September 3, 2019
The bottom line: Lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) patients face unique barriers that put them at greater risk for mental and physical health problems. Often, their health disparities result from a lack of family support, public prejudice, and fear of the health care system. Texas physicians have launched a new workgroup and are adapting their practices to treat this underserved population.
An ever-growing group of patients – many with complex health issues – too often lacks access to physicians’ care and could face health problems as a result, so a new Texas Medical Association (TMA) physician committee is trying to improve awareness and understanding of these patients, and their care.
Adults and minors who identify as lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) face unique health problems, barriers, and risks, as well as legal and social bias that contribute to their health disparities. TMA’s LGBTQ Health Workgroup seeks to raise awareness among physician colleagues to ensure these patients receive the care they need.
TMA’s September Texas Medicine magazine reports that all LGBTQ groups face high rates of mental illness, HIV, obesity, suicide, and homelessness. They also have some of the highest rates of tobacco, alcohol, and drug use.
Kelly Bennett, MD, a Lubbock family practice physician who focuses on helping Texas’ LGBTQ population, says many of their health problems are worsened by hostility.
“I was on hospital service last week, and a trans[gender] woman whose father does not approve took an overdose in [a Houston suburb],” said Dr. Bennett, who is a member of the TMA’s LGBTQ Health Workgroup. “The father tossed the kid in the car, drove [about 485 miles] to Lubbock and dumped the kid in our emergency room and then left the country. That’s the level of lack of support that some of our patients have.”
In this instance, the lack of home support might have helped the patient, who upon arrival refused to discuss the incident. But Dr. Bennett and two other physicians were able to help her because of their training to work with transgender patients and willingness to help.
“I cannot even express to you the 180-degree turn in this person’s mood, and [her feeling] that maybe there was hope for a future,” Dr. Bennett said.
These care scenarios might become more common with LGBTQ population growth. In 2017, about 3.6% of Texans identified as lesbian, gay, bisexual, or transgender, according to the Gallup daily tracking poll – with numbers rising. Those numbers might be higher because young people are more willing to identify as LGBTQ, Gallup says. The increase in identification from 2012 to 2017 was driven almost entirely by “millennials"” – those born between 1980 and 1996 – who are more likely than any other age group to identify as LGBTQ, according to the polling agency.
Texas physicians warn structural problems within the health care system frequently discourage LGBTQ patients from seeking medical help. For example, some electronic medical record systems physicians use do not provide an option to record a patient’s desired sexual identity and gender preference. Meanwhile, many physicians would like to treat LGBTQ patients but often hesitate because they fear they lack the training, according to M. Brett Cooper, MD, assistant professor of pediatrics at UT Southwestern Medical Center in Dallas. “The big thing is just encouraging physicians that these youth and adults are no different than anyone else in your practice,” Dr. Cooper said.
LGBTQ patients frequently avoid physicians because of bad experiences or because they are afraid the secret of their sexual identity will come out. This avoidance, in turn, leads to health problems that fester until they become a crisis.
Doctors in the TMA workgroup say awareness and sensitivity by physicians is important. “If I walk in the room and say something that brings up that previous [negative] experience, they may be shut down to me, and it takes me months of visits, if they’re willing to keep coming in, to reopen those doors,” said Emily Briggs, MD, a family physician in New Braunfels and a member of the LGBTQ Health Workgroup. “At times, it’s like dealing with somebody who has had abuse.”
Addressing LGBTQ patient disparity and building these patients’ confidence in the physicians who treat them begins in the exam room, according to Dr. Cooper.
“When we do make a mistake – just like we would for anything else in medicine – promptly apologize to the patient and try to do the best that you can,” he said. “I think that’s all they ask of us – that they know that you’re affirming and you want to try.”
TMA is the largest state medical society in the nation, representing nearly 53,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
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Contact: Brent Annear (512) 370-1381; cell: (512) 656-7320
Marcus Cooper (512) 370-1382; cell: (512) 650-5336
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