This article was written by Katie Taibl, RN, BSN and clinically reviewed by Kate S., MSN, WHNP-BC.
For the LGBTQIA+ community, including people who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, or other gender-diverse identities, healthcare barriers are profound. Inclusive and culturally-competent care is essential. Good healthcare is not just about taking a medical history or prescribing the right medications. It’s also about having a safe and trusted relationship with your provider.
People who belong to marginalized communities are frequently underserved by traditional medicine. Fortunately, an inclusive, proactive, and compassionate approach to healthcare can help. The concept of concordant care, or a shared identity between a patient and healthcare provider, enhances this approach. Patients feel more comfortable when their provider is similar to them. For over 9 million LGBTQ Americans, having a provider that understands their experience increases access and trust via concordant healthcare.1
The LGBTQIA+ patient experience
The LGBTQIA+ community has historically experienced mistreatment in healthcare settings. In 2020, over a third of LGBTQIA+ folks experienced discrimination from a healthcare provider. For LGBTQIA+ folks, concordant care reduces stigma and discrimination in healthcare interactions. Concordant care is one way to ensure patients receive culturally competent care.2 When it comes to concordant health care, the focus is on the patient's identity as the key to better healthcare experiences.
Three out of ten trans people had a negative experience with a healthcare provider about being trans, according to the 2015 National Transgender Survey. Negative experiences ranged from having to educate their provider about what being trans meant; to being refused care and verbal or physical assault.3 Focusing on the patient experience is vital for LGBTQIA+ folks seeking quality healthcare.
Queer and transgender people face several health risk factors. LGBTQIA+ people are susceptible to cardiovascular disease from minority stress. Mental health disorders, suicide, homelessness, HIV, and lack of preventative screenings are more common among gender and sexual minorities.4 Gender-affirming hormone therapy, which is specific to the LGBTQIA+ community, must be with a competent, affirming provider.
Challenges unique to LGBTQ healthcare
- A lack of available diverse providers.
- Long wait times to be seen at regional Centers of Excellence or LGBTQIA+ focused clinics (average six-plus months).
- A lack of education among healthcare professionals on LGBT health.1
- The stigma associated with being out, for both patients and providers.
- Bills that target LGBTQIA+ healthcare, and in some cases, ban access.
- Challenges with insurance coverage because of gender identity. (For example, gynecological care for transgender men.)
- Inequitable insurance policies that challenge access for LGBTQIA+ people. (e.g., Requirements to have had “unprotected sexual intercourse” for six months for fertility treatments.)
Solutions
The LGBTQIA+ community benefits from providers who understand their core issues and needs. FOLX Health makes it easier to connect with understanding and engaged providers who are experts in LGBTQIA+ health. FOLX's telehealth platform provides outreach to rural, distant, or underserved areas and populations in the larger US. Having increased diversity on healthcare teams and LGBTQIA+ knowledgeable care improves healthcare interactions. When LGBTQIA+ patients have healthcare providers who also identify as LGBTQIA+, it makes for a better overall healthcare experience and can lead to better health outcomes.
What is concordant care?
The definition of concordance means "agreement." Concordant care is based on a shared cultural identity. For example, racial concordance in healthcare is when a Black doctor treats a Black patient.
Feeling seen and heard by a clinician frequently creates positive health outcomes for patients. Experiencing isolation or bias can lead to minority stress, which is linked to worse health. When are people more likely to engage with their provider and follow through on their care plans? When the care is collaborative and aligns closely with their goals as a patient.5
The benefits of concordant care
When clinicians share an identity with their patients, are there better health outcomes? Research points to yes. It's easier for patients to be more proactive in their own care when they feel validated and understood by their provider. This builds trust between the patient and the provider. It also makes it more likely that patients will (and want to) follow through with their care plan.
When people from different racial or ethnic groups feel uncomfortable or experience tension in healthcare settings, it's known as a "racially-discordant encounter." A study in 2021 showed that Black men who didn't trust the healthcare system before benefited from having a healthcare provider of the same race. In fact, preventative care for heart disease could reduce the gap in death rates between Black and white individuals by 19%.
