Doctors’ prescription for LGBT healthcare

"The Lesbian, Gay, Bisexual and Transgender (LGBT) community is a highly diverse and multifaceted group of persons encompassing all cultures, ethnicities, and walks of life. Under the LGBT umbrella, each individual group faces unique cultural and health-related needs but shares common challenges, such as social stigma, discrimination, and disparities in health care, that unite them."

This statement prefaces a new paper by the American College of Physicians (ACP), on behalf of its 141,000 internal medicine and medical student members, which proposes policies to eliminate disparities in access to healthcare for LGBT persons.  ACP is the largest physician specialty society in the United States (for that matter, in the world, with chapters in Canada, Central and South America, the Middle East, Southeast Asia, and India) so the doctors' recommendations carry great weight, not only for physicians and hospitals treating LGBT persons, but in the broader societal debate over policies and practices that discriminate against LGBT persons.  ACP's prescription for better healthcare for LGBT persons include:

"The health and financial benefits of marriage for different-sex couples are widely reported, and contemporary research supports similar benefits in same-sex marriage. On the other hand, denial of marriage rights for LGBT persons may lead to mental and physical health problems. Health benefits associated with same-sex marriage result from improved psychological health and a reinforced social environment with community support."

"All major medical and mental health organizations do not consider homosexuality as an illness but as a variation of human sexuality, and they denounce the practice of reparative therapy for treatment of LGBT persons. . .  Available research does not support the use of reparative therapy as an effective method in the treatment of LGBT persons. Evidence shows that the practice may actually cause emotional or physical harm to LGBT individuals, particularly adolescents or young persons."

"Evidence shows that individuals with gender identity variants face increased discrimination, threats of violence, and stigma. . .  Employers have the option to include gender identity as part of their company's nondiscrimination or antiharassment policies even if their state does not [require it], and many companies have chosen to include comprehensive protections policies. To reduce the potential for discrimination, harassment, and physical and emotional harm toward persons who are not covered by current protections, the medical community should include both sexual orientation and gender identity as part of any comprehensive nondiscrimination or antiharassment policy."

"The cost of including transgender health care in employee health benefits plans is minimal and is unlikely to raise costs significantly, if at all. . . [and] may also result in an overall reduction of health care costs over time because patients are less likely to engage in self-destructive behaviors, such alcohol or substance abuse."

"A definition of family inclusive of all types of families, including the LGBT population, is not only fundamental to reducing the disparities and inequalities that exist within the health care system, but also important for the equal treatment of LGBT patients and their visitors in the hospital setting."

"Hospital visitation policies are not always clear or consistent about who can visit or make medical decisions for a patient if they become incapacitated or cannot do so themselves. The absence or limited access of loved ones can cause uncertainty and anxiety for the patient. In contrast, the involvement of family and outside support systems can improve health outcomes, such as management of chronic illness and continuity of care."

Some may ask, why should doctors get involved in controversial and "political" issues like same-sex marriage and the definition of family?  My answer is this: the medical profession has an ethical responsibility to speak out on anything that can cause harm to patients.

For too long, millions of people, in the United States and throughout the world, have been marginalized, excluded, and discriminated against because of their sexual orientation or gender identity, resulting in great harm to their mental and physical health.  "Addressing these disparities will require changes in the way LGBT persons and their families are regarded in society and by the health care system" writes ACP in the conclusion to its paper. "The College is dedicated to eliminating disparities in the quality of or access to health care and is committed to working toward fully understanding the unique needs of the LGBT community and eliminating health disparities for LGBT persons."

Let's hope that every physician will join ACP in advocating to change discriminatory policies that harm their LGBT patients.

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