Like all other groups that have been historically marginalized, those who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and others) often have a complex history and relationship with medicine. “In health care, just as in most parts of our society, there has been stigma around gender identity and sexual orientation,” says Kevin Kline, the director of LGBTQ+ Health in Family Medicine and Community Health and an assistant professor of Family Medicine and Community Health in the Perelman School of Medicine. “Many people are afraid of being judged by their clinicians or care team, and that can lead them to withhold information during appointments or not visiting a doctor at all in order to protect themselves.”
In fact, roughly 25% of transgender people delayed medical care that they knew was important for them out of fear that they’d experience discrimination, bias, and even physical assault, according to a 2015 survey of American trans people. And it’s easy to see the basis for that fear; in another survey from the Center for American Progress, 29% of trans people said their provider used abusive language or harsh language while treating them in the previous year. This discrimination extends to lesbian, gay, bisexual, and queer people, too, with 7% in the survey saying that their provider refused to acknowledge their family (a same-sex partner or a child), and an appalling 7% said that they received unwanted physical contact from a provider.
In order to provide equitable health care despite this history of fear and a discrimination, Penn Medicine has been focused on not only getting LGBTQ+ patients in the door to receive the important health care they need and deserve, but also on creating an environment where they feel safe, listened to, and willing to come back. Kline and those involved in the LGBTQ Health Program at Penn Medicine have been continuing work to ensure patients have access to respectful, compassionate, and equitable health care.
“Members of the LGBTQ+ community experience higher rates of many serious health conditions, like certain cancers, alcohol use disorders, depression and suicide. If we don’t make our clinics more welcoming for these patients, these disparities are not going to get better,” says Ayiti-Carmel Maharaj-Best, an assistant professor of clinical family medicine and a clinician in the LGBTQ Health Program.
One thing Kline watches out for with LGBTQ patients are potential issues and conditions that may be more common with those who identify as LGBTQ+. For example, while there has been an increase in mental health concerns across the country, depression affects LGBTQ folks at higher rates than those who are straight and cisgender. LGBTQ people may also struggle with anxiety, heavy drinking, tobacco use, and drug use.
Within Family Medicine, clinicians like Kline assume a primary-care role and can coordinate specialized care within one visit. “We have a pretty complete view of our patients, and that allows us to tag in the right people to help manage conditions, treat new ones, or discuss other needs a patient might have, such as planning for gender-affirming surgeries,” says Kline. “We always strive to holistically take care of our patients. For example, a patient might come in requesting a referral to a gynecologist to discuss contraception, but we can have that discussion and provide their contraception during that visit with us.”
Family Medicine clinicians often care for people within multiple generations of one family—from couples and their kids, parents, and entire families. That understanding of family and couple dynamics creates a shorthand when caring for patients from the same family and can lead to better follow-through on care plans and better dialogue between patients and their clinician, Kline explains.
Read more at Penn Medicine News.
