Toward Improved Care for LGBTQ Patients: New Guidelines Shine Spotlight on Addressing Health Disparities

doctorsOn 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. Continue reading

The Family Revolution and the Egalitarian Tradition in Black History

Sadie T. Alexander

In the interview with Stephanie Coontz featured earlier this month, we discussed the many changes in American households that have occurred in the 50 years since Betty Friedan published her landmark book, The Feminine Mystique. Friedan’s book was a literary catalyst that helped usher in a family revolution, in which the norm of one-earner households was replaced by the norm of the two-earner households we know today; a change that gave many women more equality in their marriages.

A strong egalitarian tradition has long been a part of black history.

What might surprise some readers is that we could have also discussed the many changes that had occurred already, even as Friedan was still writing her manuscript. Among black Americans, much of what Friedan wrote was not prescient, but dated. As Coontz wrote in A Strange Stirring: The Feminine Mystique and American Women at the Dawn of the 1960s, “Long before Betty Friedan insisted that meaningful work would not only fulfill women as individuals but also strengthen their marriages, many African-American women shared the views of Sadie T. Alexander, an influential political leader in Philadelphia, who argued in 1930 that working for wages gave women the ‘peace and happiness’ essential to a good home life.”

While sorting out the book’s legacy, Coontz wanted to explain what The Feminine Mystique had gotten right and wrong about American families and women’s domestic roles in the 1960s. A particular problem Coontz addressed was how The Feminine Mystique ignored the experiences of black and other minority women — an omission cited by many critics since the book’s publication. A book Coontz found invaluable in addressing that omission was Bart Landry’s Black Working Wives: Pioneers of the American Family Revolution (University of California Press, 2002). Landry did not write his book as a critique of The Feminine Mystique. Rather, it was while looking at historical statistics on wives’ employment that he decided to write in greater detail about an intriguing difference he noticed between black and white wives: “the employment rates of black wives were about ten years ahead of those of white wives.” Continue reading