When Alienated by Past Providers, LGBT Patients Are Often Reluctant to Seek Medical Care

Researchers say STDs are among the health problems LGBT people are more likely to experience than their heterosexual peers. One key reason is that fear of or experience of stigma from their provider keeps many LGBTs from seeking health care. Doctors could help by asking better questions, LGBT-competent providers say.

In getting to know transgender patients, a provider can ask, "How do you like to be called?” suggested Dr. Carole Allen, chief of pediatrics at Harvard Vanguard Medical Associates. Such an approach is important in speaking with adolescents who may be questioning their sexual orientation or gender, Allen said.

“As soon as you say to a patient, ‘Do you have a girlfriend?’ you’ve automatically cut off that conversation,” said Allen. About 10 years ago, Allen began asking “Have you noticed any attraction to boys or girls or both?”

“Some kids will laugh,” said Allen. “But I’ve heard some kids say, ‘I haven’t decided’ or ‘I don’t know.’”

Some youths had not talked about their sexuality with anyone else. Allen helps link confiding kids to the services they need and can talk about relevant safe-sex practices.

“It’s not necessarily what people say, it’s sort of what they don’t say,” said Tina Gelsomino, an administrator at Brigham and Women’s Hospital and co-chair of an LGBT staff group. Patient intake forms, for instance, rarely have space for patients to disclose their sexual orientation or transgender identity.

“Imagine how you would feel if you have an illness ... and you’re going to somebody [for health care] where you have to explain it to them,” said Joanne Herman, who underwent a sex-change operation in 2003. Herman said her previous doctor could not provide a gynecological exam without mentioning her lack of a cervix. Now at Boston’s Fenway Health, “my primary care doctor does my GYN exam, and it’s done without commentary,” she said.

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