National Academies Press US ; Health disparities among LGBT people are rooted in bias, stigma, discrimination, and social determinants of health, not genetics or other molecular issues, or even sexual orientation and gender identity, said Makadon.
Therefore, he said, systems changes and educational changes can make a significant difference in the ability of the health care profession to provide quality, accessible care for LGBT people.
At one time, hospitals were taking the lead in eliminating health care disparities among minority populations, but that role is now being shared more equally by community health centers and a variety of enabling organizations.
Nonetheless, hospitals continue to be a key leader in this area, and the American Hospital Association AHA has issued the Health Research and Education Trust Disparities Toolkit for collecting race, ethnicity, and primary language information from patients. In issuing this toolkit, the AHA noted that disparities in health care can be addressed through a quality-of-care framework if data on race, ethnicity, and primary language are available.
A report from Physicians for Human Rights, The Right to Equal Treatmentreiterated this message when it stated that data collection is not only central to quality assurance but also to help ensure nondiscrimination in access to care. Makadon said that by the same token, health disparities that affect LGBT people will only be addressed if the health system collects data on sexual orientation and gender identity. Building a Foundation for Better Understandingnoted the direct benefit of collecting data on sexual orientation and gender identity for individual patients.
Based Lesbian nurse takes adavantage of patient his experience, Makadon estimated that 10 to 20 percent of people would answer yes to the first question, but that close to zero would answer yes for the second and third questions.
Given that there are medical issues related to sexual orientation and gender identity, it seems that it would be difficult to provide good medical care for LGBT people without that information, and it is equally challenging to assess the quality of care being provided Lesbian nurse takes adavantage of patient the LGBT population.
He also remarked that the invisibility of the LGBT population results from a combination of patient reluctance to divulge information on sexual orientation or gender identity and physician discomfort or ignorance about the importance of this information. In terms of sexual orientation, Makadon continued, it is not simply a matter of identifying someone as gay, lesbian, bisexual, or heterosexual. Rather, he said, the real question is about how people see themselves, how they actually behave, and what their desires are.
Some people, for example, are attracted to others of the same sex but have never acted on that desire, yet they want to talk to their physicians about those thoughts. To back up this assertion, he cited a study from the New York Department of Mental Health that found 9. These men were more likely to belong to minority racial and ethnic groups, be of lower socioeconomic status, be foreign-born, and not use a condom.
In another study, between 77 and 91 percent of lesbians reported that they had at least one prior sexual experience with men, and 8 percent reported having sex with a man in the prior year. He added that while these examples might seem obvious to those attending the workshop, they are not obvious to most nurses or doctors because they do not learn about this kind of discordance between sexual identity and sexual behavior in medical school. Yet, for clinicians, it can be helpful to understand the different dimensions and manifestations of sexual orientation in order to build a better therapeutic relationship with their patients.
According to the aforementioned IOM study, lesbians and bisexual women may use preventive health services less frequently than heterosexual women. From his experience as a clinician, Makadon said that he expects that reduced access to care applies to gay men and transgender people as well.
What this Lesbian nurse takes adavantage of patient access to Lesbian nurse takes adavantage of patient translates into, he said, is that LGBT people do not receive the right preventive health screening that they need, and the only way to remedy that situation is to identify these populations. This number, which has been climbing annually sincecame as a surprise given that the number of HIV cases overall remained constant, and it likely reflects the fact that prevention efforts are not reaching men who have sex with men but do not identify as gay when asked on a survey.
This is particularly true among black men between the ages of 13 and 29 who have sex with men, a population in which there has been an almost 50 percent increase in the incidence of HIV cases between and These data highlight the fact that LGBT people are not one homogeneous group, but rather that they reflect the same cultural diversity seen throughout the general population. Understanding the cultural diversity among, in this case, men who have sex with men, is going to be key to developing ways to reach underserved populations, but that lesson applies to all LGBT people, said Makadon.
