By Katie Kerwin McCrimmon
An informal “don’t ask don’t tell” policy in doctors’ offices is preventing lesbian, gay, bisexual and transgender patients from getting optimal health care, according to a report released today called “Becoming Visible.”
Conducted by the LGBT advocacy group One Colorado in concert with the Colorado Medical Society and the Denver Medical Society, the report finds that most doctors are comfortable caring for LGBT patients.
Yet, most don’t ask about sexual orientation or gender identity. At the same time, many LGBT patients believe that medical providers may be biased against them and don’t speak up. The lack of frank discussions between providers and patients can undermine care.
Dr. Mark Thrun of Denver Health: ““We doctors are afraid to offend our patients. So nobody talks about sexual health.”
Experts say it’s up to doctors to break the silence.
“Providers need to recognize that they hold the power in these relationships. The onus is on the medical community,” said Dr. Mark Thrun, director of HIV and STD prevention and control at Denver Health and a board member for One Colorado. Thrun, who is gay, helped conduct the research for Becoming Visible, which included extensive surveys with about 400 doctors.
“We doctors are afraid to offend our patients,” Thrun said, “so nobody talks about sexual health.”
In the clinic where Thrun treats people for STDs, he said he asks all his patients about their sexual orientation and gender identity, but that’s not standard among doctors, especially among older providers.
And Thrun said studies show doctors are the least comfortable among medical providers in talking about sexual health. Nurses, social workers and nurse practitioners seem to be more at ease asking relevant questions.
Ashley Wheeland, health policy director for One Colorado, said the report helps triangulate the gap between patient views and physician perspectives.
The new report “Becoming Visible” finds that doctors aren’t always comfortable asking patients about their sexual preference or gender identity. Without this information, doctors can’t give optimal care. (Photo by Mark Manger. Courtesy One Colorado.)
“There is a disconnect in how LGBT feel in our health system and how physicians feel they’re treating LGBT people,” Wheeland said.
Doctors now overwhelmingly recognize that sexual orientation and gender identity are vital to health and that’s a huge change from just 10 years ago, said Wheeland.
Better training for doctors and simple practices to make LGBT patients feel more comfortable can make a big difference in overall health, she said.
A previous One Colorado report called Invisible http://www.one-colorado.org/news/lgbt-health-report/ surveyed about 1,300 LGBT people in Colorado and found that patients are more likely to get an array of helpful preventive services from flu shots to dental care and annual checkups if they have a good trusting relationship with their providers and believe that they are receptive to working with LGBT patients.
LGBT patients are also at higher risk for some health problems including HIV, heart disease, breast cancer and depression, so knowing their sexual history is vital.
“If I don’t know that my patient is LGBT, I may not be asking the next questions that might drive screening tests or future referrals,” Thrun said.
“And as a doctor, I need to know who my patients are, who is going to twist their arm to get them to take their meds, who takes care of them at home, who helps them stay healthy. Whether straight or gay, I need to know who your support systems are,” he said.
The major findings and recommendations from the report include:
- Physicians report high levels of comfort in serving lesbian gay and bisexual patients. Fewer providers are comfortable serving transgender patients, who are the most stigmatized among LGBT patients.
- Physicians care about how they are serving the LGBT community and recognize that sexual orientation and gender identity are vital factors in overall health.
- Physicians and other providers should ask patients about sexual history and preferences.
- Subtle signs of support for LGBT people — like rainbow or equality symbols — can let patients know they are welcome. The survey results show few providers have policies in place to show that they are LGBT-friendly even though simple changes to forms or visual cues could go a long way in helping LGBT patients feel more at ease.
- Colorado physicians are more comfortable when patients disclose sexual orientation or gender identity and are less comfortable asking patients directly.
- Physicians generally believe they are already treating their LGBT patients equally, but not all LGBT patients are getting the care they need.
- Primary care physicians were more likely than specialists to acknowledge the role that sexual orientation and gender identity may play in overall health.
- Younger physicians and those in urban areas offer more LGBT-friendly policies than those in rural areas.
Along with the report, One Colorado and the report partners also created a continuing education program for physicians on how they can better care for LGBT patients. (Click here for more information.)