Medical community must address injustices facing LGBTQ patients

Standards of care reinforce a binary, heterosexist model

We are now living in a modern time where telemedicine can become one of the biggest solutions for the massive inequalities that LGBTQ communities have historically faced in healthcare. When I think back on my OB-GYN residency at Stanford University, I was trained to order a pregnancy test for every patient who could become pregnant who was undergoing surgery — patients were treated the same regardless of or without a discussion about sexual orientation, gender identity, or sexual behavior.

This is just one example of the gaps in our system. I also witnessed an infertility doctor limiting his practice to married heterosexual couples, and even labor and delivery nurses caring for patients in same-sex relationships expressing discomfort with their assignments.

I’ve often wondered why the FDA classifies testosterone as a controlled substance. According to the CDC, a drug or other substance is tightly controlled by the government because it may be abused or cause addiction. Labeling testosterone as a controlled substance makes gender affirming hormonal therapy for transgender men and non-binary individuals restrictive.

Even further, think about the language around abortion, like the Dobbs decision by the Supreme Court in June 2022. “Erosion of women’s rights” implies a cis woman bias, which we all read in the media as well as in the language used from well-intentioned pro-choice groups. Tactics from anti-abortion groups on abortion clinics are now being repurposed. Movements in Florida and Texas exist to make gender transition-related medical care for minors a felony.

What is the root of these issues? It’s clear: standards of care in clinical medicine have been based on the white male model and when sex assigned at birth mattered, reinforcing a binary and heterosexist model. Those in LGBTQ communities have been stigmatized as a homogenous group of sexual and gender minorities and subjects of relatively little health research. The health status of LGBTQ populations is limited mostly to mental health, HIV, and other sexually transmitted infections.

Title VII of the Civil Rights Act of 1964 makes it unlawful to discriminate against someone on the basis of race, color, national origin, sex (including pregnancy, sexual orientation, and gender identity) or religion. However, religious entities may be exempt. Religious organizations still have the freedom to provide insurance policies and health care services consistent with their convictions. According to a publication in JAMA Network, the Catholic hospital market share was 18.4% in 2018.

However, there’s momentum in changing these inequalities for LGBTQ patients. In 2011, the Institute of Medicine released the report “The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.” The National LGBT Health Education Center (a program of the Fenway Institute) developed a “How To” for Providing Inclusive Services and Care for LGBT People: A Guide for Health Care Staff.

We, in medicine, have continuous training in implicit bias. Patients want clinicians who can relate to them. This is especially true for historically disenfranchised and marginalized populations. Finding someone you can identify with feels validating, and it may increase your confidence about going to the doctor and your ability to actually adhere to medical advice.

We need more underrepresented minority physicians and more female physicians in the U.S. healthcare system. What about LGBTQ physicians? Comprehensive data does not exist. We need to develop the LGBTQ physician workforce that values diversity, including LGBTQ identity, if we want to start seeing these changes.

In the meantime, that IVF doctor with whom I trained now provides inclusive care, demonstrating hope for a new era where patients of all gender identities and sexualities are treated with dignity.

The medical community is behind and needs to catch up with appropriate equal rights for the LGBTQ community. Telemedicine is one area where healthcare can move more quickly to end these disparities in care. The technology in telemedicine gives LGBTQ patients access to gender-competent, non-discriminatory care, which may be harder to find in rural areas and healthcare deserts. Inclusive online forms and language that are built into the patient experience can better serve all patients. Telemedicine is now our moment. It is THE opportunity to equalize health care and finally reduce these archaic stigmas and biases.