Population Care

Better training needed to address shortcomings in LGBTQ care

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Social acceptance of lesbians, gays and transgender Americans continues to improve, yet LGBTQ people continue to face stigma and discrimination. There’s an urgent need to provide high-quality health care for the LGBTQ patients, but better training is needed to deliver that kind of care.

That was the consensus of an expert panel discussion held recently at the AMA's Chicago headquarters, and the quality of transgender care is an especially salient issue for AMA member Magda Houlberg, MD, chief medical officer at Howard Brown Health in Chicago. The longtime Windy City LGBTQ health care organization treats more than 3,000 transgender or gender-nonconforming patients, Dr. Houlberg said at the AMA event.

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That number has grown in recent years, though Dr. Houlberg said she is unsure whether that reflects a growth in the share of transgender or gender nonconforming patients at Howard Brown or better data-collection by the organization.

“This is why it [data collection] is so important, because we don’t know unless we collect that data. We can’t pull out any health disparities if we can’t identify some of these factors,” said Dr. Houlberg, the newest member of the AMA’s Advisory Committee on LGBTQ Issues.

The AMA House of Delegates adopted several policies at the 2018 AMA Annual Meeting in Chicago, including appropriate placement of transgender prisoners, support for family and medical leave for LGBTQ workers, promotion of LGBTQ-friendly and gender-neutral intake forms, and creation of a section council on LGBTQ Health, among other policies.

Given that kind of action and the LGBTQ committee’s work, Dr. Houlberg sees AMA membership as a “huge opportunity.”

“When the AMA says something, people listen,” she said. “I saw a lot of people using the AMA and doing activism within the [Association]. That is what really got me excited about it.”

Gaps in knowledge

Another panelist, rising fourth-year medical student James Sabra, discussed research that he and his colleagues conducted about transgender women patients’ knowledge of skin changes that would happen with hormone therapy and gender-affirming procedures.

Their report, published in May in the journal Transgender Health, found that the transgender women surveyed scored a 63 percent on their knowledge of skin changes during hormone therapy.

“As clinicians you should want your patients to be well-informed and know everything that is going on,” said Sabra, a rising fourth-year medical student at Northwestern University Feinberg School of Medicine and recipient of the AMA Foundation’s 2018 Physicians of Tomorrow Scholarship.  

Sabra and his colleagues also discovered that 83 percent of the transgender women surveyed didn’t know they needed more than one laser hair-removal procedure, even the majority of respondents had already completed one procedure. This meant a medical professional did not tell them to go back again.

“We need to continue to identify these gaps in knowledge so that we can better inform patients about what they are actually getting into when it comes to procedures we are providing for them,” he said.

No to one size fits all

The need to understand transgender care goes beyond the particulars of gender-affirming procedures and treatments, Sabra noted.

In medical school, he said, “you’re taught how to screen for breast cancer, colon cancer and cardiovascular risk factors, but we are not taught if or how these screening guidelines change for transgender patients.”

To overcome this, Sabra created a pocket resource to keep in his white coat. The resource provides information on how guidelines change for screening in transgender patients.

“These populations are already medically underserved and if we’re not taught this during medical school, how are we supposed to figure this out on the go when someone is in your office and is of age to be screened?” he said.

Francesca Gaiba, PhD, of Northwestern’s Institute for Sexual and Gender Minority Health, and Kingsley Weaver, MPH, of the Chicago Department of Public Health, also took part in the AMA panel discussion.

Importance of allies

There is significant opportunity for straight physicians to help the LGBTQ community because of their critical role in decision-making that affects the lives of individual patients. And as allies, physicians and other medical professionals can help amplify the voices of LGBTQ  patients.

"Small decisions can have a big impact," said Dr. Houlberg. "Things that people don't necessarily think impact LGBTQ health actually do."