Ainur Abdrakhmanova

Caring after LGBTQ patients: methods for improving physician cultural competence

Physicians as professionals should provide everyone with equal access and quality of

medical care despite the age, race, gender, nationality. But the reality is different. Physicians are

not ready to treat LGBTQ patients [1]. Even though future physicians as medical doctors are

taught to be non-judgmental, show empathy, whenever they encounter an LGBTQ patient they

do not know how to deal with them and sometimes just refuse to treat. LBGTQ individuals

experience more discrimination than heterosexual individuals in healthcare while they face the

same health problems or even to a greater degree [2]. This is when cultural competence should

be recalled. Cultural competence is used to overcome any barriers between the patient and

healthcare professional that may result in low quality of medical help [3]. If previously the

cultural competence was directed against cultural and linguistic differences, then nowadays it

can be used to minimize or even eliminate health disparities in LGBTQ community.

There is no real data about the health disparities of LGBTQ patients because there are no

questions about sexual orientation, gender identity in such surveys [3]. However, some of the

health issues can be raised. For instance, LGBTQ patients develop smoking habit, alcohol and

substance use more often than heterosexual individuals. They are also more prone to have mental

health disorders and suicide attempts along with experiencing violence from partner [2]. Talking

about the screening programs they are not developed for LGBTQ patients. For example, gay

individual is at higher risk of having HIV infection in comparison to heterosexual one [2]. There

is less cervical cancer screening for lesbian or bisexual individuals despite the fact that the risk

for both groups is the same [2]. Cultural incompetence may affect LGBTQ patients not only in

terms of physiological health but also emotional or mental state. When a patient is faced by

assumptions, bias or judgmental tone from physicians side he may not disclose information fully

and after such experience may not want to seek medical help in the future. To solve such
problems some improvements can be done such as education of medical personnel and friendly

environment [3].

The primary goal is to raise awareness of both LGBTQ community and its health

concerns [4]. In comparison to the past nowadays people are more aware of existence of LGBTQ

individuals because they are less afraid of coming out since they have support of other

individuals. Hence, more attention should be attracted to their treatment. The first step is to

organize trainings for both physicians and medical students where they will be taught about the

health problems of LGBTQ patients, how to ask questions and not to be bias or judgmental. For

the health problems the special surveys can be done to evaluate the health state and find out what

are the most common issues in LGBTQ community. The annual screening can be arranged for

cancer, HIV, sexually transmitted diseases. Some individual or group meetings with psychologist

can be done to relieve stress and decrease incidence of suicide, home abuse. This may also help

to gain personal confidence and improve their mental health.

Regarding the questions they should be of neutral tone and open ended. For example, you

can ask How should I address to you? for instance if a person is transgender but in the

verifying document he/she has a different name. This patient will be pleased to be called by

preferred name and friendly atmosphere will be created. Such neutral questions as Are you in

relationships?, Could you tell me about your partner? could be asked while taking sexual

history [4]. Also the sexual orientation and gender identity should be asked or included into fill

in forms [5]. This will help to focus on some health aspects more during the interview.

Another issue is to try to avoid assumptions both about the patient and clinical decisions.

Such case can be considered as an example, an elderly patient who is indeed homosexual may be

perceived by physician due to his age as a heterosexual [1]. Hence, some information can be

omitted. Considering the clinical decision, you may see the male patient who has a female

reproductive system and may require consultation about pregnancy [1].

 In addition, some representatives of LGBTQ community can be invited and share their

concerns and feelings with participants of training so that they can understand and place

themselves on the patients place. Such experience will be useful not only for physician but also

LGBTQ individuals to express themselves and contribute for the healthcare improvement.

Considering the creation of friendly environment it will help the patient to feel

comfortable, trust to physician and disclose the information. One of the methods how it can be

done is to place brochures regarding the health issues of LGBTQ patients or attach the rainbow

flag and other symbolics of LGBTQ [4]. By this they will be more confident in seeking medical

help in such hospitals since medical personnel there is aware of their concerns. There could be

some posters that will state about the equal healthcare delivery to everyone despite their age,

gender identity, sexual orientation, race, nationality, socioeconomic status [4]. The welcoming

environment can be achieved if physician behaves in open, empathetic and non-judgmental way.

The appropriate questions will help the patient to talk honestly and relieve his/her concerns. As a

result the patient-centered care will be provided.

In conclusion, LGBTQ individuals experience discrimination and bias in healthcare that

is why their health issues should be improved. There are more LGBTQ patients these days. And

they need a special care due to the higher risks of some diseases in comparison to heterosexual

individuals. As a result, physicians should be ready to provide a high quality care to them.

Cultural competence can be improved mainly through the education of medical personnel and

welcoming environment. These changes will be gradually implemented since not every physician

may agree to participate in trainings about the health of LGBTQ people but still if there are at

least some of specialists who can help it will be a great step.

 Reference

[1]. Comerford. J & Wallace C. Strategies for delivering LBGT inclusive care. PSQH, 2016

August; 29-35.
[2]. Klein E.W & Nakhai M. Caring for LBGTQ patients: methods for improving physician

cultural competence. The international journal of psychiatry in medicine, 2016; 51(4): 315-324.
[3]. Improving cultural competence to reduce health disparities. Agency for healthcare research

and quality, 2016.

[4]. Guidelines for care of lesbian, gay, bisexual and transgender patients. Gay and Lesbian

Medical Association.
[5]. Ard K.L & Makadon H.J. Improving the healthcare of lesbian, gay, bisexual and transgender

people: understanding and eliminating health disparities. The national LGBT Health education

center; 1-10.