Raising the standards for LGBTQ healthcare

Published September 29, 2020

A doctor’s office should feel like a safe space, but LGBTQ patients and their advocates say that’s not always what they experience.

Discrimination and poor health

Advocacy group Lambda Legal’s 2014 Health Care Fairness Survey found more than half of LGBTQ respondents said they faced discrimination or substandard care in doctors’ offices. Many said doctors didn’t understand their needs.

Awareness is growing that LGBTQ individuals need culturally competent care. A growing body of research is showing that LGBTQ individuals face serious health disparities. According to the U.S. Department of Health and Human Services, rates of mental health conditions and chronic health conditions like obesity are higher among some LGBTQ individuals. What’s more, a growing number of people identify as LGBTQ, an expansion driven almost entirely by millennials. A Gallup poll found more than 8% of millennials identify as LGBTQ up from just under 6% in 2012. In Rhode Island, a recent Blue Cross & Blue Shield of Rhode Island (BCBSRI) survey found that more than 8% of respondents identify as gay, lesbian, bisexual and other.

Providing culturally competent care to this growing population is exactly what BCBSRI's Safe Zone program aims to address.

A certified safe zone

“The greater the trust LGBTQ patients have with their healthcare providers, the greater their health will be,” says Guillaume Bagal, diversity and inclusion lead for BCBSRI. “It’s about them feeling more comfortable and getting the care they need when they need it.”

Bagal heads BCBSRI’s “Safe Zone” certification program for healthcare providers throughout the state. A Safe Zone certification signals to LGBTQ patients that they are welcome in a medical practice, says Bagal. To become certified, each member of a clinic’s staff must take cultural competency training every year. Staff must use a patient’s preferred name and pronoun in all interactions. And at least one restroom must be gender neutral, among other requirements.

Bagal says when LGBTQ patients mistrust healthcare providers, they put off care. And that puts them at increased risk for major health problems down the road. “It’s clear why many LGBTQ people are diagnosed at a much later rate for cancer, because they’re not going for primary care,” he says. They’re also diagnosed at older ages with chronic disease, says Bagal, which means some physical damage may already have been done.

He hopes that when LGBTQ patients see the BCBSRI Safe Zone logo on a provider’s door, they’ll know they can expect affirming, inclusive care.

What it looks like in practice

Bagal says that kind of care begins the moment a patient walks in the door. If a patient hands over an insurance card with a female name but presents as a male, staff must honor the patient’s pronoun preference; some clinics may make a note in the medical record so the patient doesn’t have to explain that preference on a follow up visit. If a transgender man (someone born biologically female but who identifies as a man) comes in for a gynecology appointment, nurses at one clinic have been trained to welcome him and make the interaction as routine as possible. Some staff at certified clinics have additional expertise in hormone therapy or LGBTQ-centered behavioral health therapy.

A welcome sign for a vulnerable population

Melissa DaSilva, LICSW, heads East Coast Mental Wellness in Providence, R.I. She received her BCBSRI Safe Zone certification earlier this year. “We were already well known for our services in the LGBTQ community. But this additional recognition means a lot to me,” says DaSilva, because she believes it reinforces her expertise in caring for LGBTQ patients. DaSilva appreciated the rigorous certification process.

DaSilva says her clients share stories about the stigma they’ve faced from other providers, or the lack of knowledge a provider might have about their needs. “They feel like they’re spending half the session teaching the therapist about transitioning,” she says, referring to the process a transgender patient goes through to have the body or identity they prefer.

She points out that a majority of her patients are millennials, a generation that has helped to “destigmatize mental health.” DaSilva says that gives her hope that her patients may have better health outcomes than previous generations. A growing number of providers trained to understand their needs will help, too.

An increasing demand for Safe Zone certification – from providers and patients

So far, 39 practices have been certified as Safe Zones. Those include traditional physician practices, dental offices, mental health centers for adults and youths, and a multi-site assisted living facility. “Visits to our Safe Zone page have doubled in the past year,” says Bagal, with both providers and patients wanting to know more about certification. Bagal says BCBSRI will continue to expand the program to more healthcare systems as well as focus on more provider education and other dimensions of diversity.

Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.