12 August 2013 ~ 0 Comments

Healthier LGBT Populations – A Call for Perspective and Patience

Author: admin

Healthier LGBT Populations – A Call for Perspective and Patience is a three-part series  to promote dialogue about the patient’s experience of primary care, emphasizing LGBT populations. The series illustrates hypothetical situations in primary care from patient and provider perspectives. Recommendations and observations from leaders in health care are referenced. While suggestions are made, the intention is to encourage feedback and expand the ideas presented. This post is Part 1. Stay tuned for Parts 2 and 3.

Patient Perspective: The Waiting Room

You’ve arrived at the primary care office for your first appointment with a new provider. Whether relief, trepidation or ambivalence accompanies you, you have a fair idea of what to expect when you enter the building. A waiting room with couches and chairs organized in a seemingly logical fashion with health, nutrition and fitness magazines granting a limited opportunity to enlighten, educate, or temporarily distract the reader. End tables with pamphlets about weight loss, chronic illnesses and medication advertisements await your attention.

You approach the front desk where a health care worker or receptionist is present to greet you. You pull out your wallet, find (or fumble for) your insurance card if insured or other requested documentation. The documentation is usually exchanged for a clipboard suffocating a thick stack of papers with the expectation to collect a summary of your health history. You sit down to complete it, knowing what to expect with few surprises.

Patient’s Perspective: Improving the Waiting Room

If it were your choice, how would this office appear, what questions would the survey ask, and what literature would be available to cater more appropriately to your cultural preferences and practices, your specific health care needs and concerns? Would it look much different? How could the office and staff be more intuitive to you, the patient, to make you feel confident, reassured and comfortable? What questions can they ask you to provide effective and personalized care?

Why does this matter? Can a primary care waiting room change your experience as the patient to weave a foundation of trust before the appointment with the doctor?

The primary care waiting room is an excellent opportunity to begin building rapport and increase the comfort of the patient. The Gay and Lesbian Medical Association in “Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients” (2006, p.2) reported:

“Lesbian, gay, bisexual and transgender (LGBT) patients often ‘scan’ an office for clues to help them determine what information they feel comfortable sharing with their health care provider.”

Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients” provides a host of recommendations for health care offices to produce welcoming environments for LGBT patients. Several examples are illustrated below (2006, pp.2-3):

Photo by Flickr user Mktp

  • Post rainbow flag, pink triangle, unisex bathroom signs, or other LGBT-friendly symbols or stickers.
  • Exhibit posters showing racially and ethnically diverse same-sex couples or transgender people. Or posters from non-profit LGBT or HIV/AIDS organizations.
  • Disseminate or visibly post a non-discrimination statement stating that equal care will be provided to all patients, regardless of age, race, ethnicity, physical ability or attributes, religion, sexual orientation, or gender identity/expression.
  • Display LGBT-specific media, including local or national magazines or newsletters about and for LGBT and HIV-positive individuals.

How about the intake form? Incorporating questions about sexual orientation, how the patient identifies themselves and lifestyle are just a few examples that may increase the comfort level for LGBT patients prior to meeting with their health care provider. The intake form is the “initial conversation” with the provider. This is critical in health literacy; each of us understands and communicates information differently. If a patient feels embarrassed, afraid or uncomfortable verbalizing information, the intake form is an excellent opportunity to disclose such information.

Patient Perspective: Meeting the Doctor

Fast-forward to the initial meeting with the doctor. Though you have every reason to assume complete trust in this individual, this doesn’t eliminate the fact that he or she remains a complete stranger. Add a gown for attire and a cold room to this picture to magnify your discomfort.

This is the context in which you disclose deeply personal information. At least, that is the objective. Your encounter may last 15 minutes. The ratio of time granted versus dialogue of information you share with the doctor is grossly disproportionate. However, the goal of these interactions is for your provider to establish rapport, trust and build a sustaining relationship with you. It is one of the few places where you, the patient, can and should demand the undivided attention of a provider; one who acknowledges that a non-judgmental presence is needed to support you in sharing these important details of your health concerns.

For LGBT patients fearing implicit and explicit judgment, meeting with the health professional may be an anxiety-provoking situation. The system of primary care must view this as unacceptable and take action as role-models of patient care.  Providers can seek ideas from patients about how to increase their comfort level during visits. Offices can ask patients to suggest feedback about their visit, advocate that patients bring a loved-one or partner to an appointment, or host groups and seminars about how to improve the primary care environment. Taking these steps can potentially increase the experience of the patient and effectiveness of provider care.

Stay tuned for part 2 next week.


Gay and Lesbian Medical Association. Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients: Chapter 1 Creating a Welcoming Clinical Environment for LGBT Patients (pp.2-3). San Francisco, CA: Gay and Lesbian Medical Association; 2006. Retrieved from http://www.qahc.org.au/files/shared/docs/GLMA_guide.pdf.

About the Author:

Nicole Lighthouse is a Marriage and Family Therapist with a research background in preventive medicine and mental health. She is a graduate student in Biomedical Sciences at the Kirksville College of Osteopathic Medicine at A.T. Still University. Her career interests include family medicine and research in community and preventive medicine.

The opinions and views expressed in this blog and/or comments are those of the author(s) and do not reflect any position of the Center or the University.

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