Being an LGBT-Friendly Physician

If you weren’t aware, today is National Coming Out Day, and especially in the wake of the multiple gay teen suicides recently and 9 teenagers and young men torturing 3 men for being gay, I’d like to at least do my part to educate my fellow emergency physicians. This is a post I wrote several years ago, when I was still a wee, doe-eyed, innocent medical student, but it’s still applicable today.

A couple updates:

  • Refer to a transgender patient by his or her current gender. Or better yet, ask them how they prefer to be referred to or what name they’d like to be called. My brain forces me to struggle with this sometimes, too, but if they’re male to female transgender, refer to the patient as “she” or “her.” I’m ashamed to say I’ve heard people refer to these patients to their faces as “it” or “whatever you are.” Offensive.
  • HIV is not just a gay disease. Please please please, let’s stop with the board review questions where the tip off that it’s PCP pneumonia is that the person’s gay. I’d love to read a question that has to do with a lesbian with a broken ankle or a bisexual guy with lupus.

(Note: most of these other tips are taken from The ABCs of Sexual Health, in the BMJ, and Creating a Safe Clinical Environment for Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Patients, an excellent guide (pdf) free from GLMA.) These are not monumental, folks. It’s the little stuff that counts. Trust me.

Above all, listen, don’t make assumptions, and always be respectful.

Creating a Welcoming Environment:

  • Lesbian, gay, bisexual, transgender, and intersex (LGBTI) patients often “scan” an office for clues to help them determine what information they feel comfortable sharing with their health care provider.
  • Post a visible non-descrimination policy.
  • Put up a small rainbow or pink triangle. (I know, I hate them too, but seriously, a little goes a long way for LGBT patients.)
  • On the intake form, try “partner” instead of “spouse.” And include choices on the “Sex” category besides just “M” and “F.”

On Interviewing:

  • Try using gender-neutral words. “Are you currently in a relationship?” as opposed to “Are you married?”
  • “Do you have a girlfriend or a boyfriend?”
  • “Is there another parent?” as opposed to “Is there a father?”
  • If a patient comes out to you, recognize that you are glad they felt comfortable mentioning it, and that it’s not an easy thing to do.
  • Assess how the process is going–you may be the first person they’ve ever told.
  • Again, listen. Follow the patient’s lead.
  • Ask about sexual history honestly and openly. If you’re unsure on what or how to ask, try to let the patient explain–and let them know about your ignorance.
  • Just because someone is in a same-sex relationship doesn’t mean violence doesn’t happen.

On Counseling:

  • Be honest with yourself; if you are uncomfortable with gay people refer the patient to someone else.
  • If an adolescent is confused about his or her sexuality try to help the patient to adjust.
  • Do not have preconceived ideas.
  • If you don’t know the answer to a question, find out for the patient.
  • Know what LGBT resources are available in your area.

If you have questions or comments, please post them here; it’d be great to have an open forum to figure these issues out if you’re unsure about them.

Update: Two more great resources from AMSA: Do Ask, Do Tell, and the June 2001 issues of the AJPH.

  1. #1 by Don - October 11th, 2010 at 21:15

    Thanks for the reminder.

  2. #2 by Marianne - November 16th, 2010 at 15:36

    This reminds me of my most embarrassing moment in my entire career. I went to see a female patient with extremely close-cropped hair. Another woman with a similar haircut was sitting with her. Trying my best to be welcoming and inclusive I asked, “Are this your friend? Family? Partner?” Turned out my patient was a cancer patient and she was with her mother, who had shaved her head in solidarity.
    It seems awkward and intrusive to ask a visitor, “What is your relationship?” so instead I now just ask the patient, “And who is this here with you?” and I leave it at that.

  3. #3 by Marianne - November 16th, 2010 at 19:19

    Is this, not are this. Ugh.

  4. #4 by Marianne - November 16th, 2010 at 19:20

    “Is this”, not “Are this.” Ugh.

  5. #5 by Gary Edwards - July 23rd, 2012 at 12:12

    This is becoming more of a problem nowadays as no one wants to offend anyone. Marianne’s solution is quite apt.

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