Family Medicine Must Meet the Needs of the LGBT Community to Build Trust

Kristine M. Diaz, PsyD

This is part of a series by the STFM Group on LGBT Health for LGBT Pride Month.

“I don’t trust my family practice doctor to treat me.”

A pre-med student who identifies as a transgender male shared this statement with me recently. I swallowed my desire to pacify him with “We are working on it.” I just listened.

It was hard to sit with the feelings that we are not doing a good job at being inclusive for all of our patients.

While we acknowledge that we are experts in serving underrepresented populations, this interaction illuminated the need for continued action. His has been one of many voices I’ve heard from the LGBT community of not trusting primary care physicians to treat LGBT individuals with compassion and relevant care.

We are not doing enough. We need to allow ourselves to sit with uncomfortable feelings to hear the voices of a community in need. Once we can acknowledge our shortcomings as a field, we are empowered to reach out to others, make change, and lead.

So what can family medicine educators, residency programs, medical schools, and academic health centers do to tackle these shortcomings?

Address LGBT Health Barriers and Disparities

Individuals from diverse sexual orientations, gender identities, and sex development face multiple barriers^1-5 to care, including:

• Negative beliefs and behaviors toward LGBT communities
• Inequitable institutional policies and practices
• A poorly trained health workforce
• Knowledge gaps about the unique health concerns of LGBT individuals

These barriers amplify existing LGBT health disparities, including poor access to health care, increased incidence of human immunodeficiency virus (HIV) infection, certain cancers, and mental disorders.

Family medicine has often served as an innovator in pioneering climate and cultural shifts in academic medicine and patient-centered care in underrepresented populations. In fact, family medicine has addressed the education and training of medical residents to address cultural competency through the collaboration of the Society of Teachers of Family Medicine and the American Academy of Family Physicians Recommended Curriculum Guidelines for Family Medicine Residents on Lesbian, Gay, Bisexual, and Transgender Health.⁶ This curriculum offers a model for family medicine residency programs to expand their role as innovators in primary care, patient care, and LGBT health disparities.

Bridge the Gap of Access to LGBT-Focused Community Clinics

A disconnect remains between LGBT-focused community clinics and academic health centers in the provision of health care for the LGBT community. LGBT-focused community clinics have been caring for LGBT people for decades.^8,9 Yet, not every community has access to LGBT-focused community clinics. How can we bridge that gap?

1. Academic health centers should reach out to local LGBT-focused community clinics and/or LGBT health experts to identify strategies to operate comprehensive and sensitive medical care in a work culture and climate that is supportive of its LGBT individuals.
2. Academic health centers should complete the Human Rights Campaign’s Healthcare Equality Index to evaluate their health care policies and practices in equity and inclusion for LGBT patients, visitors, and employees. It is imperative that academic health centers address the role of institutional culture and climate as they strive to meet the needs of LGBT populations and comply with the national LGBT recommendations.

Collaborate With Champions

The release of the Association of American Medical Colleges’ (AAMC) Axis Committee on Sexual Orientation, Gender Identity, and Sex Development is leading the charge to pull together all of the threads in addressing LGBT Health: faculty development, curriculum development, and evaluation and research.

The AAMC’s comprehensive guidelines on Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born With DSD: a Resource for Medical Educators marked a significant shift in the culture and climate of academic medicine. This guide offers family medicine educators and medical schools a multimodal approach toward inclusion of LGBT issues in academic medicine. Additionally, this medical education resource identifies champions in the implementation and integration of LGBT health concerns at their respective institutions.

To advance the work in academic medicine, educators, researchers, and medical school administrators may want to collaborate with either the AAMC and/or the identified champions in the evaluation of curriculum development in LGBT health education and training of health students, trainees, and professionals. Most importantly, advancement of this work should address the impact on the improvement of patient outcomes in the LGBT patient population.

What Will You Do to Enact the Change?

The LGBT community continues to ask for support from family medicine. Are you listening? Will you hear them? Will you seek partnerships to contribute to the cultural and climate shifts occurring in academic medicine?

References

1. Makadon HJ, American College of Physicians. The Fenway guide to lesbian, gay, bisexual, and transgender health. Philadelphia: American College of Physicians, 2008.
2. Institute of Medicine. Collecting sexual orientation and gender identity data in electronic health records: Workshop Summary. Washington, DC: Institute of Medicine, 2013.
3. Healthcare Equality Index. Creating a national standard for equal treatment of lesbian, gay, bisexual and transgender patients and their families. Healthcare Equality Index, 2011.
4. When health care isn’t caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV. New York: Lambda Legal, 2010.
5. Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA 2011 Sep 7;306(9):971-7.
6. American Academy of Family Physicians. Recommended Curriculum Guidelines for Family Medicine Residents: lesbian, gay, bisexual, transgender health. http:// www. aafp. org/online /etc/medialib/aafp_org/documents /about/rap/curriculum/ LGBTI*health.Par.0001.File.tmp/LGBTI*-health-curriculum-guidelines.pdf. Accessed June, 22, 2015.
7. Association of American Medical Colleges. Implementing curricular and institutional climate changes to improve health care for individuals who are LGBTI, gender nonconforming, or born with DSD: a resource for medical educators. AAMC, November 18, 2014. Accessed March 8, 2015.
8. Advancing effective communication, cultural competence, and patient- and family-centered care for the lesbian, gay, bisexual, and transgender (LGBT) community: a field guide. Oak Brook, IL: Division of Healthcare Quality Evaluation, The Joint Commission. October 2011.
9. Institute of Medicine (US). Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: National Academies Press, 2011.