Practice Management Alert

Making patients feel comfortable and supported is common sense.

Everyone, regardless of political or religious persuasion, needs medical care at some point, and providers are uniquely situated to see and serve the majority of the population. It’s both good practice and good business to truly “see” your patients as individuals — and to make sure your space is inclusive to all people.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people face — or anticipate facing — discrimination in healthcare situations, including being refused care, healthcare practitioners refusing to touch them, verbal or physical abuse, or blaming patients for their healthcare status, says the Human Rights Campaign (HRC) in the 2019 Health Equality Index. Seventy percent of transgender and gender-nonconforming people reported experiencing one or more of these situations and 56 percent of lesbian, gay, or bisexual people reported experiencing one or more of these situations, HRC says.

A population that is vulnerable — medically or otherwise — may be delaying seeking healthcare. Make sure your practice is inclusive and welcoming for everyone, regardless of their gender identity.

Be Intentional

Conduct an audit of your practice to see if and where you need to make adjustments, suggests Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMCSC, CMCS, ACS-CA, SCP-CA, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at Code Cast in Laguna Niguel, California. Look at everything, from the physical signage to the conversations your schedulers have with patients to your patient intake forms, and note which aspects are not inclusive of various gender identities and expressions.

Make Inclusive Language a Habit

Embrace inclusive language in your practice and invest time in training your staff to make its use a habit. Format your initial patient intake questions so that you’re asking for the information you need as a provider while also demonstrating sensitivity to and awareness of myriad sexual or gender identities. Ask for the patient’s legal name, but also the name that they prefer to be called, as well as the pronouns they prefer. If you ask about gender identity, provide choices beyond male and female, even a simple “Other.”

Words do matter: All staff need to be retrained to use inclusive language that is outside the male/female vernacular during patient interactions, Fletcher says.

“Sometimes, a legal name is not the name that an individual uses or identifies with, and it can be painful to be referred to as such. Make a note of their name and pronoun within their chart so everyone can refer to them in an affirming manner. Practice using ‘they/them’ for an individual whose pronouns you don’t know yet or who uses ‘they/them’ as their pronoun,” says the Family Equality Council in a sample letter to medical providers.

If sexual health is an important discussion in your practice or specialty, make sure you utilize language that encompasses various preferences, as well as various manifestations of gender identity, including the use of hormonal therapies. If you ask about sexual health and sexual partners on your intake forms, provide multiple choices, like with gender identity, and instruct the patient to check all that apply.

Similarly, let the patient lead in the exam room when it comes to language. Use their preferred terminology for their body and body parts, the Family Equality Council suggests. Don’t assume a person’s gender or gender identity or anatomy based on their appearance.

When referring to a patient’s network, consider other roles beyond “mother,” “father,” or “spouse” and utilize terms like “caregiver,” “guardian,” and “partner.”

“Also try to avoid assuming a person has two primary guardians within their family. This best practice can affirm and support many people and families beyond LGBTQ+ families,” the Family Equality Council says.

Demonstrate Representation and Awareness

If you have art or photographs of people adorning your practice’s walls, make sure you’re representing people of various appearances and family situations. Add gender identity to your patient bill of rights. Consider adding a rainbow sticker to your website, and front door or front desk area, or display signage indicating that your office is a safe space. If you have magazines in your waiting room or in exam rooms, consider subscribing to an LGBTQ+-specific publication.

Adjust the physical signage, too, including on bathrooms, if they’re currently separated by gender, so that the signs are gender-inclusive.

The gender with which a patient identifies affects that patient’s overall health, Fletcher notes, including specific health concerns if a patient is using hormone therapies. Patients may already feel anxious about seeking medical care, and the idea of blundering through uncomfortable or awkward or discriminatory interactions with healthcare professionals may cause people to delay needed care.

Understanding the ways that you, as a provider, can boost your cultural competence will make patients feel safer in your practice and more trusting, she adds.

Once your self-audit reflects an inclusive practice, seek awareness for your efforts. Health Professionals Advancing LGBTQ Equality, which goes by GLMA (as it was formerly known as the Gay & Lesbian Medical Association), offers a provider directory that has free registration and listing.