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    5 ways to let LGBTQ patients know that respect awaits them at your office

     

    Use the patient’s preferred pronoun consistently, and make sure that other staff members do so as well. Place a big note in the patient’s chart in such a way everyone who cares for that person will see it and know how to address them.

    In a related matter of language, if you need to do an exam that involves the genitals, ask the patient how they refer to those areas of their body. Iroku-Malze gives the example of a transgender man, who was considered female at birth.

    “They may not want to refer to the vaginal area of their body as their vagina. That is a part of their body that they are not comfortable with,” she says.

    In that kind of situation, if you need to do a cervical exam anyway, go slowly. Be circumspect. “You can’t just get the speculum and get the exam done right away. You have to gain trust and make this exam as comfortable as possible acknowledging that they identify as male,” says Iroku-Malize. You might need to gently explain each step of the exam. “Okay, I am about to approach x and I will do this and do that.” 

    Taking the time to respect their sensitivities and use their preferred words affirms the patient’s identity, she explains. “Everything I do as a primary care provider acknowledges who they are as a person,” she says.

    Be honest with the patient,” says Iroku-Malize. “Say, ‘I am not experienced with this and I need you to guide me in what is appropriate and not appropriate as I am speaking to you so this encounter is comfortable for you.’” Tell them that you need their help to gain their trust and be as helpful as possible, she suggests.

    [3] Scrupulously uphold confidentiality for these patients.  Patients can only be honest and open with you if they trust you to zealously protect their health and lifestyle information. “The provider must be confidential, acutely sensitive and aware that there are places where this [being a queer person] could lead to job loss or to the patient’s family members being ostracized,” says Iroku-Malize. 

    [4] Own your own limitations. Be self-aware enough to recognize if your own discomfort or disapproval disqualifies you from caring for a gender-nonconforming patient. If so, be prepared to refer those patients to clinicians who will welcome and care for them well. If there is no one in your area that seems appropriate, you may need to learn about good telemedicine options for these patients.

    Iroku-Malize says that her healthcare system, Northwell Health, has established a dedicated referral service for members of the queer community.

     “More and more healthcare systems are doing that,” she says. This simplifies the patients’ search for quality care.  

    [5] Create a welcoming waiting room. If you have pictures of happy families in that area, include families of different sorts. “Even having a small rainbow flag in the waiting room says to patients, ‘You are welcome here,’” says Iroku-Malize.

    Make sure that your staff understands the basics of serving queer patients. “Anyone working in primary care has to be culturally sensitive to the gender identities of patients coming in,” says Iroku-Malize. Training resources are available to you and your staff. 

    For instance, this is relevant guidance from the American Academy of Family Physicians. The Human Rights Campaign Foundation also offers resources to healthcare providers. Be curious and willing to keep learning.

    Remember, queer patients who arrive at your office are likely to have had unwelcoming encounters elsewhere.  In fact, you may be the third or fourth primary care provider that a gender-nonconforming person has turned to, and the first three or four may have been condescending, dismissive or judgmental says Iroku-Malize.

     “You don’t need to be an expert in managing this,” says Iroku-Malize. She emphasizes that being willing to listen and learn and wanting to help are all that it takes to make a big difference in the lives of these vulnerable patients. 

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