Though these studies center on racial concordance, the same concept can be applied to LGBTQIA+ communities. In a study with lesbian and bisexual women, researchers found their healthcare was negatively affected by providers who made incorrect assumptions about their sexual orientation and practices. Although participants supported LGBTQ health education programs for healthcare providers, the lesbian and bisexual women in the study were skeptical if these programs would be effective.6
For LGBTQIA+ people, tension frequently arises in healthcare settings. Discrimination from in-person visits or overcomplicated health insurance claims put minority stress on LGBTQI+ individuals. For example, a person who does not engage in sexual activities that can create a pregnancy may not need a pregnancy test. In another case, someone who engages only in receiving anal sex may not benefit from a urine STI screen. Many healthcare professionals who are not LGBTQIA+ don’t understand the stigma and cultural nuances that impact care. When there is a lack of cultural competence, receiving care can create more risk for ongoing health disparities.
Better health outcomes lowers costs
Hesitancy to see a provider in person because of discrimination is a concerning barrier to care for LGBTQIA folks. Preventative care, such as finding an affirming primary care physician, is challenging. Without concordant care, LGBTQ folks may be less motivated to seek preventative health care.
Concordant care creates safer spaces that allow providers to address health disparities head-on. It often results in more specific and accurate approaches to care. In turn, more tailored approaches can lead to more cost-effective healthcare.
Our LGBTQIA+ community has more specialized health needs. Specialized preventive care, like PrEP, immunizations, and more STI screenings, can help LGBTQIA+ folks focus on wellness and stay healthy.
This calls attention to the risks of conditions that are higher in our community. For example, substance abuse or mental health issues are higher in the LGBTQIA+ community. Understanding this increases providers' screening efforts to identify concerns early on.
Another example might be when a medical provider is sensitive to not just name and pronoun, but alert to body and/or gender dysphoria. This is especially important when it comes to touching a patient or the physical exam.
Concordant care helps LGBTQIA+ folks feel safer and more comfortable. This can improve not just the patient-provider relationship but also lead to improved health outcomes. Access to an EMO or Expert Medical Opinion in LGBTQIA+ health can help eliminate misdiagnoses. Expertise combats costly diagnostic tests and errors. Virtual access to EMOs allows high-quality personalized care to be accessible to more LGBTQIA+ people.
Virtual healthcare with FOLX
Virtual healthcare from our experts in LGBTQIA+ health can help reduce discrimination and make care more accessible. This is especially true for gender and sexual minorities who live in underserved local or regional areas of the US. It allows LGBTQ providers to connect with LGBTQ patients who are farther away. Many might have difficulty accessing transportation or cannot take a lot of time off from work to travel to their appointments. From apps to LGBTQIA+-friendly telehealth, technology will help increase concordant care.
The FOLX model of healthcare, a telehealth-based platform for the LGBTQIA community by LGBTQIA healthcare providers, takes concordant care to a new level of shared identity. From virtual health care to gender-affirming hormone therapy, the needs of a specific population are addressed by experts who are culturally similar to the patients they serve. The dedication of a provider deeply integrated into a community surpasses the kind of care from someone who is not.
At FOLX, we understand how vital it is for gay, queer, and trans patients to feel validated and heard by their healthcare providers. A clinician who is current on emerging studies and best practices, and who understands the importance of body autonomy and shared decision-making, is important for all people seeking quality health care.
Our FOLX healthcare professionals listen carefully to each patient and understand the importance of being:
- Supportive of LGBTQIA+ specific health issues, including pronouns and gender expression.
- Informative and well-informed, especially of gender-affirming medical care options and in the context of a rapidly changing legislative landscape.
- Able to promote LGBTQIA+ specialized healthcare services and referral to LGBTQIA+ competent providers.
Improving access to patient-centered care for all is crucial to creating inclusive workspaces and societies where LGBTQIA+ folks feel valued and safe. Offering proactive, preventive, LGBTQIA+ specialized healthcare services sends an important message. It's not just for LGBTQIA+ folks, but for family members and allies who understand the importance of health equity. FOLX Health and its LGBTQIA+ expert care create health equity and care access in all parts of the US.
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FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!
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References:
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370394/
2https://pubmed.ncbi.nlm.nih.gov/27846805/
3https://transequality.org/sites/default/files/docs/usts/Executive%20Summary%20-%20FINAL%201.6.17.pdf
4https://www.wpath.org/publications/soc
5https://pubmed.ncbi.nlm.nih.gov/18474881/
6https://www.liebertpub.com/doi/full/10.1089/heq.2017.0041
