Provider education, advocacy key for LGBTQ+ health access

Provider education essential to better LGBTQ+ care

Poor healthcare experiences are not uncommon for members of the LGBTQ+ community.

In May, a survey from Bespoke Surgical found that 71% of LGBTQ+ patients have experienced some form of discrimination in the healthcare setting. Another February 2024 report found that around half of trans patients have had a poor healthcare experience, ranging from bad patient-provider interactions to a higher volume of insurance claims denials.

Poor healthcare experiences can beget poor healthcare access.

In June 2023, KFF reported that trans patients tend to have lower healthcare access, in many cases because it can be hard to find a provider trained to deliver care to a trans or nonbinary patient.

"We see a lot of care avoidance linked to clinician issues, clinicians who maybe aren't as educated about providing care to queer folks," she said.

It's incumbent on healthcare providers and leaders to pursue that provider education. In doing so, organizations and clinicians can work toward greater health equity and better experiences for all populations.

Treating LGBTQ+ patient populations

It's important to note that the LGBTQ+ population is not a monolith, Oosting stressed. A cis-gender, gay, White man might face different healthcare challenges than a trans person of color.

Still, there are some common strategies that can equip a healthcare provider treating a patient from the LGBTQ+ community

For starters, it is essential to understand the unique challenges facing patients. Queer people face a disproportionate share of social determinants of health, including a higher likelihood of housing insecurity. Social stigma, discrimination, higher odds of mental illness and higher odds of substance use disorder are also relevant, as is community violence.

"We need to make sure that we're aware of how impactful these forces are on the health of LGBTQ+ folks as opposed to some inherent difference in our physiological selves," Oosting stressed.

Other communication strategies that can support a better visit for LGBTQ+ patients can include the following:

• Asking patients' preferred names and pronouns at the first visit to normalize the conversation. Clinicians should properly document this information in the EHR.
• Avoid assumptions about the patient, including and especially about interpersonal and familial relationships. Rather, providers can ask who is joining the patient today and whether the patient would like them included in the care plan.
• Enable customizable patient intake forms with inclusive language.
• Offer tailored patient education pamphlets and signage throughout the clinic.

Healthcare professionals might also consider continuing medical education courses focused on treating LGBTQ+ individuals.

Training in cultural competency

Continuing education about LGBTQ+ populations and embedding that type of coursework into medical education curricula has been a professional bright spot for Oosting.

In her experience as an educator teaching classes about care for LGBTQ+ patients, she said she's mostly encountered clinicians making good-faith efforts to learn more.

"That, to me, is incredibly reassuring," she explained. "The fact that so many folks see these communities as a priority for their education is very heartwarming and reassuring because it says that we have so many allies out there. Our community is large, but we cannot do this alone."

Oosting also runs an organization called Rainbow Health Consulting that facilitates training for healthcare and related organizations across the country.

But the mission isn't just about how to help LGBTQ+ populations; it's also about highlighting the healthcare strengths of those populations. For instance, folks steeped in LGBTQ+ healthcare are very well-versed in how to deliver preventive care effectively, and there's a lot the whole industry can learn from that.

"That education piece for our allies is absolutely essential," she continued. "Most people have good intentions in their hearts. They want to use this proper terminology. They want to take proper care of folks. They just may not have had the education, they may not know where to start or they may be afraid of someone getting hurt or using a term improperly, so they don't try because they're nervous about hurting someone."

Stronger provider education fortifies the medical workforce and expands the number of clinicians able to see and treat all patients equitably. Additionally, education helps strengthen and grow the community that props up LGBTQ+ healthcare efforts. As Oosting stated, the community is large, but they can't go it alone.

Providers, equipped with the knowledge to treat and partner with LGBTQ+ individuals, must now join in advocacy efforts as certain types of LGBTQ+ healthcare are being limited.

Using clinician advocacy to transform policies

One of the key strengths of the LGBTQ+ population is its ability to foster a sense of community that can readily offer social support, Oosting said.

From building social networks, ensuring PrEP access to all who need it, to outreach campaigns for STI testing and mpox vaccination, the LGBTQ+ community has learned how to work around the disparities it faces.

"In terms of the resilience of the community, every rollback or potential rollback of care has triggered an equally robust network of care and innovation of care," Oosting explained. "This includes community-funded telehealth, statutes for shield states or states welcoming folks to come to our states for care."

Ideally, there'd be no need to work around legislation and policy, Oosting indicated. But in reality, the LGBTQ+ community is facing policy-driven limitations in healthcare access, especially gender-affirming care access.

"Our task as a healthcare community is to scale up those bright spots of the healthcare vision faster than the barriers multiply," Oosting said. " We are working as fast as possible to mitigate that elimination so that folks can continue to receive lifesaving gender-affirming care. And it is lifesaving. All of the numbers point to that."

Notably, the American Medical Association has taken a stance against policies restricting gender-affirming care, while the American Academy of Pediatrics has asserted that the treatment is evidence-based. Restrictions on gender-affirming care infringe on the patient-provider relationship, AAP said in a recent joint statement signed by five other leading medical associations.

But in order to effectively push back against restrictive policies, Oosting said healthcare professionals must lend their voices to the science.

"When we, as individuals, bring our individual voices of the community to policymakers, it can really help shift that needle," Oosting said. "As clinicians, we are trusted messengers. When we speak out, it cuts through the partisan noise of these policies. People hear their most trusted clinicians saying, 'this is what our expertise is, and here's what the clear-cut ethics are of these issues.'"

Ultimately, advocacy is a form of care, Oosting asserted, and it's incumbent upon healthcare providers to engage in it as a part of their professional responsibilities.

"Care does not end at the bedside," she concluded. "It travels to the curriculum, it travels to the legislature, it travels to the insurance plans, and it builds resilience. It builds resilience in our communities because we know that we're not alone."

Sara Heath has reported news related to patient engagement and health equity since 2015.