Caring With Pride

About four years ago, I served as the palliative medicine consultant for a 35-year-old patient with relapsed leukemia. She was dying, and I was asked to aid in symptom management and psychosocial support. I vividly remember her sadness and fear. She was alone in her hospital room the first time I saw her. It’s challenging for me to delve into end-of-life conversations before developing some rapport. I cannot imagine how much more daunting that is for a patient. We spoke about her symptoms, her understanding of her illness, and her support system outside of the hospital. I asked if I could come back to see her again the next day, and she agreed. 

Before I exited her room, she sheepishly pointed at the pride flag on the lapel of my white coat. She then held up her hat that her partner had knitted for her, also decked out in rainbow colors. She’d been holding it in her hands during my visit, her own version of a security blanket. And with a tear in her eye, she said two words, “Thank you.” And with that, our rapport was solidified.  

I’ve worn a pride flag on my lapel for the last decade, ever since I was an intern; it’s a small yet powerful gesture. While LGBTQ+ rights have dramatically improved over the last 10 years, there’s recently been significant backlash and rewinding of these rights, especially for the trans community.  

Historically, LGBTQ+ patients have experienced implicit and explicit bias in healthcare settings, which has contributed to various poor health outcomes. Many clinicians lack cultural awareness and humility and haven’t had formal education on LGBTQ-inclusive care. Luckily, this is changing, and progress is slowly being made.  

Here are some recommendations for LGBTQ-inclusive care that I’ve incorporated into my practice:

Communication  

Avoid assumptions about gendered language. If you’re unsure, ask. This can include asking a patient if they have a “spouse” or “partner” as opposed to a “husband” or “wife.” 

Greet new patients without gender markers (like Mr., Ms., Sir, Ma’am) Sincerely apologize if you accidentally misgender someone. 

Call people by their preferred names and chart accordingly. Use preferred pronouns. 

Use body language and words that show nonjudgment and acceptance.  

Culturally aware care  

Recognize the difference between sex assigned at birth and gender.  

Avoid heteronormative language.  

Explore sexual and intimacy needs.  

Address insurance barriers, especially when considering transgender-health needs. 

Psychosocial assessment 

Questions about one’s transition or genitals should only be asked when medically necessary.  

Explore spiritual and/or religious beliefs and values. 

Ask about family of choice and other support systems. 

Other considerations 

Speak up if you hear a colleague acting in a discriminatory way.  

Intake forms should reflect patient diversity.  

Post a non-discrimination policy in the waiting area.  

Become familiar with common terms used by the LGBTQ+ community.  

Advocate/implement ongoing educational opportunities for staff.  

Advocate for inclusion of sexual orientation and gender identity (SOGI) data in the electronic medical record. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.