Tips for creating a welcoming practice
By Laura Dan and Dr. Cyndi Gilbert
Lesbian, gay, bisexual, transgender, questioning, two-spirit, intersex, asexual, plus (LGBTQ2SIA+) individuals experience interpersonal, structural, institutional, and internalized discrimination at significantly higher rates compared to the general population. As a result, they’re more likely to experience a range of disparities such as mental health issues, substance abuse, sexually transmitted infections, bullying, isolation, self-harm, and suicide.
These individuals don’t only face these adversities in their daily lives; many report inequities and discrimination in the healthcare system. It’s common for LGBTQ2SIA+ patients to feel fearful or mistrustful of healthcare providers.
In fact, 18% of LGBTQ2SIA+ adults report avoiding or delaying care out of fear or hesitation of anticipated discrimination from their healthcare provider, and 16% report experiencing discrimination in healthcare settings.
The LGBTQ2SIA+ community often receives low-quality healthcare due to multiple factors such as stigma, insensitivity, or poor practitioner cultural competency and awareness of the unique healthcare needs of LGBTQ2SIA+ populations. Furthermore, the prejudices, personal beliefs, religious beliefs, and attitudes held by providers can worsen quality of care.
As a healthcare provider, what can you do to help current and future patients feel safe, accepted, and respected in your practice? Keep reading to learn some practical tips for fostering a welcoming environment and caring for LGBTQ+ patients.
Tips for creating a welcoming clinical environment
Refer to the tips below to help create a hospitable environment and provide the best care for your patients. Dr. Cyndi Gilbert, ND, a naturopathic doctor and educator committed to an anti-oppression model of care explains, “Health and wellness providers can curate welcoming practices for patients who identify as LGBTQ2SIA+ in many ways. Client interactions are complex, and every part of that experience needs to be addressed to create an inclusive, responsive, affirming, and anti-oppressive space. Often, practitioners know they need to take more meaningful action than “love is love” images and Pride flags but don’t know how.
Reflecting on and challenging personal bias is a great place to start. Unlearning cisnormative, heteronormative, allonormative, and other beliefs about gender, sex, and sexuality is vital. Conducting a quick practice audit helps to identify areas for improvements (e.g., space, signage, media, communication, policies, clinical skills, etc.) and any additional training desired to upgrade knowledge, skills, and language. Throughout this process, it’s critical to consider intersectionality, how other social determinants such as racism and ableism converge to impact accessibility and inclusion. During clinical encounters, the key is providing triple A care: affirmation, allyship, and advocacy.
Complete cultural competency care training
Cultural competency as the “ability to understand, appreciate, and interact with people from cultures or belief systems different from one’s own.” A solid understanding of cultural competency is essential for building practitioner-patient relationships and enhancing quality of care so pursuing training and continuing education for yourself and your staff is key.
“As a queer ND, I rarely saw myself or my community represented, so I co-founded Heal All, an educational and consulting hub to help health and wellness practitioners create safer and more welcoming spaces for LGBTQ2SIA+ clients,” says Dr. Gilbert.
Be aware of the unique health risks
To provide optimal care to this community, it’s important to acknowledge its’ significant health challenges. The LGBTQ2SIA+ community experiences higher rates of physical, emotional, and sexual abuse, sexually transmitted diseases (STDs), substance use (e.g., alcohol, tobacco), mental health issues, suicide, and cardiovascular disease. These patients may also have poor access to quality healthcare and health insurance.
“Health risks and inequities primarily stem from stigma, discrimination, and barriers to care. These risks are amplified for LGBTQ2SIA+ folks who are Black, Indigenous, and People of Color (BIPOC), those living with disabilities, young and old individuals, and others who face discrimination on the basis of multiple socially constructed categories,” explains Gilbert. “Widespread structural, institutional, and interpersonal discrimination increases many specific health risks from cardiovascular disease and cancer to mental health conditions, all associated with reduced access to quality healthcare, underutilization of services, lack of representation in health research and public health policies, and social isolation due to discrimination at work, school, and home. The good news is many of these increased risks decrease or even disappear when people feel connected, when their identities are affirmed, and when they are supported by their families, workplaces, schools, and neighborhoods.”
Use welcoming visuals and share online
Using welcoming visuals such as posters or flags and displaying educational materials can help patients feel welcome in your practice. You can also post relevant information on your website and/or social media accounts to help spread the word about the inclusivity of your practice. And, use inclusive language on intake forms
LGBTQ2SIA+ patients may be hesitant to disclose information related to their sexual orientation or gender identity due to privacy and confidentiality concerns. The experience a patient has while filling out intake forms is one of their first glimpses into how your practice operates.
Set the tone by following these guidelines: 1. Avoid gendered terms such as husband, wife, father, or mother. Instead, use spouse, partner, parent, or biological relative. 2. Provide training to front desk staff who are often the first point of contact for patients. Instruct your administrative staff to avoid using gendered terms. 3. Only if required by your regulatory body or for insurance purposes, ask about a patient’s “sex assigned at birth” or “legal sex.” When asking about gender, use a blank space for patients to write in their identity or include multiple options, including “non-binary,” “Two-Spirit,” “questioning,” and “transgender” in addition to “female” and “male.” 4. Use the term “relationship status” instead of “marital status” and include options such as “partnered.” 5. Use appropriate terms such as “sexual orientation,” “gender identity,” and “gender expression” when requesting demographic information on intake forms, and request that patients share their pronouns and preferred name.
Pronouns and chosen name
A simple way to build rapport and show your respect is to refer to them by their pronouns and chosen name. You can request this on intake forms, or you can also ask them directly or introduce yourself. “I’m Dr. Smith. My pronouns are she/her. How would you like to be addressed?”
Make sure to note your patients’ pronouns and chosen name in their chart so that staff are aware and use it in all interactions.
The practitioner-patient relationship is built on trust, which can make or break a patient’s experience and even influence their health outcomes. Build trust by assuring confidentiality, asking open-ended questions, honoring your patients’ identities and lived experiences, using neutralized clinical language, and familiarizing yourself with the correct terminology.
The bottom line
As a practitioner, you have the potential to help reduce the barriers and help patients feel safe, valued and accepted. In Dr. Gilbert’s words, “Practitioners can make a difference by working to create inclusive clinical environments as well as advocating for supports and positive change in their larger communities. Inclusive care isn’t a one-and-done activity–engage in ongoing allyship, affirmative care, and advocacy. Take opportunities to expand and update your knowledge and skills.”
Dr. Cyndi Gilbert, ND (she/they) is a naturopathic doctor, author, and educator with a focus in mental health, trauma, and LGBTQ2SIA+ health. Laura Dan BSc, NDTR, Medical Content Specialist at Fullscript. *This article originally appeared on Fullscript.com.