This content was originally published by the Longmont Observer and is licensed under a Creative Commons license.
Have you ever visited a doctor and felt uncomfortable, left irritated with their bedside manner or were upset over personal questions that didn’t seem relevant to your care?
Many LGBTQ patients experience this treatment, or lack thereof, on a regular basis when seeking medical care.
For example, Michal Duffy, education and program manager at Out Boulder County, went to the dentist for
“While I was seeing the dental hygienist, they’re asking me all these questions about my transition,” said Duffy. “It was super awkward and uncomfortable, and I did not want to be talking about it. It has nothing to do with me getting my teeth cleaned. So I wish I hadn't put that, you know? I did, because I'm thinking I have to be thorough filling out my forms, but it was distracting and then really uncomfortable.”
Duffy is not alone in their experience. According to Invisible: The State of LGBT Health in Colorado, a 2011 report from One Colorado, only 59 percent of LGBT people surveyed described being very open to their health-care provider about their sexual orientation or gender identity and expression. Respondents said they were not open with their providers for a variety of reasons, including but not limited to: feeling their sexual orientation or gender identity has nothing to do with their health, feeling their provider won’t understand their health care needs and worrying the provider is not supportive of LGBT people.
In fact, almost 9 out of every 10 transgender-identified respondents reported a community fear or dislike of LGBT persons to be a problem when receiving health care services. Additionally, 53 percent of transgender respondents and 21 percent of all LGBT respondents have been refused services by a healthcare provider or their staff.
“That happens a lot where providers are just like, 'I don't know about this, I'm not comfortable, I'm not going to see you because I don't know.' Which is super problematic when you're trying to get basic health care,” said Duffy. “Just because you're trans and you get a cold doesn't mean it has to be treated differently. You would still just need the same basic health care as any human.”
To deliver culturally competent care to LGBTQ people, providers need to understand the intersections of identity and be culturally responsive to a person’s gender identity and expression or sexual orientation as well as their language, race, ethnicity and other factors.
“If you're being misgendered, or if you feel like you can't be out to your doctor, you can’t be open about your identity to your doctor, then that's going to really hinder the quality of care,” said Duffy.
Providers also need to understand the physical, sexual, mental and behavioral health needs that are unique to the LGBTQ community.
“There’s a hesitancy to receive medical care that exists within the LGBT community for fear of discrimination, which we know in public health can lead to some pretty serious health disparities and negative health outcomes if someone delays care or doesn't seek care” said Heather Crate, OASOS (Open and Affirming Sexual Orientation and gender identity Support) Program Coordinator for Boulder County Public Health. “So [medical providers] building an inclusive environment through training, through looking at forms, through looking at physical spaces, really can have huge impacts in a positive way for the LGBTQ community.”
In Invisible: The State of LGBT Health in Colorado, not one transgender-identified participant said that they had access to everything they needed to be healthy.
“As far as health care needs, there are a fair amount of providers around here that are aware of trans issues, especially around hormone replacement therapy and surgery referrals,” said Duffy. “There are some surgeons locally, or regionally I will say, that can meet the needs of the trans community, but there's definitely not enough. Looking for trans-competent health care around here is still a challenge. The lack of culturally competent healthcare providers definitely exists in Longmont.”
One way in which Boulder County is trying to make quality health care providers more accessible to the LGBTQ community, specifically transgender people, is with an online resource, transhealthbouldercounty.org. It's a comprehensive database of healthcare providers who are LGBTQ culturally competent.
All of the listed mental health providers have completed an extensive questionnaire in order to be included, but some of the physicians currently listed have not. Rather than only listing just a couple of physicians that had completed the survey, they incorporated additional physicians that Out Boulder County had vetted.
“There are very few folks listed in Longmont or Boulder,” said Crate. “A lot of the sort of leaders in medical care that are trans-specific are Denver-based, which can often be a barrier for folks. We're constantly looking for new medical providers in the area.”
The website’s questionnaire asks about what type of insurance the provider accepts, their experience serving trans and non-binary patients, if they provide hormone therapy, what kind of training they’ve had and if their staff also had training, what types of protocols they follow and more.
“It’s a pretty important thing for trans folks to know what standards of care that provider is following,” said Crate. “That can make a difference. Having to go to a mental health provider before you can access medical care can add an additional barrier for transgender folks.”
LGBTQ community members in need of health care recommendations can reach out to Out Boulder County, which has offices in both Boulder and Longmont, or the Boulder County Public Health OASOS youth program. Medical providers interested in listing their services on the Trans Health Boulder County website should contact Heather Crate for more information.
