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Disparities in the access and availability of needed services significantly affect the health and wellbeing of the LGBTQIA+ community.
Two experts outline some of the issues behind care inequities and what Swedish is doing to address the problem.
March 20 – 24 is National LGBTQ Health Awareness Week – an annual event dedicated to raising awareness about the health challenges LGBTQIA+ people regularly experience.
Discrimination, disrespect and prejudicial policies should never be part of anyone’s health care experience. But for many members of the LGBTQIA+ community, disparities in care are often commonplace. And the toll it takes on patients’ mental and physical health can be significant.
March 20 – 24 is National LGBTQ Health Awareness Week, an annual recognition week sponsored by the National Coalition for LGBT Health to raise awareness and offer solutions that promote health and wellness for the LGBTQIA+ community.
We talked to two health leaders at Swedish who are working to improve equity and access to care for the LGBTQIA+ population to get their insights into the issues they deal with daily. Here’s what they shared.
“LGBT healthcare is something we need to think about every day, every month, every week, every year – not just once a year,” says Kevin Wang, MD (He/Him), medical director of Swedish’s LGBTQI+ Program. “It's not just putting up banners on our website and raising the Pride flag. It's about integrating LGBTQIA+ awareness into as many places as possible within our institution.”
Dr. Kevin Wang, medical director of Swedish's LGBTQI+ Program, discussed the program on KING 5's New Day Northwest.
Dismissed, ignored, mocked and misgendered
“Understanding why healthcare disparities exist in the first place begins with being aware of some of the historical context,” says Dr. Wang. “One of the reasons these inequities exist is because there is a shortage of knowledgeable clinicians providing care for the LGBTQIA+ populations. But it also goes back to the biases and the responses we have as a result of the environment in which we grew up.”
Research by the Substance Abuse and Mental Health Services Administration found that LGBTQIA+ persons have physical, emotional and sexual health needs that are routinely dismissed or ignored by their care providers.
- Between 16 and 60% of transgender people are victims of abuse or physical assault and intimate partner violence is a continuing problem.
- People with same-sex partners often experience increased rates of depression, post-traumatic stress disorder and other mental health issues.
- Gay men are more likely to have poor body image and more likely to experience eating disorders such as bulimia and anorexia than their straight counterparts.
- Up to 32% of transgender people have attempted suicide and up to 65% have considered it but not taken action.
- Lesbian and bisexual women may have a significantly higher risk for breast cancer than heterosexual women.
- Alcohol and substance abuse rates tend to be higher for the LGBTQIA+ community than are experienced by their cisgender peers.
The reasons for this vary widely, according to Dr. Wang.
“LGBTQIA+ patients are no more likely to get a chronic condition than anyone else,” says Dr. Wang. “It's not that they're more prone to chronic conditions because they're LGBTQIA+. It might be because their LGBTQI+ identity is all the clinician thinks about when they meet them,” he adds.
“Usually, when someone who identifies as LGBTQIA+ goes for care, a lot of clinicians start with the assumption the first thing they need to do is to make sure the patient doesn’t have any sexually transmitted infections and HIV. They start with questions like, ‘Do you do drugs? Do you smoke? Do you drink?’ They don’t look at the whole person because of their biases and some of the societal "understanding" of the LGBTQIA+ community,” says Dr. Wang.
Knowledge builds understanding
Inadequate training and education about the unique health challenges of LGBTQIA+ persons hampers care on many levels. Swedish is addressing that need with a program for caregivers and physicians designed to improve their understanding of the community for which they provide care.
“Historically, the medical system has not been kind to the LGBTQIA+ community. We have made a lot of strides, but we're still nowhere near there,” says Vinny Fox (They/Them), senior program coordinator for LGBTQIA+ education and team lead of the LGBTQI+ Program at Swedish.
“Lack of training is a problem that affects all providers when it comes to their LGBTQIA+ patients. Certainly not just doctors, but physician assistants, nurse practitioners, midwives, nurses, people on our environmental services team, our front desk staff . . . everybody, right? We often don't create an environment where people want to come for support on their health journeys," says Dr. Wang.
The health consequences can be substantial.
"Many LGBTQIA+ people would rather deal with whatever they've got going on than risk going into an office and being mistreated, harassed, misgendered, mocked and looked down on. It's just easier to deal with whatever medical problems you have yourself rather than going out and seeking medical assistance,” agrees Vinny.
“We are all people regardless of gender identity and sexual orientation,” explains Dr. Wang. “We all have different sexual practices. We all have different behaviors. But when we start putting people who are LGBTQIA+ into this whole category of, ‘All I really need to talk with you about is sexually transmitted infections and drug use,’ then it misses the rest of the person.”
Respectful communication is a vital first step in creating an inclusive environment.
“It's about meeting your patients where they're at and getting to know them. It's about deferring to the language patients use for themselves rather than just making assumptions,” says Vinny. “It’s about asking questions like, 'Are you comfortable? Do you need to have somebody in this appointment with you? What are your concerns?’ Don’t immediately think, 'Oh, it's a gay man. Therefore, we must talk about STIs.’ Or ‘you're transgender. Therefore, everything you come in must be related to gender dysphoria. I know you're here for a broken arm, but somehow, it's still related to your gender.”
“I think we definitely do try to have that inclusive culture at Swedish. I never want to say that we do because there's always work that can be done. But we are definitely working towards that and doing the most we can,” adds Vinny.
We see you, we hear you, we stand with you
“We give everybody who sees patients who goes through training the option of being listed on an external website as LGBTQIA+ health informed. That helps patients find someone,” says Vinny. “We try to get more and more providers to sign up for that every day. It makes it easier for patients to know that they're meeting with someone who has gone through training and been taught the basics of what it means to care for LGBTQIA+ people.”
“The work that I do covers a lot of basics. I start everyone off with a one-on-one introduction course. We talk about making sure you're calling people by the right names. We discuss using the correct pronouns, sharing your pronouns and asking others theirs. We teach providers how to start the conversation so patients will feel more comfortable getting the care they need,” says Vinny.
Other inclusivity efforts at Swedish include:
- Using gender-inclusive pronoun pins for clinicians and team members
- LGBTQIA+ competency training for providers of all types
- Construction of all-gender restrooms
- Gender-inclusive language on signage, intake forms, brochures, pamphlets and other patient education materials
Even in the best of circumstances, mistakes like using the wrong pronoun or addressing someone incorrectly, happen, says Vinny. The key to success is identifyng these teaching moments and leaning into them to change behavior.
“We're all human and we are all going to make mistakes. Everyone is going to say the wrong thing at some point. It's not a matter of if. It's a matter of when,” says Vinny. “So, when it happens and you correct yourself, the patient corrects you or someone else corrects you, you take that with grace and continue on with whatever you're doing.”
“In training, I talk a lot about correcting each other but never taking it as a personal attack. If someone corrects you, that does not mean they look down on you or think you're a horrible person. Take the correction and continue on with whatever conversation you're in. The more you focus on the mistake, the more it makes it worse. Treat it as you would any other mistake you would have made. Correct it and carry on with what you're saying,” says Vinny.
Learn more and find a provider
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.