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How hospitals are stepping up efforts to best accommodate LGBTQ patients

JoAnn Schramm, 63, likes it when people call her JoAnn. The Ohio-based retired plumber and pipe fitter especially likes it when she’s in a room full of people so that everyone will be on the same page. After all, when you’re slated for gender reassignment surgery, you want to be treated like the gender you are.

Schramm used to go by Joseph, but she hasn’t worn men’s clothes for over a year. She says people don’t make a big deal about her gender at the Cleveland Clinic, where she is set to undergo the procedure soon. But many transgender people are afraid to get health care at all for fear of discrimination.

While Schramm may not mind if she gets called the wrong name — she knows doctors are busy, and offered nothing but praise for the hospital — these and other issues are cause for concern for the transgender community. According to a 2009 survey by advocacy group Lambda Legal of 4,916 LGBT people and those living with HIV, 30 percent of respondents said they were afraid medical personnel would treat them differently because of their gender expression and presentation. More recent research in the 2015 U.S. Transgender Survey Report, for example, found that in the year prior, nearly one-quarter of respondents claimed they didn’t seek health care on account of mistreatment fears related to their transgender identity.

Hospitals and health care facilities have been stepping up efforts to best accommodate LGBTQ patients by implementing new protocols and processes. But despite these developments, there are still many steps hospitals and health care providers can take to ensure optimal care.

[See: 10 Lessons from Empowered Patients.]

Treatment Concerns

Treatment concerns lurk for LGBTQ patients (the terms LGBT and LGBTQ are used somewhat interchangeably in the community). Lambda Legal’s study found that 73 percent of transgender patients in particular feared that medical personnel would treat them differently because of their identity. And 89.4 percent of transgender respondents felt there weren’t enough health professionals adequately trained to care for people who are transgender.

James Lehman, a gay psychiatry resident at UW Health in Madison, Wisconsin, added that LGBTQ patients often don’t have the expectation of being treated with dignity — and therefore often withhold key information from medical professionals.

Zachary Zane, a bisexual writer who lives in New York, says he felt blatantly discriminated against because of his sexual orientation in a recent medical encounter.

“Just went to see a new doctor in NY. He didn’t know of [ Truvada, pre-exposure prophylaxis for HIV prevention]. I explained what it was,” Zane recounted in a June Facebook post. “He said most people wouldn’t need that and refused to prescribe it. He then shamed me for my ‘lifestyle’ and said I wouldn’t have these problems if I settled down with a woman monogamously.”

Even clinics that tailor care to the LGBTQ community aren’t immune from missteps.

Before receiving care at the Pediatric and Adolescent Transgender Health, or PATH, clinic at American Family Children’s Hospital in Madison Wisconsin, for example, Beth*, then a young transgender teen, encountered a health care provider who misgendered her. Later, she was able to change her gender marker on her medical record, as well as her preferred name. Once that happened, people stopped making mistakes, her mother Sandra* says. Beth is 19 now. (*For their privacy, Sandra asked that U.S. News withhold their real names.)

“Even when there was a lot of goodwill, there was a lot of silence around the health and wellness of LGBTQ youth,” says Dr. Brittany Allen, a pediatric and adolescent medicine provider at the PATH clinic. While some hospitals have made significant improvements, issues persist, she says.

[See: How to Find the Best Mental Health Professional for You.]

What Hospitals Are Doing

Hospitals and health care facilities are taking a variety of approaches to offer more inclusive care amid a broader cultural shift toward LGBTQ acceptance, from ensuring patients’ preferred names appear in electronic medical record systems to creating employee resource groups that advocate for LGBTQ patients and staff members.

Several hundred hospitals and health care facilities around the country have earned the designation of LGBTQ Healthcare Equality Leader from the Human Rights Campaign as part of its 2017 Healthcare Equality Index, a rating project and resource for LGBTQ care-affirming hospitals. The Human Rights Campaign surveyed and scored 590 participating hospitals and health care facilities on four topics: non-discrimination and staff training; patient services and support; employee benefits and policies; and patient and community engagement.

