Safe and sound care   

By Corey Tapper, MD, MS, Johns Hopkins Medicine 

The LGBTQIA+ community has long faced health disparities; the reasons for this are numerous. Until recently, appropriate healthcare for this population wasn’t routinely taught in undergraduate or graduate medical education. Further, this community has faced structural discrimination over the span of many generations. In addition, recent advances in equity for the LGBTQIA+ community are being rolled back or are at risk for further dismantling. For example, the current federal administration has erased more than $800 million in National Institutes of Health funding for LGBTQIA+ health research. 

Due to the understandable mistrust in the healthcare system and a fear of facing discrimination, the LGBTQIA+ community often doesn’t access routine primary care or treatment for serious disease in a timely manner. Mistrust is especially prominent in the older LGBTQIA+ population. When independence is lost due to illness, and long-term care becomes necessary, many go back into the closet out of fear of discrimination. Historically, this community also had decreased access to insurance, food, transportation, and safe housing compared to their cisgender and heterosexual counterparts. As a result, LGBTQIA+ individuals have experienced worse health outcomes, including higher rates of disability, cancer, coronary artery disease, and mental health disorders–to name a few. 

Significant efforts are still needed to correct the disparities in healthcare for the LGBTQIA+ population. Many solutions must be conducted at the systemic level, while others can be achieved with improved education of our healthcare workforce. Supporting our LGBTQIA+ patients is more important now than ever before.  

Here are some ways to incorporate allyship into your practice: 

Patient care 

1. Use inclusive and nonjudgmental language. Avoid gendered language as much as possible. Ask about preferred pronouns and call patients by their chosen names.

2. Address insurance barriers, especially when caring for those seeking gender-affirming care.

3. Provide appropriate primary care and preventative services. While many care recommendations are similar to the general population, there are some nuances that are important to consider for the LGBTQIA+ community, including specific vaccinations, advance care planning, and specific screening for STI’s, cancer and mental health conditions.

Safe spaces 

1. Clinical intake forms should reflect patient diversity.

2. Post non-discrimination policies in clinical areas.

3. Provide gender-neutral bathrooms.

4. Display LGBTQIA+ affirming materials.

Education 

1. Encourage training in both implicit bias recognition and becoming an upstander (i.e. speaking out when witness to discrimination).

2. Offer and implement continuing clinical education on LGBTQIA+ inclusive care.

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