Why safe spaces in healthcare are important for LGBTQ+ patients

Andrew, a 39-year-old New Yorker who identifies as gay, says his first primary care provider was very gay-friendly.

“He was straight, but he was raised by two fathers who created a very welcoming environment for him,” Andrew told ABC News about the former doctor.

Andrew says when his doctor transferred, he realized how important it was to his health. The new doctor was less familiar with strange problems, he says. “There were always barriers and discomfort,” he says.

Andrew said he had trouble communicating and didn’t feel like he could tell his doctor everything. “You’ve had experiences with doctors who were queer-friendly, and you’ve had doctors who weren’t queer-friendly, so you understand the importance of not being judgmental,” he said.

Experts say being able to have open conversations about sexual identity can be important for health care, especially when it comes to issues such as proper general health, sexually transmitted infections, and mental health testing.

The LGBTQ+ community faces disproportionate barriers to health care, including untreated depression and anxiety, untreated cardiovascular health risks, and missed vaccinations to prevent infectious diseases and even cancer. Studies have shown that this can lead to poor health outcomes.

However, many members of the LGBTQ+ community feel unable to talk openly with their doctors. In one study, 39% of bisexual men and 33% of bisexual women reported not disclosing their sexual identity to health care providers, often for fear of stigma or criticism.

Some members of the LGBTQ+ community fear discrimination, and others report being refused treatment by health care providers solely because of their sexual orientation or gender identity. Research shows that fear of overt discrimination or implicit bias can deter people from seeking treatment and prevent them from receiving recommended health tests.

“Some of the barriers are around access, and some are around willingness to participate in the health care system,” says Dr. Renee Crichlow, vice chair for health equity in the Department of Family Medicine at Boston University School of Medicine.

Dr. Critchlow also points out that a major problem is that LGBTQ+ people are less likely to receive consistent primary care. This is why women in the LGBTQ+ community are significantly less likely to receive preventive health care than other women, according to a study published in the Journal of Urban Health. After adjusting for other factors, these women had a 1 in 10 chance of having a timely Pap test and a 1 in 4 chance of having a timely mammogram, the study said. . As another study has shown, this likely contributes to the increased incidence of various cancers in that community.

Healthcare providers can, and many do, take steps to address disparities and reduce these barriers. Providers can implement intentional strategies to recognize and overcome implicit bias. This involves asking patients open-ended questions without assumptions or judgment. “If people don’t feel comfortable in a medical environment, you need to create a safe atmosphere very clearly,” says Dr. Crichlow.

For patients, there are resources to help find an LGBTQ+-affirming health care provider near you, including GLBT and GLMA: Health Professionals Advancing LGBTQ+ Equality. And Dr. Crichlow’s advice is to use the community as a resource. “Check with your friends and colleagues. Is there a reliable clinic they can go to?”

And bring a friend along and say, “You don’t have to do these things alone. There are many people out there who are willing to engage with the LGBTQ+ community in compassionate and supportive ways. If your first clinic doesn’t work. ‘Trust me, there’s another place for you,’ says Dr. Crichlo.

Alex Sheldon, executive director of GLMA: Health Professionals Advancing LGBTQ+ Equality, said patients can also try having a candid conversation with their current doctor. “Express your concerns, emotions, and discomfort in a respectful and firm manner. Your provider may not be aware of your concerns, and addressing them directly may improve the relationship. “There’s a gender,” Sheldon says.

If you’re not satisfied with your current doctor, Sheldon says you may be able to use telemedicine for some services.

Additionally, LGBTQ+ youth struggling with depression or anxiety can contact The Trevor Project’s Crisis Helpline. Individuals in the transgender community can contact the Trans Lifeline Peer Support Hotline to connect with resources such as mental and health care services. Finally, Sheldon says people can reach out to patient advocacy groups and support networks to learn more about their condition and treatment options.

Even when LGBTQ+ patients find a doctor they feel comfortable with, they don’t necessarily know what issues to raise. GLMA provides patients with resources on things to remember to discuss with their doctors. These include things all patients should discuss, such as screening, heart disease risk factors, and concerns about diet and exercise. But for those in the LGBTQ+ community, there’s more to consider, including the risk of intimate partner violence, her PREP for HIV, and screening for depression and anxiety.

There are also things trans patients should discuss, such as questions about side effects from hormone therapy and drug interactions.

As for Andrew, he said he has found a doctor he trusts again, and that has made a big difference. “Now every time I go to the doctor, I have a nice conversation. I feel safe knowing it’s not just a sterile environment, it’s a place I trust,” he says.

Elizabeth Gundakley, MD JD, is a resident physician in internal medicine at the Cleveland Clinic in Ohio and a member of the ABC News Medical Unit.

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