That understanding cannot start without data about these underserved populations. In terms of understanding the T in LGBT, the IOM report noted that there are significant health disparities that have been documented among transgender people.
The only way to get this information is by educating both clinicians and the transgender community about the importance of discussing these issues to ensure access to high-quality care. The clinician, said Makadon, has to be the point person in gathering this information, but the field needs to figure out ways to help clinicians so that they do not spend all of their time just gathering data and not having time to talk to their patients.
The first case involved a year-old woman who developed a high fever and chills after head and neck surgery. She Lesbian nurse takes adavantage of patient have received much quicker treatment for her infection had her surgeon and the hospital staff known she was a transgender woman. The second case involved a year-old man who came to his physician with pain and on X-ray appeared to have metastases from an unknown primary cancer.
None of his physicians were aware that he was a transgender man, so he had not been advised to have routine breast screening even though his mother and sister Lesbian nurse takes adavantage of patient also had breast cancer.
Makadon then discussed some of the new opportunities that exist for gathering patient information on sexual orientation and gender identity that take advantage of patient portals that many health care systems have now installed Figure These portals are designed to enable patients to input information about themselves in the privacy of their homes, which could be particularly important for LGBT people.
New opportunities for gathering LGBT data during the process of care. In closing, Makadon said that there Lesbian nurse takes adavantage of patient a few issues that need to be considered in preparation for collecting LGBT data in clinical settings.
Clinicians, he said, need to learn about LGBT health issues and the range of expression related to identity, behavior, and desire. Health care system staff members also need to understand these concepts given that patients often report that uncomfortable questions come up at the reception desk, not in the exam room. Patients, too, need to learn about why it is important to communicate this information and to feel comfortable that it will be used appropriately. Finally, collecting data on sexual orientation and gender identity is critical and has to be done sensitively, without assumptions, and for every patient along with all other demographic data.
InLambda Legal, together with more than partner organizations, surveyed 4, people representing a diverse sampling of Lesbian nurse takes adavantage of patient communities and people living with HIV, regardless of sexual orientation, gender identity, HIV status, race, ethnicity, age, and geography. She added that the findings were surprisingly high in terms of discrimination and substandard care.
For example, 56 percent of lesbian, gay, or bisexual individuals and 70 percent of transgender people said that they had experienced discrimination or received substandard care.
Nearly 8 percent of lesbian, gay, or bisexual people and almost 27 percent of transgender people reported being refused needed health care. More than 10 percent of lesbian, gay, or bisexual people and more than 15 percent of transgender people reported having had the experience of a health care professional who refused to touch them or used excessive precautions before touching them.
Almost 11 percent of lesbian, gay, or bisexual people and almost 21 percent of transgender people said that they had experienced a health care professional use harsh or abusive language with them and 4 percent of lesbian, gay, or bisexual people and almost 8 percent of transgender people described receiving physically rough or abusive treatment from a health care professional.
In nearly every case, people of color and low-income people had higher rates of experiencing discrimination. In terms of barriers to care, the survey found that significant percentages of LGBT individuals expressed concerns about accessing health care.
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Nine percent of lesbian, gay, or Lesbian nurse takes adavantage of patient people and almost 52 percent of transgender people feared they would be refused medical service; more than 28 percent of lesbian, gay, or bisexual people and 73 percent of transgender people expressed concern that medical personnel would treat them differently than non-LGBT people; 49 percent of lesbian, gay, or bisexual people and almost 90 percent of transgender people said there were not enough health professionals who were adequately trained to care for them because of their sexual orientation or gender identity status; more than 24 percent lesbian, gay, or bisexual people and more than 50 percent of transgender people said there were not enough support groups; and almost 29 percent of lesbian, gay, or bisexual people and almost 59 percent of transgender people said there were not enough substance abuse programs for LGBT individuals.
Again, the numbers were all higher in people of color. As part of this project, Lambda Legal and its partners also collected 50 personal stories that provided real-life illustrations of the discrimination and substandard care LGBT people experience.