PCC recently hosted our annual Users' Conference. One of the courses we offered discussed ways that pediatricians can support LGBTQI patients and their families. Our panel of experts, who work in the community as advocates for LGBTQI youth, shared their insights and advice. This post includes highlights from that presentation.
Pediatricians are in a unique position to support patients who identify as LGBTQI. They have established, longterm relationships with their patients and are able to provide the kind of compassionate and confidential space where patients can share, ask questions, and get access to support and resources. Knowing the best practices to help these patients feel safe and supported is key.
It's important to understand what the acronym LGBTQI stands for so that you can use the words appropriately with patients. Ultimately, you want to know the language, but at some point move away from focusing just on words in order to focus on the person who is in front of you:
- L: Lesbian; typically refers to women.
- G: Gay; typically refers to men, but can encompass more than one gender.
- B: Bisexual; typically refers to both the same and other gender.
- T: Transgender; generally refers to both genders and indicates that an individual had a sex assigned at birth, but they have moved away from that to identify with another gender. Someone can identify as transgender whether or not they have undergone gender reassignment (e.g., hormone therapy, surgery).
- Q: Queer (or can mean Questioning); although for some generations this word could have a negative connotation, in more recent years the LGBTQI community has been taking this word back as a more spacious and fluid descriptor.
- I: Intersex; from the root 'inter' which means 'between.' Some babies are born without the 'typical' combination of chormosomes, and thus they have the anatomy and secondary sex characteristics of both genders. Intersex people remind us that biology runs along more of a spectrum than simply male versus female.
The following are 7 tips for best practices to support LGBTQI patients:
Be mindful of how you communicate with your LGBTQI patients. During appointments, limit your curiosity by asking yourself why you are asking what you are asking. Make sure to only ask the questions that are necessary and within the context of what you would normally discuss during a visit. Although you may want to know more, refrain from asking anything extra about your patient's lifestyle and choices.
Let them lead the conversation. Ask, "what words do you use to describe yourself and how would you like me to address you?" Don't make assumptions.
Don't use gender-specific words for body parts, as your patient might not use the words that you might think they would. Let the patient lead in that regard. Another example is to not make assumptions around dating when initiating a conversation around relationships or sexuality. Rather than asking a boy "do you like any of the girls at school?", try rephrasing it to "is there anybody at school that you like?" Keep your language and your assumptions neutral until you have clarity from your patient on the correct words to use.
2. Show Your Support
Offices can visually indicate that they support LGBTQI patients. Displaying a rainbow Ally sticker in a prominent spot in your office lets patients know they are in a safe space where they won't be judged. Having a visual display of support also allows a patient to know right away that they are in a supportive environment without having to ask or wonder. Another idea is to request a Safe Space Kit from GLSEN (Gay, Lesbian & Straight Education Network), which includes a sticker and poster that you can put up in your office.
Many LGBTQI youth feel an intense sense of isolation, particulary in rural areas. These youth face far higher suicide rates, as well as rates of anxiety and depression. They often do not feel a sense of belonging. Simply providing an opportunity for meaningful conversation, and a chance for your patients to ask questions or share their experience will go a long way in helping them feel supported.
4. Let your patient be the author of their own experience
Sometimes you may be in the position of knowing your patient identifies as LGBTQI before their family does. When this happens it can be tempting to want to encourage your patient to tell their family before they are ready to. You may feel without a doubt that their parents would be supportive, but if your patient is not on the same page it is important to not push. As one of our panelists said, "it's a very common thing to not be your most authentic self with your family. We live in a 'hetero-normative' society. To even have to 'come out' is already a set up for adversity." Therefore, it is important to separate what we might want for our patients versus what they want for themselves. Trust that your patient is in the driver's seat. Trust their process.
5. Make it part of your workflow at the front desk
Checking in at the front desk has the potential to feel awkward for a transgender youth who does not want to be called by their given name, yet their chart still states the name and gender they were assigned at birth. While you may need to keep their legal name in the chart for insurance purposes, you can use the 'nickname' field that is built into PCC's software for their preferred name. That name will show up on the checkin screen.
Another way to highlight this is to enter a note with their preferred name into the 'reason for visit' field. That way, it will show up right away and catch the provider's eye when they open the patient's chart.
You can also ask about a preferred name when you do your 'active updates'. This is the list of things you check on every time the patient comes in. You can ask, "Do you have any insurance changes? Any address/phone changes? Any changes to your preferred name?" Alternatively, provide the questions on paper or an ipad in case they are more comfortable writing it rather than talking about it.
However you choose to integrate it, making the conversation part of your workflow normalizes it, and that shows support to your patients.
6. Coordinate care
The pediatric office is one stop along a larger roadmap for many LGBTQI youth. It is often where people first disclose information around their identity and sexuality, so it is important to be aware of both local and national resources. Being able to coordinate care with other providers in support of your patients is essential. Strive to become a one-stop shop where your patients can get information and access to other care and resources. You might not be the provider to best address all of their needs, but you can make sure they are connected to what they need. Don't feel you have to be the expert in everything. Consider providing information and access to:
- family support groups
- youth support groups
- local advocacy groups
- transgender clinics
- educational resources both online and in the community
7. Start the conversation sooner
Organizations like the Family Acceptance Project from San Francisco State University have research linking a family's level of acceptance of their LGBTQI child to that child's mental health outcomes. The greater the level of acceptance, the greater the outcomes. Tell parents about this. Tell them that we know this, and ask how you can help them to get to the place of greater acceptance if they are struggling with that. It is important to engage patients and families in conversations as soon as it is appropriate. Since we know that LGBTQI youth have higher rates of depression and suicide, it is essential to provide support and resources sooner, before a situation escalates.
There are endless ways to show your support of LGBTQI youth and their families. Creating a safe space, being an ally, opening the communication lines, providing resources, and ultimately looking beyond labels to the patient in front of you will all go a long way to increase the quality of care for your patients.