As a physician treating or preparing to treat lesbian, gay, bisexual and transgender (LGBT) patients, you may wonder whether you’re saying the right things or whether your practice environment is welcoming to patients of all sexual orientations. Find out how experts on LGBT care answered questions from your peers.

Implementing ways to create a comfortable setting for patients of all sexual orientations, gender identities, gender expressions and sexual practices can help you provide more inclusive care for your patients. Recently, physicians had the opportunity to ask a panel of experts their most pressing questions about treating LGBT patients.

Here are four questions physicians asked an expert panel from an education session at the 2015 AMA Interim Meeting in November:

  • When patients ask if a practice provides LGBT care, what are some good responses for physicians who might not feel they have the right answer?

“The humility of acknowledging that you don’t know all of it is more valuable than knowing any ‘magic keywords,’” said Kimberly Acquaviva, PhD, associate dean for faculty affairs and associate professor at the George Washing University School of Nursing. “Then take your commitment to learn more” and educate your practice team. ”Most patients would rather hear ‘I don’t know but I’m willing to learn.”

“If the inquiries are coming in initially, reach out to the resources in your state and make sure you’re getting the right education to support LGBT patients,” said Brigid Scarbrough, navigation services team leader at The Health Initiative. “Don’t quiz the patient,” learn what you need to know before you begin treating LBGT patients if you can.

  • Transgender individuals have gained a lot of positive PR in the past two years. Has this created a problem in education or caused people to think more about those patients than the wider LGBT group?

“I see it as a new challenge,” Acquaviva said, “and as someone who is part of the LGBT community, I see it as an obligation as a provider to continue to work with other providers and educators to say that just because we’re seeing inclusion around the LGB issue does not mean that we forget our trans brothers and sisters. Wherever there is that tension, that’s where we need to educate.”

“I think that the positive PR and the regular PR that trans people are getting is getting more trans people coming out to seek care,” said Jason S. Schneider, MD, associate professor, division of general medicine and geriatrics at Emory University School of Medicine. I think it’s a call to action to the AMA and other to ensure that a variety of physicians and practices are ready to be welcoming.

The incoming generation of physicians may not need the same kind of education in LGBT patient care, Dr. Schneider added. “From the educator perspective, the medical students that I teach … [understand the nuances of] sexual orientation and gender identity. They want to know things like ‘what hormone levels do I use for the trans woman I see?’”

“They’re light years ahead on many issues,” he continued. “That’s always reassuring to me—I think the challenge for us in practice and medical education, is to meet the needs of our learners and not assume that they need as much teaching as the previous generation did.”

  • Are there any specific health issues that should be the focus of LGBT patient care?

“Take comfort that the super majority of issues that your LGBT patients will have will be the exact same as other patients who walk through the door,” Scarbrough said. “Try placing an LGBT publication in the waiting room to let them know it is a welcoming environment.”

Panelists recommended that physicians consult the Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health, which addresses important issues facing patients and physicians, including caring for LGBT patients of different age groups, information on the development of gender identity in children, sexual health and HIV prevention.

Also, if your practice is treating LGBT patients, check out the seven things to consider when making sure your practice is transgender friendly.

  • What about elderly LGBT patients? Are there specific issues for these patients that physicians should consider?

“[Patients] who grew up in a time when being gay could get them fired, or they grew up in a time when they could go to jail or they could be beaten,” Acquaviva said, “may not ever feel comfortable coming out to you. That’s not a failure on your part as a clinician—that’s where they’re at.”

“Not everyone is going to come out to you,” she continued. “What you want to do is strive, particularly with the older patients, for creating a climate where they’re comfortable being who they are and disclosing the things they need to disclose to you to receive the care they need to receive.”

For example, Acquaviva said, when you have an elderly women who needs a family member to drive her home, don’t ask if her husband will be picking her up, but rather ask her which family member or friend will be driving her home. 

This education session was hosted by the AMA LGBT Advisory Committee. Visit the committee’s Web page for several resources to help physicians, residents and fellows, and students develop strategies, programs and policy to better care for LGBT patients. A video of the event is available for download from the AMA LGBT Advisory Committee.

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