How to Address Healthcare Disparities in the LGBTQ Community

• Members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community are among those who face healthcare disparities.  
• Understand and address gender identity as part of the healthcare process.  
• Be aware of your own biases that might interfere with the therapeutic relationship between nurse and patient.  

In America today, there are still disparities in some people’s healthcare. One of these disparities has to do with the people from the lesbian, gay, bisexual, transgender, and queer (LGBTQ) population. Some healthcare disparities for this group are related to the differences in their sexual behavior and their health risks, “but others are associated with social and structural inequities, such as the stigma and discrimination that LGBT populations experience,” according to the Centers for Disease Control and Prevention (CDC). In addition, this population is also often undertreated due to the “lack of healthcare providers’ awareness and insensitivity to the unique needs of this community,” according to a 2017 literature review in “Cureus,” a peer-reviewed medical journal. Some of those needs, which can lead to mental and physical health problems, are related a higher risk for rejection, depression, isolation, sexual and interpersonal violence, drug and alcohol abuse, suicide, smoking, obesity, sexually transmitted diseases, certain types of cancers, HIV, hepatitis, and cardiovascular diseases, the literature review stated.    

People in the LGBTQ community live in every region and come from every walk of life, no matter their age, race, socioeconomic factors, or ethnic background, the CDC stated. A lot of people from this minority group don’t have health insurance and avoid or delay treatment due to fear of discrimination and LGBTQ bias that is present in the healthcare system, according to “Increasing cultural competence with LGBTQ patients,” a June 2019 “Nursing” feature. 

Discrimination and prejudice can lead to dysfunctional/nontherapeutic patient-to-nurse relationships. For example, if or when a member of this group does seek treatment, nurses are usually the patient’s first point of contact. If we are unfriendly and have biases, the patient might refuse to interact with us, or we might inadvertently judge and tell the patient what we think he, she, or they should do. In this situation, the patient’s unique needs would never be revealed, and their health concerns would never be addressed.    

How People Identify 

As nurses, we must understand how patients want to be identified since “proper use of gender identity terms, including pronouns, is a crucial way to signal courtesy and acceptance,” according to an NPR special report. Nurses often review a patient’s identity during the initial encounter. Identity information, the report stated, should include:   

• The biological sex of the patient at birth (female, male, or intersex).   
• The gender identity or the gender the patient identifies as (man, woman, neither, or both).   
• Sexual orientation or the patient’s physical, romantic, or emotional attraction to other people (lesbian, gay, bisexual, and straight orientations).  

Key terms associated with gender identity include:   

• Transgender: People whose gender identity is different than the sex they were born.  
• Cisgender: People who identify with the same sex that they were born.   
• Nonbinary or genderqueer: People who don’t identify as either sex.   

Key terms associated with sexual orientation:  

• Homosexual, lesbian, or gay: Prefer relationships with the same sex.  
• Heterosexual or straight: Prefer relationships with the opposite sex.  
• Bisexual or pansexual: Are attracted to both genders.  

Using the correct pronoun to address your patient is imperative since “it’s just about letting someone know that you accept their identity,” the NPR report stated. Some patients might want to be addressed by their legal first or last name or a chosen nickname. However, when it comes to pronouns, some patients might want to be addressed differently than how they look or might identify as two pronouns (she/they or he/they). For example, just because a person looks like a male or a female doesn’t mean they identify as one. Discussing the pronoun that a patient wants to be recognized as can break the ice so the patient and nurses can get to know each other better. To start the conversation, we can first address the pronoun we identify with (she, he, they/them). If we accidentally call the patient the wrong pronoun after our initial assessment, we can apologize for our mistake and move on. Showing a “simple gesture of apologizing quickly and moving on shows the other person that you care,” according to the NPR report.    

Fixing the Problem 

Liz Margolies and Carlton Brown wrote in the “Nursing” feature that “LGBTQ (lesbian, gay, bisexual, transgender, queer) is an umbrella term for two distinct facets of identity: sexual orientation and gender identity.” As nursing students, most of us only received a couple of hours of training on interacting with this population, if any! 

In 2015, a national survey “found that the estimated median time devoted to teaching LGBTQ health in nursing school was 2.12 hours,” according to Margolies and Brown. We need additional training and competencies to help correct this lack of education, so we feel more comfortable caring for this population. Cultural competencies related to this group, according to Margolies and Brown, can teach nurses about the LGBTQ culture, the barriers to high-quality healthcare, communication skills, and how to have a welcoming attitude. Developing a trusting therapeutic relationship is imperative to assess our patients’ risk factors accurately. While caring for this population, or any patient, we need to use a patient-centered approach to help our patients feel safe and respected and use shared decision-making treatment plans, so the patient is involved. 

A Welcoming Attitude 

As nurses, we want our patients to feel welcomed and cared for. To help a patient from the LGBTQ population feel welcomed and safe, we need to be aware of our own biases that might interfere with our therapeutic relationship, and we need to respect the patient’s wishes regarding how they would like to be addressed.  

As mentioned above, how a patient wants to be identified must be addressed during their initial presentation. Margolies and Brown stated that nurses need to assess a patient’s gender identity and sexual behavior in order to understand their possible health risks and advocate for the recommended health screening tests to be done. A patient’s sexual history and gender identity can be obtained through open-ended questions asked during the history interview or obtained from a questionnaire form that the patient fills out before the appointment.  

Some patients might feel better filling out a confidential questionnaire. The information received should include the patient’s legal name, preferred name, gender born, current gender identity, and current relationship status. To help the patient feel more confident sharing this sensitive information, we should advocate for developing pamphlets or additional literature addressing this confidential information. The literature should be shared with all the new patients, so they have additional phone numbers and resources in case they are too hesitant or afraid to reveal too much information during the initial visit.   

A Welcoming Work Environment

Diversity has been shown to have an impact on the healthcare system. Process improvement has been linked to having diversified teams with people sharing ideas to develop the best solution. Nurses are at the forefront. Nurses should advocate for interdisciplinary teams to be developed where we work.  

The team should include employees from the LGBTQ population so we can discover and eliminate any discrepancies. The multidisciplinary team could help work on the organization’s nondiscriminatory statement and post it in waiting rooms and breakrooms for all to see. They could work with the organization to develop educational pamphlets to hand out to all their patients. They also work with human resources to ensure that nondiscriminatory statements and cultural competency are included in the new employee orientation and advocate for employee benefits that include the partners of any employees from this minority group.   

The Bottom Line

Healthcare discrepancies still exist in minority groups, such as the LGBTQ population. Some of these discrepancies are related to their sexual preferences and their risk factors, but others are related to discrimination and stigmas. Understanding a patient’s sexual orientation and how a patient wants to be identified is imperative for developing a trusting, therapeutic relationship since it shows courtesy and acceptance. As nurses, we need to set aside any biases we might have and learn how to improve our communication with a welcoming attitude so we can develop a trusting therapeutic relationship with this diverse group. Organizations’ nondiscriminatory statements should be posted where people can see them so people from diverse groups feel welcomed.  

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