On January 5, Florida became the 36th state in the nation to legalize same-sex marriage, joining a movement that is sweeping across the United States. With federal judges striking down same-sex marriage bans left and right, it seems inevitable that we will soon live in a country that recognizes the freedom to marry. Yet, although more Americans than ever support marriage equality, the fight for the full inclusion of lesbian, gay, bisexual, and transgender individuals in our society is not over, as they continue to face significant barriers to quality medical services.
Full equality includes access to high-quality medical care, regardless of sexual orientation or gender identity.
The obstacles that have historically prevented LGBTQ patients from obtaining medical care continue to plague our modern health care system. Sure, the American Psychiatric Association no longer considers homosexuality a mental illness. But a concerning number of health care providers still refuse to serve LGBTQ individuals, and until the passage of the Affordable Care Act, insurance companies were not required to extend domestic partner benefits to same-sex couples. Moreover, the stigma that surrounds homosexuality prevents many patients from disclosing their sexual orientation to doctors. Because the LGBTQ community faces higher rates of certain conditions, including depression and substance abuse, failing to discuss sexual activity can lead to inadequate treatment.
One of the U.S. health care system’s most serious shortcomings is its failure to prepare doctors to work with LGBTQ patients. Young doctors are emerging from medical school ill-equipped to deal with the specific needs of the LGBTQ community. A 2006 study published in Family Medicine surveyed 248 medical students, finding that the vast majority of students held positive attitudes toward LGBTQ patients and hoped to provide them top-tier care. Unfortunately, the same group of students failed spectacularly when tested on LGBTQ-specific health concerns. Another study revealed that most medical schools throughout the United States and Canada devote minimal (if any) instructional time to LGBTQ issues, and that the quality of such instruction varies drastically across institutions. And significantly, many doctors report that they feel uncomfortable discussing sexual behavior with LGBTQ patients.
These lapses in education can have serious consequences for patients. A physician who assumes that a transgender patient does not require a basic pelvic exam might fail to diagnose certain cancers or sexually transmitted diseases. Doctors who are unfamiliar with LGBTQ-sensitive mental health providers might not refer a gay man struggling with an eating disorder to the proper organization. Health care professionals who have never learned about lesbian sex cannot inform their patients how to remain sexually healthy.
Important public health organizations have finally begun to take action regarding health care for LGBTQ people. Healthy People 2020, published by the Centers for Disease Control and Prevention in 2010, aims to “improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender individuals.” A breakthrough in itself, HP2020 marks the first time that a Healthy People report has included LGBTQ health among its special topic areas. Meeting the objectives set forth in the document, however, demands adequate medical education.
In an attempt to remedy the systemic deficiencies affecting medical education and fulfill HP2020’s goals, the Association of American Medical Colleges recently released the first ever set of guidelines for training doctors to treat LGBTQ patients. The publication emphasizes the need for inclusion, nondiscrimination, and the eradication of the health disparities that affect the LGBTQ community. It discusses how to integrate these broad topics into existing medical school curricula, and it offers ways for faculty members and administrators to promote LGBTQ health.
The guidelines also help medical students envision how to provide complete medical care to LGBTQ patients by addressing a number of clinical situations — such as working with pediatric patients who have two lesbian mothers and two gay fathers, addressing the needs of a transgender man with a growth in his cervix or uterus, or discussing risk behaviors for HIV with a male patient who has sex with men.
And, perhaps most important, the guidelines encourage doctors to discuss “sexual history, sexual practices, and gender history with their individual patients” while respecting patients’ preferred terminologies and self identities. These topics should not be embarrassing for doctors or patients; rather, they should be openly discussed in order to ensure proper diagnosis and treatment.
Although the AAMC’s guidelines are a much needed first step in addressing physicians’ lack of knowledge about LGBTQ issues, the guidelines will not be easy to implement. As noted in the publication, some medical schools lack faculty members who are trained (or willing) to teach LGBTQ-specific content. In addition, nationally accredited medical examinations do not include very much material regarding LGBTQ health; therefore, medical schools have little incentive to cover such subjects in their curricula. It will require long-term dedication to ensure that the AAMC’s guidelines become integrated throughout academia.
The health disparities faced by LGBTQ individuals are enormous, but not insurmountable. While it seems easy to blame doctors for their apparent lack of knowledge, it is important to remember that their medical educations may not have encompassed LGBTQ health. By providing a tool for medical schools to incorporate LGBTQ health into their existing curricula, the AAMC’s guidelines attack health disparities at a foundational level. Hopefully, they will pave the way for other medical establishments to become more sensitive to LGBTQ issues.
Ultimately, though legalizing same-sex marriage across the United States constitutes an incredible success, it does not address very real concerns that the LGBTQ community faces on a daily basis. The fight for equality does not end at marriage — it continues until everyone enjoys access to resources like high-quality medical care, regardless of sexual orientation or gender identity.