Improving Culturally Competent and Inclusive Health Care for LGBT Patients Through Resident and Staff Education

By Jennifer Hammonds,LCSW and Alicia Markley, MPAS, PA-C

Bob arrived to establish receive care in our rural site clinic. As the nurse was going through the rooming process with the patient, she noticed he seemed very apprehensive about answering questions. Bob began to open up to the nurse about a recent negative experience he had at a local emergency room. He had presented to the ER for abdominal pain. Throughout the visit, Bob could hear the ER staff at the nurse’s station, laughing, joking about him, and speaking negatively about him and his concerns. This experience was traumatic, and fear of having this happen again had caused him to put off seeking medical care for some time. The nurse was rightfully upset on the patient’s behalf and wanted to put him at ease in our clinic.

This is a glaring example of health disparity, but why was Bob treated differently? Bob is a transgender individual. Bob’s legal name is Barb.

Research has shown that LGBTQ patients experience higher levels of discrimination, stigma, and stress and are at higher risk for poor health outcomes. Our primary goal is to provide quality patient care for our patients. All our patients. This nurse took a step back and looked at her ability to provide culturally competent care for this patient. She naturally wanted to treat this, and every patient respectfully, but she knew that she had some obvious questions about how to address certain situations.

This incident sparked a conversation between the two of us. As a whole, the clinics seem to be adept at being LGBTQ sensitive toward our adolescent patients, but we weren’t sure about our adult population. How comfortable is our nursing staff in asking patients for pertinent, though sensitive, health information? Do our front desk staff know how to address patients when their insurance card information differs from the information provided by the patient? Is our clinic known in the community as being LGBTQ friendly, or are we missing the big picture? We quickly realized that we were uncertain about many of these things. Questions often spark the need for answers, so we decided to embark on a project, one that would, hopefully, highlight our strengths, as well as areas in need of improvement.

We decided to begin simply, with a survey of all staff, nurses, faculty, residents, and social workers, to determine our comfort level, knowledge base, and understanding of LGBTQ patients and their healthcare needs. We used a SurveyMonkey tool, knowing full well that this was a less-than-scientific method of data collection.It nonetheless served our purpose of information gathering.

The responses were quite interesting. Many professionals expressed having only basic knowledge of LGBTQ patient needs but were willing to learn anything we could teach them. A few identified as being a member of the LGBTQ population and were delighted to learn of our project intent. The feedback received engaged us fully, and we made it our goal to find the best resources to educate ourselves and provide the best quality care to all patients in our community.

Herein lies the rub—the two clinics within our residency program provide two vastly different perspectives. One is located within the University City limits with a significantly diverse population. The other resides in a homogenous, rural area that has limited exposure to people of different backgrounds. As our goal of education began to take shape, it was necessary to consider our audience as well. Luckily for us, the National LGBTQ Health Education Center had a tremendous amount of learning material, PowerPoint presentations, and seminars available for use. Both clinics were receptive and engaged with the material presented, and subsequent nonscientific polling suggested that the exercise was a beneficial one.

Throughout this process, we both deepened our own intellectual and emotional understanding of our patients and cemented our belief that our colleagues were dedicated to providing the most positive and beneficial care to our patients, no matter their gender or orientation. We plan to revisit these training materials yearly with hope that we can continue to grow and fulfill our mission of meeting health care needs through education, patient care, research, and service to the community.