An article recently appeared in the Chicago Tribune that really got me thinking about what we do here at the National Coalition for LGBT Health. What do we want for the LGBT community? What is so wrong with the current healthcare system? Why, essentially, do we do what we do?
The article, titled “Mystery patients help uncover medical errors,” discussed how many doctors suggest a diagnosis or care plan without knowing background like a patient’s socioeconomic status. The article’s real-life example was that of an older, emaciated man who was being screened for cancer, which was thought to be the cause of his low weight:
"Where are you living?" [the doctor] remembers inquiring. "I move around a lot," the haggard man responded. [The doctor] then asked if his patient was eating regularly. Sometimes, but not every day, the man admitted. A diagnosis snapped into focus: The disheveled patient was homeless and starving. [The doctor] canceled the medical tests and called in a social worker.
To test whether or not doctors would notice clues to or ask about a patient’s socioeconomic status, a team of Chicago researchers sent actors playing sick patients into hospitals across the nation. The actors stuck to a script that dropped hints about their personal situations that should have changed the doctor’s diagnosis and treatment plan, had they paid attention to them. In almost all of the cases, the doctor failed to notice.
What if the older man in the example above had been LGBT-identified? Would the doctor’s knowledge of this have had any impact on his health?
Most likely, yes.
Data collection on most federally-funded health and demographic surveys, the method by which the federal government designates money for various health programs and makes health recommendations such as those outlined in Healthy People 2010, excludes questions about sexual orientation and gender identity. Many health practitioners fail to ask their patients these same questions. Knowledge of a patient’s gender identity and sexual orientation can drastically improve the accuracy of the care they receive, as a non-judgmental doctor who respectfully takes a detailed patient history can offer more comprehensive care. Had the doctor been able to identify the patient in the above example as a gay elderly homeless man through open discussion with the patient, he would have been able to offer additional health services that this man may have needed, such as free HIV screening and referrals to LGBT-friendly housing services and other resources.
Undisclosed gender identity, too, can be a huge factor in properly assigning a patient’s care. For example, without feeling comfortable telling their doctors they are transgender, patients may not receive appropriate preventive care, such as a transgender man needing a pap smear to check for cervical cancer, or a transgender woman needing a prostate exam to check for prostate cancer.
In effect, all LGBT patients are "mystery patients." Being LGBT has a major impact on health outcomes (for some amazing fact sheets on this, please click here), and the healthcare system should equip its practitioners with the knowledge to positively affect LGBT lives through expanded competence. If practitioners ask good questions about a patient’s background, and LGBT patients feel that they can openly advocate for themselves without fear of receiving care of a lower standard (or no care at all) due to their identification as LGBT, both parties will have worked together to ensure a correct diagnosis and plan of care. Making LGBT lives visible within the healthcare sector and ensuring confidential and respectful doctor-patient dialogue on sexual orientation and gender identity is essential to providing accurate care in the most welcoming environment.
What are your thoughts? Are you out to your doctor? Have you ever had a practitioner ask you your sexual orientation or gender identity? Did they not, and did it affect your care? Feel free to respond below.
This piece was written by Dara Kagan, policy intern at the Coalition.