By Denise Williams | News & Views
For LGBTQ+ populations, walking into a healthcare provider can sometimes mean entering an environment of discrimination and misunderstanding.
According to a 2020 scientific statement from the American Heart Association, members of the LGBTQ+ community are at greater risk for poor cardiac health due to factors including elevated rates of tobacco use, lower levels of physical exercise and use of gender-affirming hormones, to name a few. Because they also report a high rate of unfavorable interactions in clinical settings, the AHA document adds, these populations also tend to be skittish about seeking medical attention – often choosing inaction over the prospect of discrimination or second-class treatment.
That sounds about right, according to Kelsey Loy, MS, RCEP, at Centura Health in Colorado Springs, Colorado. There’s no empirical evidence; but when the exercise physiologist considers the sheer number of participants passing through the cardiac rehabilitation program she manages and then considers the mere handful who are openly part of the LGBTQ+ community, she finds it entirely believable that many individuals identifying with these groups are putting off necessary care. “I think that population in general tends to be a little more guarded – for good reason, unfortunately,” she muses. “For one, they don’t always know how they’re going to be treated, even by healthcare professionals.”
If cardiac rehab professionals make LGBTQ+ patients uncomfortable, Loy believes it’s with neither malice nor intent; rather, she cites unconscious bias as a likely contributor to an environment that may not seem welcoming to this community. For example, a common knee-jerk reaction (and not just in healthcare) is to assume that when someone is married, it is to a person of the opposite sex. Loy goes out of her way – and coaches her staff accordingly – to use gender-neutral terminology, like partner or spouse, instead of making assumptions about husbands and wives.
That’s not a bad place to start, according to Donna May, co-founder of Breyla May Consulting LLC and Resiliency Coaching and HR Consulting in Wilmington, Delaware. The human resources executive and life coach, who is certified in Diversity, Equity and Inclusion (DEI) and counts Delaware HIV Consortium and TransitionsDE among her clients, has additional suggestions for making rehab more welcoming to LGBTQ+ patients:
- DON’T stare or whisper.
- DON’T discuss personal information loudly with individuals who may desire privacy.
- DON’T jump to conclusions about how a patient identifies.
- DON’T presume to know the gender of a person’s partner.
- DO revise intake forms to be more inclusive, since not everyone identifies as Mr., Ms. or Mrs. Ask for preferred pronouns and, importantly, ACKNOWLEDGE AND USE them!
- DO provide a private space for check-in or patient assessment where LGBTQ+ patients can share necessary information out of the earshot of others.
- DO invest in literature, wall posters, badges with preferred pronouns and other materials that represent LGBTQ+ people. Visibility is affirming!
- DO offer gender-neutral restrooms. Modifications can be as simple as taking down signage on single-occupancy bathrooms marked “Men” and “Women” and replacing it with “Vacant” or “Occupied” indicators. For more complex retrofits, investigate whether federal grant money may be available.
- DO bring staff up to speed! Although many organizations now expose employees to general diversity/discrimination education, there also are resources specifically targeting LGBTQ+. TransitionsDE, for example, recommends the following for medical professionals who are interested in free web training in this area: https://www.lgbtqiahealtheducation.org/.
For facilities that want to formally mobilize their efforts toward equity and inclusive environments, May recommends getting buy-in from top management from the very beginning, assembling a committee, conducting a needs/wants assessment with all staff, holding focus group meetings, rolling out an action plan and prioritizing items on that agenda. She suggests tackling “low-hanging fruit” first, such as updated intake forms, before taking on more involved changes.
‘Just Treat People Like People’
May’s insights resonate with Loy, the exercise physiologist, who empathizes not only from a professional standpoint but also as a gay woman. She is thrilled and proud that Centura Health has recently launched a diversity committee, although the overwhelming interest in it meant she wasn’t able to land a spot on the panel herself. Still, Loy is excited at the possibilities that could result – from small nuances such as gender-neutral prompts in the electronic medical records system to more noticeable changes like private spaces where electrodes can be placed for telemetry away from curious or prying eyes.
Whether she eventually gets on the committee or not, Loy plans to continue to serve as a sort of “ambassador” in her own right by setting an example for staff that is grounded in basic principles of humanity and common sense. “Just being conscious of your own words, being conscious of your own assumptions, is the first step we can take,” she says, followed by embracing open-minded communication and engagement – particularly with transgender individuals, who make up a highly stigmatized and politicized group right now. Loy recalls attending a recent leadership seminar, where the question was posed: How do I communicate with a transgender person? What an odd thing to ask, she remembers thinking. “You TALK,” she says, answering the question herself. “You just treat people like people. Talk to them on a very real and genuine level; and if you have questions and you ask them with sincerity, you’re not going to get a negative response.”
In Loy’s eyes, the highly diverse cardiac rehab ecosystem – which encompasses a multitude of demographics in terms of age, race, gender and identity – is just a smaller reflection of broader society. And just like the world in general, she reasons, there are some areas that are marked by excellence and others that have room for improvement. Equity is an area where she believes the cardiac rehab community has an opportunity – and a responsibility – to step up. “Creating a culture of diversity and good communication” is just so critical, Loy says. “Whether transgender people, gay people, bi people – anyone – we need to do a better job of identifying people’s differences, embracing that, and seeing value in all individual populations.”