Ramona Peel, Lead Trainer and Trans Patient Navigator, The Equitas Health Institute for LGBTQ Health Equity
Close your eyes. Imagine yourself in a doctor’s office. You look around, and you don’t see any indications that someone like you is welcome. No pride flags or stickers. Straight couples are splashed all over the brochures and magazines on the table in front of you. On your intake form, there’s no option that represents your gender identity or sexual orientation. When it’s your turn to see the doctor, the receptionist calls out a name that you don’t use any more. How do you feel?
If you’re part of the LGBTQ community, you’ve probably been faced with a health care environment that isn’t inclusive or welcoming. According to a comprehensive 2009 study conducted by Lambda Legal, 56 percent of LGB respondents and 70 percent of trans or gender non-conforming respondents reported experiencing at least one of the following types of discrimination in health care settings: being refused care; health care providers refusing to touch them or using excessive precautions; being addressed with harsh or abusive language; being blamed for their health and/or HIV status; or providers being physically rough or abusive.
This is shocking but perhaps not surprising. According to a 2011 study, only about 5 hours are spent on average over the entirety of clinical medical school training on LGBTQ-specific issues. In addition, about 80 percent of first-year medical students expressed some form of bias against lesbians and gays in a 2015 study by the National Institutes of Health.
Given all of these obstacles, even if one is able to gain access to health care as a queer-identified person, there is little guarantee that the care received will be provided in a culturally competent manner. There is a desperate need for providers to undergo that sort of training (that is both frequent and of high quality), but what can you do as a patient to make sure that you get the best possible care?
First, it’s important to know your rights as a patient. Despite the uncertainty surrounding the future of the Affordable Care Act, you still have certain protections under the law. Perhaps the most important of these are the rules under HIPAA (The Health Insurance Portability and Accountability Act). HIPAA, among other things, protects the privacy of all your personally identifiable information. This includes things like your sexual orientation, gender identity, and sex assigned at birth. For example, if a doctor asks you if he or she can bring in medical students to “learn about you,” you have every right to say no under HIPAA regulations.
Mentally preparing yourself before an appointment can be helpful, too. Before your appointment, write down a list of questions you want your doctor to answer. It can also be helpful to visualize scenarios that might come up during an appointment and practice how you’d like to respond to them. Remember that you have the right to refuse a suggested plan of action from your doctor, and you have the right to change your mind. You can also insist upon an explanation for a recommended course of action, and you can correct providers when they get information wrong.
You interpersonal effectiveness with your provider is also something that you can control. Many people find that expressing feelings or opinions in the context of “I want” rather than “you should” is a helpful strategy, as is asserting yourself by asking for what you want or saying no clearly. Appearing more confident in your tone of voice, maintaining good eye contact, and using neutral or positive body language are among the other tactics that have proven to be effective.
Practicing basic mindfulness skills can also be beneficial. One method is emotional regulation, which can be helpful in stressful situations. This starts by observing your emotions without judgment or suppression, and also includes being mindful of where in your body you are feeling emotional sensations. This will help you remember that you can feel an emotion, but that doesn’t mean that you have to act upon that emotion. Also, remember that you are completely free to tell your provider that you need to take a break for a drink of water, or to collect your thoughts, or to use the restroom.
Equitas Health holds Patient Empowerment Workshops across the state. Please visit equitasinstitute.com or contact us at firstname.lastname@example.org for more information.