patients, cultural competency, LGBT-sensitive language for forms and paperwork, and suggestions for ways to make your practice more welcoming for all.
Providing Comprehensive and Culturally Competent Care for the LGBT Community
Updated June 2020
The proper use of relevant terminology fosters effective communication in general and is crucially important in matters related to sexual orientation and gender. We have listed below several resources that provide a glossary of helpful terms related to the LGBT community:
- AAMC, Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD, Appendix A, p. 219.
- U.S. Department of Health & Human Services, Substance Abuse and Mental Health Administration, Center for Substance Abuse Prevention, Top Health Issues for LGBT Populations Information & Resource Kit, A-1.
- National LGBT Health Education Center, LGBTQIA+ Glossary of Terms for Health Care Teams.
Promoting a safe and welcoming waiting room for LGBT patients
LGBT patients often experience barriers to care because of their sexual orientation or gender identity/expression. Fear of discrimination and prejudice may make it difficult for LGBT patients to confide in their doctor, ask questions, or even seek treatment. You can take steps to show your patients that they can expect superior treatment in a safe environment.
- Consider providing gender-neutral facilities, such as single-occupant or "family" designated restrooms.
- You may want to sign up to be included in the provider referral programs offered by LGBT organizations, such as the Gay and Lesbian Medical Association. This program allows potential patients to search for providers (such as primary care providers, specialists, therapists, dentists, and other health professionals) by region. Making sure you are included in these databases sends a clear signal to LGBT patients that you are going to provide sensitive care in a welcoming environment.
- Update intake forms and other paperwork to make sure that they reflect appropriate options for all patients. You can view a sample intake form provided by the National LGBT Health Education Center online.
- If appropriate, consider using posters showing racially and ethnically diverse same-sex couples or transgender people. Often, local non-profit LGBT or HIV/AIDS organizations have these kinds of materials already prepared and are willing to provide them for your use.
- Stock your waiting room with brochures that discuss diverse health concerns, such as breast cancer, safe sex, hormone therapy, mental health, substance use, and sexually transmitted diseases/infections.
Detailed LGBT resources for physicians
The Joint Commission provides a wide range of valuable information in its publication, Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care. The Joint Commission guide can be used both as an organizational self-assessment tool and as an educational resource. Information included in this publication includes:
- The role of leadership in establishing a welcoming culture in medical practice.
- Providing medical care in a manner to meet the needs of all patients using effective communication and being responsive to the needs of all patients.
- Providing a medical practice environment to ensure that LGBT employees are equitably treated and are able to provide care to LGBT patients that is competent and welcoming.
- Responding to the needs and demographics of patients and their families, and the communities in which they live.
- A checklist for leaders to help assure effective communication, cultural competence, and both patient- and family-centered care for the LGBT community.
Association of American Medical Colleges
The Association of American Medical Colleges (AAMC) in 2014 released guidelines on training physicians to treat LGBT patients, produced by the AAMC Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development, which includes 30 competencies the AAMC recommends physicians learn. Make sure you and your staff are up to date on this information.
The AAMC guidelines, while designed for use in medical schools, are nonetheless vitally important for established physicians to incorporate into their practices. The guidelines provide information on important competency objectives to improve health care for individuals who are or may be LGBT, gender non-conforming, and/or are born with differences of sex development in each of eight domains:
- Patient Care
- Knowledge for Practice
- Practice-Based Learning and Improvement
- Interpersonal and Communication Skills
- Systems-Based Practice
- Interprofessional Collaboration
- Personal and Professional Development
In addition to describing these competencies, the AAMC paper also discusses integration of those competencies into medical school curricula, and many other issues of importance.
American Medical Association
The American Medical Association has a webpage, "Creating an LGBTQ-friendly practice," featuring resources and suggestions for creating an LGBT-welcoming practice. The AMA provides information and links on a number of relevant topics, including:
- Information about the Gay and Lesbian Medical Association (GLMA) Provider Directory.
- Determining how medical practices treat their LGBT patients and employees.
- Providing a welcoming environment for LGBT patients.
- A discussion of recommended standards of practice with LGBT patients.
- Sample patient intake form.
- A podcast on expanding a medical practice into the LGBT marketplace.
U.S. Department of Health & Human Services
The U.S. Department of Health & Human Services, through the Center for Substance Abuse Prevention (CSAP) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have put together a detailed publication regarding health care for the LGBT community. The Top Health Issues for LGBT Populations Information & Resource Kit. This publication includes discussions concerning:
- A detailed glossary of relevant terms.
- A discussion about gender identity.
- Discussions about top health issues for members of the LGBT community.
- A list of web-based resources.
- A PowerPoint presentation on the top health issues for the LGBT community.
Gay and Lesbian Medical Association
If you would like a more comprehensive primer on being sensitive to unique LGBT needs and health issues, be sure to check out the educational webinars provided by the Gay and Lesbian Medical Association (GLMA). The website features four free webinar lectures (complete with slides), which "delve into the clinical concerns specific to LGBT persons—both in terms of physical health and mental health." The webinars are free and include content that has broad relevance to clinicians, administrators, researchers, and academics alike.
Center for Excellence for Transgender Health
The Center of Excellence for Transgender Health, affiliated with the University of California, San Francisco, serves "to increase access to comprehensive, effective, and affirming health care services for trans communities." The center provides community perspectives on developing and implementing programs in response to community needs, including the use of a national advisory body comprised of 14 recognized leaders in the transgender community. The center's staff includes a comprehensive medical advisory board. The center's website is another great resource for physicians on a number of topics, including:
- Clinical services.
- Coalitions in Action for Transgender Community Health (CATCH) (Which seeks to increase the medical community's capacity to engage in HIV prevention activities).
- Transitions Project (Which provides training and assistance to programs seeking to implement HIV prevention measures in transgender communities).
- Sheroes (Culturally relevant HIV prevention research).
- Primary Care Protocols Project (Evidence-based protocols for clinical care).
- Transgender Evaluation and Technical Assistance Center (TETAC) (Enhancing engagement and retention in quality HIV care for transgender women of color).