A patient arrives in the emergency department without an established relationship with the physician. Trust must be built, and appropriate care delivered, in a setting that promises urgent attention. Yet research has found that lesbian, gay, bisexual and transgender patients often delay “seeking emergency care when they felt that they truly had an emergency, or they avoided the emergency department altogether, because they were concerned about the stigma,” according to Erick Eiting, MD, vice chair of operations for emergency medicine at Mount Sinai Downtown in New York.
“They were concerned about the experience that they were having,” said Dr. Eiting, also vice chair of the AMA Advisory Committee on LGBTQ Issues.
Ready to hear more from Dr. Eiting on care for LGBTQ patients? Subscribe to the AMA's new podcast, Moving Medicine. The third episode is adapted from Dr. Eiting's presentation at the 2018 AMA Annual Meeting in Chicago. Episodes four and five of the podcast focus on providing care to other at-risk populations such as prisoners and seniors.
A key point of Dr. Eiting’s talk was to think past assumptions about LGBTQ patients.
“What somebody is and how they identify doesn't necessarily describe their behavior,’’ he said.
Dr. Eiting described one of his encounters with a patient—a 32-year-old woman, identifying as lesbian, and accompanied by her female partner. The woman presented with a constellation of symptoms that indicated a pregnancy test was called for—it turned out positive—but that might not have been as obvious a choice had he taken the patient, as part of that couple, at face value.
“Just keep in the back of your mind that behavior is not always something that's going to be disclosed,” cautioned Dr. Eiting. “You can sort of see how in this scenario maybe this patient wouldn't have wanted to disclose some behavior that may have become problematic or troublesome if her partner had heard it.”
The possibilities can multiply with transgender patients.
“There could be transgender patients who are on medical therapy, including hormones. There are transgender patients who may be post-op who may have had a gender-confirmation surgery,” said Dr. Eiting.
“There also may be patients who identify as transgender who are not taking any hormones—who are not undergoing any sort of medical therapy that we sort of assume that our transgender patients have done—and they may not ever have any intention of ever having surgery.”
Inclusive practices start with staff
Before patients ever see a doctor, they typically encounter the office staff members who are going to form the first impression of a practice. That can be important to any patient, but more so to one already apprehensive about receiving care.
“You need to train your registration staff, making sure that they're using terminology that's inclusive,” said Dr. Eiting. It’s also important for staff to help reassure patients on the issue of confidentiality. It’s something that may be assumed by many other patients, but it can present a greater trust issue for LGBTQ patients.
It is not only a question of people, but of a setting that signals a space that is safe and inclusive.
“One of the things that I did in my urgent care is we posted a rainbow flag and it's very subtle,” said Dr. Eiting. “There are patients who look at that and they say, ‘Wow, I can really relate to this.’” Signage that involves same-sex couples can send a similarly welcoming message.
Dr. Eiting underscored the importance of unisex bathrooms. Most people would not think twice about a trip to the restroom, “but for some people that can be a traumatic event. “
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