Coming out is a difficult and scary time for many of the LGBTQ community. I came out in 1985 at the age of 17 years during the AIDS crisis. I was fortunate to have loving and supportive parents and family. They accepted me and were open about discussing how to protect myself against HIV/AIDS. To this day, I credit them for helping make safe decisions back then. Unfortunately, many in the LGBTQ are not so lucky. Many face rejection, shame, and even expulsion from their family.
Coming out to a health care worker can also be a scary event for some. My husband faced such a reaction when at 19 years he came out to his primary care physician. He went for care for a potential sexually transmitted infection. He was ridiculed, belittled, and shamed for being gay, and was told to "change his lifestyle." Although this was a traumatizing event for him, he was eventually able to find a primary care provider who was open and accepting.
Many marginalized groups have been incorrectly judged by clinicians leading to issues of mistrust. However, in order for health care workers, especially primary care providers such as nurse practitioners (NPs), establishing a trusting relationship is key. Nurse practitioners in primary care need to create an environment that is safe and welcoming of diversity and inclusion. It is incumbent on the nurse practitioner to create a space that allows for open dialogue and communication. To do this, NPs and other providers must be educated about understanding these issues. That is why it is imperative to generate and publish science related to the care of LGBTQ individuals.
The Human Rights Campaign (n.d.) offers the following tips for providers:
* Educate yourself. Learn about the specific health issues facing LGBTQ+ people.
* Be sensitive. Make sure you and your staff know which pronouns are appropriate to use when referring to a transgender patient or same-sex couple. Present visual cues. Displaying an HRC equal sign or other LGBTQ+ friendly emblem will demonstrate that your office is a safe space for all.
* Revise client forms. Allow options for male/female/transgender and use neutral terms like "partner" or "spouse" rather than "unmarried," "married," or "divorced." Use "parent 1" and "parent 2" to include same-sex couples raising children.
* Don't assume. Avoid making assumptions about a patient based on their appearance. When taking a sexual history, ask, "Are your current or past sexual partners men, women or both?
* Listen attentively. Be sensitive to the fact that this disclosure may be difficult for your patients.
What can you do to advance our knowledge base in the care of LGBTQ individuals? At JAANP, we encourage and promote scholarship in this area. Here are some other tips for getting involved.
* Commit yourself to reading a scholarly article on the topic quarterly
* Volunteer to participate as a member of a research team and/or writer for a manuscript
* Join a diversity equity inclusion Committee
* Join Gay & Lesbian Medical Association (http://GLMA.org), it is for LGBTQ health professionals and their allies and provides updates on research and policy
* Listen to LGBTQ-focused podcasts (both HRC and Gay Lesbian Alliance Against Defamation have podcasts).
Open communication with a health care provider is critical to good health care. To provide quality care, NPs need to know patients' sexual orientation and gender identity. Talking about sex and issues surrounding sexual orientation and gender identity is never easy. However, transparency about sexual orientation and gender can help tailor care plans.
Coming out ultimately is a personal choice. Encouraging patients to be open and honest can lead to lasting relationships and better health outcomes.
It is key to meet the standards of practice in caring for LGBTQ patients. Review the "Community Standards of Practice for the Provision of Quality Health Care Services to LGBT Clients." This is a set of recommendations created by the LGBT Health Access Project and were designed to improve LGBTQ access to quality care and to assist clinicians and their facilities in promoting inclusive environments. The guidelines address standards related to a) Personnel, b) Client's Rights, c) Intake and Assessment, d) Service Planning and Delivery, e) Confidentiality, and f) Community Outreach and Health Promotion. (Gay Lesbian Bisexual and Transgender Health Access Project, n.d.)
Ultimately, it is up to NPs and other providers to put in the work: to be open to learn about LGBTQ individuals and other minority groups. It is 2021 and there is access to a wealth of information, organizations, and research. Claiming ignorance is no longer an option.
References