LGBTQ Healthcare is Primary Care – 2017 LGBT Health Awareness Week

Jessica Sherman, CNP

Jessica is a nurse practitioner at the Equitas Health Short North & King-Lincoln Medical Centers and is accepting new patients.

At Equitas Health we believe LGBTQ healthcare is primary care. Our goal is to improve the health of the LGBTQ community by providing culturally competent, patient-centered care that meets the varied needs of those we serve. We recognize the acronym “LGBTQ” encompasses an extraordinarily diverse group of individuals and that this diversity extends beyond sexual orientation and gender identity. This diversity is reflected in the patients we see at Equitas Health. On a given day, I may see an affluent, gay, African American man for PrEP. My next appointment might be with a young women struggling with drug addiction and depression. The next visit may be a person from a small town who is not “out” and is afraid to seek health care in their community. Next could be a young transgender person who needs medication for high blood pressure. Followed by a young gay male newly diagnosed with HIV. I may end my day with a middle-aged woman here with her wife so they can learn about her diabetes together. What ties these patients together are their shared experiences of marginalization and discrimination as sexual and gender minorities. There is a long history of this marginalization and discrimination manifesting in healthcare. Feeling misunderstood, judged or unwelcome has shaped the health-seeking behaviors of many members of the community, and has led to serious health disparities between LGBTQ individuals and the population at large.

A lack of culturally competent care has been the main driver of these disparities.  Many providers remain uncomfortable caring for LGBTQ people, and are unfamiliar with the challenges faced by these groups. As a result, many of my patients have a long history of negative interactions with the healthcare system. They feel uncomfortable and judged. Often, they find themselves pushed into treatment paths that are not relevant to their personal circumstances. One of my patients memorably described being lectured by her provider for twenty minutes on birth control, even though she does not partner with men. My gay male patients often find that HIV is the only thing a provider wants to talk about with them, frequently to the exclusion of the concerns that actually brought them to the office.

This may not seem like a big deal. But when patients feel judged and uncomfortable, they don’t share information that we need to plan effective care. Even worse, they don’t come back. This ineffective care and disengagement leads to poor health.

Addressing this issue is our main focus. We strive to embrace diversity, and to create a safe and welcoming environment. This starts from the moment you walk in the door. We use inclusive language on our forms. We ask which pronouns are appropriate and allow patients to tell us how they identify themselves both in gender and sexuality.  Our staff reflects the diverse community we serve. All of these things make patients feel safe and at ease before they even enter the exam room.

In the exam room, my goal is first and foremost to listen. I listen to each patient’s experiences, their concerns, and their goals for their health. I use what I learn to develop a relevant and achievable plan of care.  For example, if a patient is a smoker, and primarily smokes as a way of coping with crippling anxiety, I will not simply lecture the patient on quitting smoking. Instead, I will work with them to address the anxiety issues that make quitting smoking a huge challenge. This is how we get the best outcomes for our patients.  By listening and developing plans that are relevant and realistic. We have to meet patients where they are at. This kind of patient-centered approach is crucial to keep patients engaged in care and improve health.

I also aim to create a welcoming environment in the exam room. I use inclusive language. I may ask “do you have a partner?” rather than “are you married?” I will often ask a patient which pronouns they use or how they identify. I also make sure my patients know I am not perfect and that if I use a language that makes them uncomfortable they should absolutely tell me! Beyond using correct language – I strive to create a relationship of trust and openness with my patients. This way they feel comfortable sharing information with me and asking questions.

Our experience thus far has shown our approach works. Since we expanded our mission to be a healthcare home for the LGBTQ community, our patient base has grown rapidly. We have patients that come from all over Ohio because they feel welcome and comfortable seeking care. I’ve had patients tell me how nice it is to feel like they finally have place that is their own, that is dedicated to addressing their needs.

At the end of visits I tell my patients “My door is always open – I’m here if you have questions.” At Equitas Health, we believe LGBTQ healthcare is primary care. Our door is open. When you’re ready, we’re here to provide you with high quality, culturally competent and individualized care.