LGBTQ patients have faced obstacles to culturally competent care for decades, and shelter-in-place orders related to the COVID-19 public health crisis have aggravated inequities. A recent episode in the AMA’s “Prioritizing Equity” video series features insights from physician experts on how to better care for LGBTQ patients both during the pandemic and in the long term.
The AMA and the Centers for Disease Control and Prevention are closely monitoring the COVID-19 pandemic. Learn more at the AMA COVID-19 resource center, consult the AMA’s physician guide to COVID-19 and check out other episodes in the AMA “Prioritizing Equity” video series.
New HHS policy worsens concerns
The U.S. Supreme Court recently ruled that protections against sex discrimination in the workplace established by the 1964 Civil Rights Act also protect LGBTQ employees. But the decision came on the heels of a policy change by the Department of Health and Human Services (HHS) removing nondiscrimination protections for LGBTQ patients.
Many legal experts believe the Supreme Court’s decision bodes well for finding the HHS rule change unconstitutional. But such a decision could be years away, adding to the anxiety many in the LGBTQ community are feeling during the pandemic.
A road map for improvement
The panel discussion, led by Aletha Maybank, MD, MPH, chief health equity officer and group vice president of the AMA Center for Health Equity, featured several leading LGBTQ physician advocates, who recommended five ways to address patients’ top-level needs:
Create a welcoming environment. Many of the practices that specialize in caring for LGBTQ patients have closed during the pandemic.
“I've had patients absolutely terrified about going to the emergency room, short of breath and saying, ‘I don't know where to go. I don't want to leave my house,’” said Asa Radix, MD, PhD, MPH, senior director of research and education at Callen-Lorde Community Health Center, in New York City. “This pandemic has really exposed the major gaps in the system that are really detrimental to LGBTQ folks, especially trans and gender-diverse people.”
Add to your knowledge of LGBTQ issues. The AMA Ed Hub™, for example, recently rolled out an LGBTQ Health, Diversity and Inclusion online CME module.
“What is there is … just a small portion of what will eventually be available,” said Shilpen Patel, MD, associate professor in the University of Washington Department of Global Health and immediate past chair of the AMA Advisory Committee on LGBTQ Issues, noting collaboration with the LGBTQ community that is ongoing. “There’s a lot of learning that each of us as health care providers need to do, and we need to encourage our peers to do some learning and to help carry that banner forward.”
Innovate where you see a need. One example of this is a program called Door 2 Door, launched by the New York City Health Department’s Bureau of HIV.
“New Yorkers can order condoms and other safer sex products and have them delivered directly to their homes,” said Oni Blackstock, MD, MHS, Assistant Commissioner for the Bureau of HIV, noting that the bureau also has a program that enables individuals to order HIV self-tests online for home delivery. Both programs are important during the pandemic because “sex is an important part of intimacy. And we want to be able to support New Yorkers’ … being as safe as possible and also help them to reduce the spread of COVID-19.”
Involve your employer. “We have to demand accountability of the places that we work,” said Jesse Ehrenfeld, MD, MPH, senior associate dean at the Medical College of Wisconsin School of Medicine, highlighting the Human Rights Campaign’s Healthcare Equality Index.
“Hospitals and facilities can voluntarily participate in this ranking system where they look at policies and say, ‘Do you have everything in place that you should or not? Are you adhering to best practices or not?’ And lots of places have gaps. Those gaps shouldn't be acceptable, and we need to demand that they get addressed.”
Use your platform. “I think it starts with modeling your behavior and then also kind of being a voice, whether it be on social media or with a YouTube channel or with other kinds of media outlets to put yourself out there,” said David J. Malebranche, MD, MPH, associate professor of medicine and director of Student Employee Health Services at Morehouse School of Medicine. “You never know who's listening.”
Watch the full video or read a complete transcript of the “Prioritizing Equity” episode on LGBTQ voices. Throughout the COVID-19 pandemic, the AMA is carefully compiling critical health equity resources from across the web to shine a light on the structural issues that contribute to and could exacerbate already existing inequities.
Essential Tools & Resources
Read AMA policies on health equity
Explore health equity on JAMA Network™️
Read the latest on health equity from AMA Journal of Ethics®️
Learn more about health disparities on AMA Ed Hub™️
COVID-19 Q&A: health equity in pandemic
Release the Pressure: Heart health equity with Essence