One of the 303 recognized facilities is UW Health, the Madison, Wisconsin-based health system that includes University Hospital and American Family Children’s Hospital, among other branches.

Under the leadership of the PATH Clinic’s Allen, the system launched an LGBTQ task force in 2013, which strives to build an equitable and affirming experience for LGBTQ people and their families throughout UW Health. That includes continually tailoring care to best meet their needs, according to chief diversity officer Shiva Bidar. The task force has focused on educating staff on issues facing LGBTQ patients in addition to adding inclusive language to medical forms (i.e., “spouse” or “partner” instead of “husband” and “wife”). Currently, the hospital is working on a sexual orientation and gender identity form to include in the electronic medical record as well as the creation of employee resource groups. These groups are meant to create a visible community for diverse populations in a given organization and to leverage the unique skills of these groups for the overall good of the organization.

Bidar notes that UW Health is making a concerted effort to cater to traditionally marginalized populations — such as the LGBT community — “that have suffered from longstanding disparities in their health outcomes.”

New York Presbyterian Weill-Cornell — one of the campuses of New York-Presbyterian University Hospital of Columbia and Cornell — is one of several other hospitals focused on improving care for LGBTQ patients and families. This includes everything from offering ongoing staff training online in conjunction with the Human Rights Campaign to engaging more actively with the local LGBT community through various partnerships. The hospital was the official medical sponsor of New York City Pride this year, for example.

[See: What Your Doctors Wish You Knew.]

What Hospitals Can Do Better

While it’s a positive sign to see hospitals and health care facilities taking steps like tweaking paperwork to be more accurate and inclusive, experts say more action is needed moving forward. To further improve care, they offer a number of possible solutions.

Figure out what works best for your population. Are patients more comfortable going to LGBT centers, or would they visit a physician in a hospital-affiliated primary care clinic along with the rest of the general population? Cleveland Clinic went with an embedded primary care model (meaning it doesn’t segregate its LGBTQ population from its general patient base) for a number of reasons. For one thing, it helps LGBT people realize that the issues they face are somewhat common to all.

“Some areas such as STD and HIV care, and primary care for transgender patients, require specific knowledge or competencies, which our caregivers possess while still being embedded within a primary care clinic, such as a larger internal medicine or family medicine practice,” says Dr. James Hekman, medical director of Cleveland Clinic’s Chagrin Falls Family Health Center and Lakewood Family Health Center.

Hekman adds that biological sex still plays a role when it comes to taking care of transgender patients because of “the way the body metabolizes medications.” Says Hekman: “We don’t yet understand how the interplay between sex of birth and hormonal and surgical therapies can affect drugs used for other medical purposes.”

Listen to your employees. This is where employee resource groups come in. Lehman says these groups can offer powerful consult on a variety of issues. A hospital or health system can turn to this group whenever any kind of population health intervention is being launched, be it for HIV or obesity, to ensure it’s being inclusive of LGBTQ people. Such groups can also be a support system for employees interested in or affected by LGBTQ issues.

Understand the needs of individual patients. How many of your patients are asking for PrEP? Which pronouns does your patient prefer? These questions and more will come up for the LGBTQ population.

Juan Mejia, vice president of operations at New York Presbyterian Weill-Cornell campus and chair of the New York Presbyterian LGBTQ Task Force, says understanding the patient as a unique individual is very important.

“The worst thing we can do is have patients feel uncomfortable or scared while they’re receiving care in our hospital,” Mejia says.

Lehman adds that giving patients high-quality care means acknowledging them fully for all pieces of their identity, and understanding how their experience has been shaped by it.

Schramm may be OK if people mess up her pronouns — she’s had enough trouble with them herself. But if getting it right makes her and patients like her feel good, why not take the extra step?

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