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Tackling LGBTQ+ Bias in Healthcare


The chief medical officer for Grand Rounds Health and Doctor on Demand says the healthcare industry needs to be committed to creating equitable and inclusive environments.

Diversity, equity, and inclusion have become part of the national conversation, yet biases based on race, cultural and sexual orientation, and gender identity still pervade the medical profession. Everyone deserves to be understood and be cared for fairly and competently by their healthcare providers. However, systemic social and environmental barriers are still prevalent in our country. For too many in the LBGTQ+ community, those barriers stand in the way of a person’s ability to effectively manage their health. It is well past time that we consider how the medical community can and should overcome these barriers and raise the standard of care for everyone.

Ian Tong

Ian Tong, M.D.

Healthcare challenges for the LGBTQ+ community

The LGBTQ+ community is highly underserved by the U.S. healthcare system. LGBTQ+ people face discrimination at rates that far surpass the non-LGBTQ+ population. In a national study with over 1,000 LGBTQ+ employees from Fortune 100 companies, nearly half reported a negative healthcare experience or discrimination in a healthcare setting. According to a 2017 survey by the Center for American Progress, 29% of transgender respondents reported that a healthcare provider had refused to see them because of their sexual orientation or gender identity.

This discrimination leads to distrust of healthcare providers and care avoidance. The LGBTQ+ community postpones or avoids care at a rate that is two to three times greater than the broader U.S. population — putting their physical and mental health at risk. This is devastating for a community that already experiences physical and mental health issues at higher rates than their cisgender and heterosexual counterparts.

Creating more inclusive healthcare experiences

The healthcare industry needs to be committed to creating equitable and inclusive environments in which every patient feels safe and confident in knowing their provider is clinically and culturally competent, if not culturally concordant. Historically, the medical profession has struggled to achieve adequate diversity across its physician workforce, making it harder for the LGBTQ+ community to feel comfortable seeking care in the first place. This is unacceptable.

Health and medicine represent one of the largest industries in the U.S. Those who work in the field must reflect the diversity of our nation. There's a difference between true representation and tokenism. It requires the recognition and dedication of those in power to address the problem and to balance the scale. These efforts must start at the top. Healthcare organizations need to hire and promote those who identify as LGBTQ+ into leadership positions.

In addition, healthcare leaders should review and revise policies and practices to promote inclusion, advocacy, antiracism, and other forms of active anti-oppression, and encourage language that promotes diversity, inclusion, and representation. They may also consider resources to help manage implicit biases, such as cultural competency training and continuing medical education on providing more effective and personalized care.

A lack of diversity is not only obvious in clinical practice, but also in medical school curricula across the country. Too many medical students, including myself, graduate without the tools or training to provide appropriate “allyship” to LGBTQ+ patients. Providing medical students with training to increase provision of culturally competent care is essential. This includes training on how to appropriately inquire about and be supportive of a patient’s sexual orientation and gender identity to enhance the patient-provider interaction and regular use of care.

Improving healthcare outcomes

Hope for a more inclusive and equitable future is on the horizon, but the stark reality of today is that discrimination is pervasive in our country and is negatively impacting people’s health and wellbeing. We can help ensure everyone benefits from better health outcomes by connecting our patients – especially those who are otherwise underserved by our traditional healthcare system – to better healthcare providers and resources to meet their unique needs.

The most successful clinical outcomes and patient-to-clinician relationship is one that is built on trust. Finding a clinician that patients can identify with can help build trust and increase their confidence in going to the doctor. But it doesn’t end there. We must individualize the care we provide to the physical, social, and emotional needs and experiences of our patients. Care filled with implicit bias will never achieve the standard set by care that is culturally concordant. A one-size-fits-all approach to healthcare doesn’t work. Instead, offering individualized care is key to inclusivity and driving equitable outcomes.

As we celebrate LGBTQ+ Pride this month and throughout the year, we must remember that we as physicians and practitioners have an ethical imperative to be the change we want to see in healthcare. In order to raise the standard of care for everyone, we must truly understand the unique needs and preferences of the diverse members we serve, actively identify opportunities for improvement, and hold ourselves accountable for delivering compassionate, affirming care to all.

Ian Tong, M.D., is chief medical officer for Grand Rounds Health and Doctor On Demand.

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