I found an article in JAMA Neurology, August 2015, by Nicole Rosendal, MD, compelling. Its target audience is neurologists, but I think everyone can learn from it.

It is estimated that 9 million Americans, or 3.5% of the adult population, identify as lesion, gay, bisexual, or transgender (LGBT). An additional 19 million (8.2%) report having had same-sex sexual behavior, and 26 million (11%) acknowledged same-sex attraction.

Over 50% of lesion, gay, and bisexual individuals and 70% of transgender people in a survey in 2009 reported believing they were discriminated in the healthcare setting. Examples were being refused needed care, being blamed for their health status, having healthcare professionals refuse to touch them, have professionals use extensive precautions such as wearing masks and gloves, use abusive or harsh language, or act physically rough or abusive. Many LGBT patients are reluctant to share their sexual orientation with their physician.

The rates of neurological diseases are higher in the LGBT community. Lesbians are more likely to be obese, a difference that begins as early as adolescence. Smoking prevalence and substance abuse disorders are higher.

In order to treat patients effectively, physicians must develop trust. New levels of awareness and acceptance can improve trust. Examples include asking for the patient’s preferred name, and using terms like partner or significant other rather than boyfriend / husband / girlfriend / wife. These are nonjudgmental behaviors that help to establish trust.

Dr Rosendal correctly concludes that if physicians believe they should advocate for true equitable health for all patients, the LGBT community remains an underserved population.

Jack Florin, MD

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