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More than 25 years later, the memory still clearly troubles Abigail Mitchell. She was a student nurse in the early 1990s when the care team she was training with assigned her to put a catheter into a female patient. When Mitchell entered the patient’s room and began the procedure, she quickly discovered that her female patient was, in fact, anatomically a male. She was surprised. She felt embarrassed. She felt unprepared. Her colleagues had set Mitchell up as a joke, not telling her that the patient was transgender. Needless to say, it wasn’t funny … not to Mitchell, and certainly not to her patient.
Now consider this:
Nearly 1.5 million adults in the United States identify as transgender. In total, more than 10 million Americans identify as LGBTQ. How many LGBTQ people have endured similar experiences, or much worse? How many health care professionals have either explicitly or implicitly shown bias when it comes to LGBTQ patients?
For LGBTQ individuals, the ramifications can be dire.
According to the U.S. Department of Health and Human Services, LGBTQ people are at a higher risk than the general population for substance abuse, obesity, mental health disorders, STDs, sexual abuse, and suicide.
“I’ve been in health care for a long time, and I personally don’t believe we are making appropriate progress in reducing the health disparities that affect LGBTQ patients,” says Mitchell, DHEd, MSN, RN, CNE, FHERDSA, who serves as a faculty member with Capella University.
Mitchell believes that unconscious bias toward LGBTQ patients is a major issue negatively affecting outcomes for this population today. By that, she means the lack of cultural awareness of and sensitivity toward LGBTQ patients among some health care professionals. Those professionals may not intend to be isolating or insensitive, but due to their lack of understanding of LGBTQ realities, they can come across that way. According to Mitchell, LGBTQ patients are quick to pick up on that and can be reluctant to seek follow-up care. That only exacerbates the disparities in health care outcomes among LGBTQ patients.
How to combat implicit bias?
Use culturally sensitive language
According to Mitchell, developing that cultural sensitivity can be as simple as addressing LGBTQ patients by their preferred pronoun or name. In other words, don’t assume by appearance or physical attributes that a patient wants to be referred to as she or he. Respectfully ask the patient for their preference.
“Just taking the time to ask what name they would like to go by can work wonders in building trust,” Mitchell says. “A patient’s legal name might be one thing, but that person may prefer to be called something else. Respect that and ask, ‘What is your preferred name? What is your preferred pronoun?’ It’s about making a welcoming environment where individuals can feel safe and ask questions.”
Get the full context
Preferred names and pronouns are just the beginning. The realities that LGBTQ patients face are complex, and health care professionals must take the time to explore the full context of their lives to provide the best possible care.
“Too often, health care professionals just want to address the most immediate issue,” Mitchell says. “They only want to know specifically what’s wrong at that moment. We really need to dig deeper with this population. Health care professionals simply must be culturally competent if we are going to achieve the health outcomes that these patients deserve.”
Part of developing that cultural competency is to understand the many nuances of the LGBTQ culture. For example, the terminology to define gender and sexuality is constantly evolving. Health care practitioners need to ask themselves if they truly comprehend what concepts such as two-spirit, cisgender, agender, and pansexual mean, for example.
“We all need to be educated and aware that LGBTQ patients represent a complex spectrum of individuals, and that they are in every community and can and do walk into any hospital and clinic seeking help,” Mitchell says. “It can be as simple as being nice, and appropriately curious in a respectful way. Some of the conversations you will have may feel uncomfortable at first, but they need to happen. That is the only way we can unearth underlying factors affecting a patient’s health.”
Mitchell suggests resources such as the National LGBT Health Education Center to help develop the cultural competencies required to work effectively with LGBTQ patients.
Practice empathy and build trust
“It’s also incredibly helpful to put yourself in the shoes of LGBTQ individuals to be truly empathetic to what they may be going through,” Mitchell concludes. “For many LGBTQ individuals, their histories and day-to-day existence can be incredibly stressful and traumatic. You need to let them know that you are there for them. That they are safe with you and can be open and honest. Only when we break down barriers and gain that trust will we begin to see health disparities for LGBTQ patients disappear.”
An online degree in public health from Capella University can help prepare you for the complexities of providing health care equitably to all individuals.