Q&A: Improving health care for the LGBTQ community

We talked to Joseph Angel, MD, about the challenges faced by the LGBTQ community and what health care providers can do to create a more welcoming and accepting environment for this marginalized group. Dr. Angel is a MultiCare family medicine physician who focuses on women’s health and LGBTQ health, as well as serving all marginalized communities.

What are the biggest health concerns for the LGBTQ community?

Dr. Angel: A lot of people clump this group together as if there’s one singular issue faced by everyone in the community, but it’s a huge and varied population. The answer really is that each one of these groups is extremely different and each are affected by different health concerns.

For example, lesbian women in general are less likely to be pregnant or be on birth control, and studies show increased gynecological cancers because of that.

For the transgender and gender queer community, who face a lot more discrimination than others, there are huge health disparities — but unfortunately there’s not a lot of research. What we do know, from the 2011 National Transgender Discrimination Survey of 6,450 transgender individuals, is that:

• 55 percent of respondents had lost a job due to discrimination
• 51 percent were bullied or harassed in school
• 61 percent were victims of physical assault
• 64 percent were victims of sexual assault
• 33 percent delayed or didn’t access preventive care due to fear of discrimination
• 41 percent had attempted suicide
• 26 percent used drugs or alcohol to cope with discrimination
• 48 percent postponed or avoided medical care when sick or injured due to fear of discrimination

Many of these disparities are faced by anyone who is part of a marginalized community, so you do see several of these issues cropping up for lesbian, gay and bisexual individuals, as well as people of color and other groups that face discrimination.

It’s important to make a distinction here. LGBTQ people don’t have mental health problems because they’re LGBTQ. There’s nothing intrinsic about being LGBTQ that leads to mental health problems, substance abuse, and so on. Daily stress caused by stigma and discrimination can lead to these negative mental and physical health outcomes. People develop these problems after being subjected to the stress that comes with being part of a marginalized group.

What are the biggest barriers to the LGBTQ community receiving and accessing health care?

Dr. Angel: Discrimination is a big one, and it exists for everyone in this community. It’s daunting. You walk into a clinic and maybe you don’t look like the sex stated in your medical record. The front desk is confused, asks for your ID or other proof that you are who you say you are. You’re already put off by the whole situation and feel unwelcome. Then you see a provider who doesn’t have any experience treating LGBTQ individuals who maybe makes assumptions based on you being part of the LGBTQ community — perhaps jumping to conclusions about sexual promiscuity.

Being asked the wrong questions, or inappropriate questions, is another struggle. Independent of what group you’re a part of, everyone wants to be treated with dignity and respect. No one wants to be asked unnecessary questions that make them feel uncomfortable — especially when seeing their health care provider. Providers should only ask medically appropriate questions, rather than questions out of curiosity, upholding the same standards with the LGBTQ community that they do for all other patients. The burden should be on the provider to use inclusive and neutral language, not on the patient to explain what’s appropriate. For example, asking “What personal pronouns do you prefer?” instead of “Are you a girl or a boy?” and “What do you call your partner?” instead of “Do you have a wife/husband or boy/girlfriend?”

How can health care providers better care for LGBTQ patients?

Dr. Angel: The goal should be the same as with every other patient: quality and compassionate care. A lot of it is common sense. It’s more welcoming for LGBTQ patients if you familiarize yourself with commonly used terms and different identities within the community.

With transgender patients, use preferred name and pronouns. Listen to patients and how they describe their own identities, recognizing the importance of affirming their gender identity, because sometimes that supersedes other health concerns. If someone feels uncomfortable in their own skin, they’re not going to care if their diabetes is uncontrolled. Making them feel comfortable will help make them care about other health issues.

Many people in the LGBTQ community have had negative experiences with the health care system, and can be defensive because of those experiences — until they feel comfortable.

How did you come to specialize in LGBTQ care yourself?

Dr. Angel: I’m a gay Latino from a working class background, so I have firsthand experience of having to navigate a complex and uninviting medical system. I came out 20 years ago as a teenager and things were a little bit different then. The idea that my doctor could be LGBTQ was not even fathomed. So when I became a physician, specifically a family medicine provider, I wanted to focus on underserved populations.

My goal and philosophy is that all individuals, independent of their race, socioeconomic status, gender identity, religion, etc. should be able to receive high-quality and compassionate care in a welcoming environment. It’s not a novel idea but unfortunately it’s one that still needs to be emphasized.

What do you hope for the future of LGBTQ care?

Dr. Angel: It’s unfortunate that I have to say I hope the future is that people within the LGBTQ community have access to nonjudgmental, quality and compassionate care. Right now we’re not really there yet.

Obviously I want to improve health outcomes, such as decreasing rates of substance abuse, HIV, tobacco use, violence, sexual assault, mental health concerns, cancers and so on. However, access to a nonbiased and accepting medical system is essential before we can achieve some of these beneficial outcomes.

Health equity at MultiCare

MultiCare is working to improve health equity — the ability for everyone to have access to quality health care and live a healthy life, regardless of factors such as sexual orientation, gender identity, religion, socioeconomic status and race.

As part of that work, MultiCare has been working with the Rainbow Center to provide LGBTQ competency training for all staff. We also recently signed the American Hospital Association’s #123 for Equity Pledge to Act Campaign to accelerate progress toward eliminating health disparities, increasing quality of care and advancing diversity and inclusion in health care.