Commentary: Listening to LGBTQ patient voices

This month, lesbian, gay, bisexual, transgender and queer communities around the nation are holding Pride observances to recognize hard-fought civil rights battles and to celebrate sexual diversity. While LGBTQ freedom, rights and acceptance have come a long way, there is more work to be done in the American healthcare system.

Limited access to healthcare and mental health care has long been a factor for LGBTQ communities because of discrimination, societal stigma and fear–and they face greater health challenges and poorer health outcomes than the general population.

For example, the risk factors for heart disease—physical inactivity, obesity and smoking—are higher among lesbians than other women. Discrimination faced by LGBTQ people also is associated with mental health conditions, substance abuse and suicide. More than 42% of LGBTQ teens have seriously considered attempting suicide, compared with 14.8% for heterosexuals of the same ages, according to 2015 statistics from the Centers for Disease Control and Prevention. Research shows that violence experienced by LGBTQ teens has effects on their health into their adult years.

To reduce health disparities, discrimination, fear, and increase access to basic care, the Permanente Medical Groups and Kaiser Permanente have applied three approaches. These include an emphasis on listening to the patient voice, improving data collection for LGBTQ populations and developing organization-wide policies and culturally responsive training.

Hearing the patient's voice

Devoting time to listen to patients reveals powerful insights. For an individual who may feel marginalized by society, and seemingly invisible to the world, genuine attention, active listening and understanding from a physician goes a long way to building a trusting relationship that can lead to better outcomes for all.

With more than 12.2 million members across the country, Kaiser Permanente instituted comprehensive, integrated transgender member care programs that treat a person's total health—mind, body and spirit. When our Oakland Multi-Specialty Transitions Clinic opened in 2013, it was one of the first transgender person health clinics offering comprehensive services opened by a major U.S. health organization.

At the inception of these programs we asked LGBTQ members to help design and plan the care pathway. Transgender Member Patient Advisory Councils have provided remarkable insights into what culturally responsive care really means. For example, it is essential that patients are given the opportunity to let all care providers know their preferred pronoun and have it embedded in the medical record. It's of critical importance so physicians and healthcare teams are truly connected to the identity of transgender patients.

Inclusive data

The National Academy of Medicine cited improving data resources as a key recommendation in its 2011 landmark assessment of ways to improve understanding of LGBTQ health needs. Comprehensive data collection can help to identify research gaps in LGBTQ communities, improve culturally competent care and help to provide a welcoming, inclusive healthcare environment. We agree and have moved toward integrating patient-provided data—such as sexual orientation, gender identity, disability and veteran status—to address health disparities and better address the healthcare needs of our patients.

Systematic cultural change

While data is a starting point for addressing the health challenges faced by our LGBTQ members, the care we provide needs to be as high-touch as it is high-tech. Hearing the voices of our diverse patient populations is fundamental to providing person-centered care. Culturally humble care training for the entire healthcare team ensures that every patient gets the right care at the right time and in the right place.

Diversity and inclusion are inextricably linked to our healthcare mission and humanity. As a medical community we are on a journey to improve the well-being of our LGBTQ patients and their communities.

Dr. Richard S. Isaacs is CEO and executive director of The Permanente Medical Group; president and CEO of Mid-Atlantic Permanente Medical Group; and co-CEO of The Permanente Federation.



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