Last Updated: Jun 28, 2021
By Tamar Carmel, MD
As Pride month draws to a close, let’s take this time to reflect on how we can best support our LGBTQ+ patients, friends, and family members. According to the latest Gallup1 assessment from 2020 of more than 15,000 interviews, 5.6 percent of U.S. adults identify as LGBT, of whom 54.6 percent identified as bisexual, 24.5 percent and 11.7 percent identified as gay and lesbian respectively, and 11.3 percent identified as transgender. A recent study2 of U.S. high school students in an urban, mid-sized U.S. city, one of the largest community samples and the most racially and ethnically diverse to date, found that nearly 10 percent of high school youth have a gender-diverse identity (i.e. transgender, nonbinary, agender). We can postulate that increasing awareness, understanding, visibility, and acceptance of LGBTQ+ identities in the U.S. has helped individuals come out earlier in life to live their truths as their authentic selves.
However, societal discrimination and victimization of LGBTQ+ individuals, including in health care settings, and associated health care disparities persist.3 The cause of which is multifactorial, related to:
- Lack of LGBQT+ education and training in medical schools, residencies and fellowships, and other clinical training programs
- Lack of LGBTQ+ competency training of ancillary medical staff
- Limited research on LGBTQ+ health care needs
- Lack of LGBTQ+ inclusion/demographic questions in broader health care research
- Less access to health insurance
- Less access to health care services in general
- Lack of access to safe, culturally competent and affirming health care
- Discrimination in health care settings
- Outright denial of care by insurance companies and health care providers
Furthermore, because of experiences of trauma and discrimination in health care settings, as well as fear and anticipation of such, LGBTQ+ individuals avoid needed health care. All of these factors contribute to LGBTQ+ health care disparities. LGBTQ+ individuals are less likely to get preventive screens, access health care at later stages of illness/disease, and overall have worse physical and mental health outcomes compared to cisgender, heterosexual peers. Certain populations within the LGBTQ+ umbrella, such as LGBTQ+ elderly folks and communities of color, have even worse health care outcomes due to the increased burden of societal discrimination, even less access to social services and health care resources, and institutional discrimination (i.e. structural racism, ageism, ableism, transphobia, trans-misogyny, etc.).
To break down these health care barriers, it is important for us as physicians to regularly engage in LGBTQ+ cultural competency and health care trainings, openly identify ourselves as LGBTQ+ competent and affirming so that patients can find us to access needed medical care, and be cognizant of the health care disparities and needs of LGBTQ+ populations to be able to provide high quality care.
The Pennsylvania Medical Society is looking for physicians to help bridge the health care divide in LGBTQ+ communities by connecting patients to affirming physicians. We encourage you to identify yourself as LGBTQ+ affirming by adding your name to PAMED's list. We plan to provide this list publicly on PAMED's website to assist LGBTQ+ patients seeking care.
Tamar Carmel, MD
Pronouns: he/him/his
Medical Director of Mental Health Services at Central Outreach Wellness Center
Pittsburgh, PA
References:
- https://news.gallup.com/poll/329708/lgbt-identification-rises-latest-estimate.aspx
- Kidd KM, Sequeira GM, Douglas C, et al. Prevalence of Gender-Diverse Youth in an Urban School District. Pediatrics. 2021;147(6): e2020049823
- https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health