Why safe spaces in health care matter for LGBTQ+ patients

(NEW YORK) — Andrew, a 39-year-old New Yorker who identifies as queer, says he got lucky with his first primary care provider, who was very queer friendly.

“He was straight, but raised by two dads and created a very welcoming environment,” Andrew told ABC News of his former doctor.

When his doctor moved, Andrew says he realized how much it mattered for his health. He says his new doctor was less comfortable around queer issues. “There was always a barrier and a sense of awkwardness,” he said.

Andrew says the lack of good communication left him feeling he could not tell his doctor everything. “Having experienced queer friendly doctors and not queer friendly doctors you see the importance of nonjudgment,” he said.

Being able to have open conversations about sexual identity can be important for health care, experts say, especially around issues like appropriate general health, STI, and mental health screenings.

The LGBTQ+ community disproportionately experiences barriers to health care, and studies have shown this can lead to worse health outcomes stemming from things like untreated depression or anxiety, unaddressed cardiovascular health risks, or missed vaccines that can prevent infections or even cancer.

But many members of the LGBTQ+ community don’t feel able to talk openly with their doctor. In one study, 39% of bisexual men and 33% of bisexual women reported that they had not disclosed their sexual identity to their medical provider, often for fear of stigmatization or judgment.

Some members of the LGBTQ+ community fear discrimination and others have reported being denied care by health care providers solely due to their sexual orientation or gender identity. The fear of outright discrimination and implicit bias can deter people from seeking care, making them less likely to complete recommended health screenings, research shows.

“Some of the barriers are about access and some are about willingness to engage with the health care system,” says Dr. Renee Crichlow, vice chair of health equity for the Department of Family Medicine at Boston University Medical School.

Dr. Crichlow also notes a big issue is that LGBTQ+ individuals are less likely to have a consistent source of primary care. This is why women in the LGBTQ+ community are significantly less likely to access preventative health care than other women, according to a study in the Journal of Urban Health. After adjusting for other factors, these women were ten times less likely to have received a timely pap test and four times less likely to have received a timely mammogram, the study said. This likely contributes to higher rates of various cancers in that community, as another study indicated.

Health providers can take steps to address disparities and lessen these barriers, and many are. Providers can implement intentional strategies to recognize and overcome implicit biases. This includes asking patients open-ended questions without assumptions or judgment. “If people don’t feel comfortable in a healthcare environment, you have to create a very overt atmosphere of safety,” Dr. Crichlow says.

For patients, there are resources that can assist in finding health care providers who are LGBTQ+ affirming, like GLBT near me and GLMA: Health Professionals Advancing LGBTQ+ Equality. And Dr. Crichlow’s advice is to use the community as a resource, “Check with your friends and colleagues. Do they have a trusted clinic they can go to?”

And bring a friend: “You don’t have to do any of these things alone and there are lots of people willing to engage in a compassionate supportive way with the LGBTQ+ community. If the first clinic doesn’t work for you, trust me, there is another place out there for you,” Dr. Crichlow says.

Patients could also try having an open conversation with their current doctor, says Alex Sheldon, executive director of GLMA: Health Professionals Advancing LGBTQ+ Equality. “Express your concerns, feelings, and discomfort in a respectful but firm manner. Your provider may not be aware of your concerns and addressing them directly can lead to improvements in your relationship,” Sheldon says.

If people don’t feel comfortable with their current doctor, they may be able to use telehealth for some services, Sheldon says.

In addition, LGBTQ+ youth dealing with depression or anxiety can reach out to the Trevor Project crisis help line. Individuals in the transgender community can reach out to the Trans Lifeline peer support hotline to be connected with resources, including mental and health care services. Finally, Sheldon notes, people can reach out to patient advocacy groups or support networks to learn more about your conditions and treatment options.

Even after finding a doctor they are comfortable with, LGBTQ+ patients don’t always know what issues they should bring up. GLMA provides resources to patients about things to remember to discuss with your doctor. These include things that all patients should discuss, like concerns about screenings, heart disease risk factors, diet and exercise. But there is more to consider for people in the LGBTQ+ community, including risks for intimate partner violence, PREP for HIV, and screening for depression and anxiety.

There are also things that trans patients should bring up, including questions about side effects or drug interactions with hormone therapy.

As for Andrew, he says he has again found a doctor he can trust, and says it makes all the difference. “Every time I go into the doctor now, we have a good conversation, and it helps me feel at ease because it’s not just a sterile environment, it’s a place of trust,” he says.

Dr. Elizabeth Ghandakly, MD JD, is a resident physician in Internal Medicine from The Cleveland Clinic in Ohio and a member of the ABC News Medical Unit.

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