A Second Chance at a First Impression: Creating an LGBTQ-Friendly Environment

Background: Advocate Illinois Masonic Medical Center (AIMMC) is located in the nation’s first municipally recognized LGBTQ neighborhood and has been named a “Leader in LGBT Healthcare Equality” in the Human Rights Campaign Healthcare Equality Index for the past 7 years. The LGBTQ community is a significant portion of the patient population. Health disparities in the LGBTQ community include (1) decreased access to healthcare/insurance; (2) low rates of pap smears and mammograms; (3) higher rates of suicide, depression, and substance abuse; and (4) an unknown proportion of LGBTQ patients in the practice.

Methods: We administered a 19-question survey assessing participants’ comfort in interacting with LGBTQ patients to 27 providers and staff at the AIMMC – Ravenswood Family Medicine Clinic. Response rates were as follows: attending physicians (26%), resident physicians (26%), medical assistants (19%), nurse practitioners (11%), registered nurses (4%), patient service representatives (7%), and other office ancillary staff (11%).

Results: The respondents indicated that the intake forms do not adequately capture gender identity. Providers and staff also signaled their interest in educational opportunities regarding LGBTQ issues. In response, 2 interventions were developed. The first intervention was training in providing an inclusive environment for all patients with topics on sharing difficult patient encounters, addressing patients at the front desk, asking for preferred pronouns, developing comfort discussing gender identity, and taking a complete sexual history. The second intervention was the development of a new intake form. On the current form, all questions are separated by sex. The form does not offer a gender pronoun area for transgender patients, and the number of sexual partners equates to sexual health, resulting in inadequate assessment of risk. The proposed new intake form is unisex and has space for name choice and gender pronoun. The review of systems questions are broad and can be discussed further with individual providers, and the sexual history question is more relevant to sexual risk. Plans are to conduct a follow-up meeting and administer a survey after a trial period of the new form.

Conclusion: Providers and staff are not confident in their approach to care for LGBTQ patients, but they are eager to learn how to better serve this population. Making changes to the way we address our patients does not have to be painful, and changes can be fluid and incremental.