New Institute of Medicine Report Addresses Health of the Lesbian, Gay, Bisexual and Transgender Community
Daniel Knight, M.D.
Diversity Process Coordinator
Center for Diversity Affairs
A new report from the Institute of Medicine, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding by the Institute of Medicine, reviews current knowledge of the health of lesbian, gay, bisexual, and transgender (LGBT) persons and proposes a research agenda to study the health needs and risks of this population.
A lack of solid health data about LGBT persons – including reliable population numbers – is an impediment that must be addressed, if research is to move forward, according to report authors. It is estimated that individuals who identify as LGBT comprise 4 to 10 percent of the U.S. population.
Groups under the LGBT umbrella are actually quite diverse, with race, ethnicity, and other social factors modifying risks for certain subgroups. But individuals within that group are more likely to experience intensified health issues beginning in adolescence: various mental health disorders and heightened risk of suicide, homelessness or injury; increased incidence of HIV/AIDS, greater rates of smoking, alcohol and substance abuse, obesity, and some cancers; and less access to preventive care due to stigma and mistrust of the health care system as well as unavailability of health insurance for same-sex partners.
Besides lining out a proposed research agenda for the National Institute of Health, the report recommends action on the federal level to begin planning for the collection of data on sexual orientation and gender identity as part of electronic health records, while acknowledging there may be resistance to that.
The report states: “At present, possible discomfort on the part of health care workers with asking questions about sexual orientation and gender identity, a lack of knowledge by providers of how to elicit this information, and some hesitancy on the part of patients to disclose this information may be barriers to the collection of meaningful data on sexual orientation and gender identity. Nonetheless, the committee encourages the Office of the National Coordinator to begin planning for the collection of these data as part of the required set of demographic data for electronic health records. Detailed patient-level data such as those found in electronic health records could provide a rich source of information about LGBT populations and subpopulations.”
Daniel Knight, MD, chair of the UAMS Department of Family and Preventive Medicine, agrees that collecting these data would be good not only in the interest of research but also better patient care.
“In family medicine especially, we emphasize knowing the whole person, and unless you know their sexual orientation or gender identity, you really don’t know the whole person,” Knight said.
Providers who want to be supportive sometimes don’t know how to open up the line of communication with patients they believe are LGBT. Others struggle with conflict between their dedication to the provision of compassionate care for all and their personal conviction that any deviation from heterosexuality is wrong.
Such prohibitions have meant that academic health centers have been slow to address LGBT health in their education and training programs.
That medical schools provide instruction on LGBT health is a requirement of The Joint Commission, but UAMS, like most other institutions, currently provide “very little” – about three to five classroom hours for medical school and residency years combined, said Knight.
“It is a very, very broad topic, and especially when you add the T and the Q,” Knight said. “Each topic would have to be taught separately.”
Knight is beginning preliminary research which will guide his development of a curriculum on LGBTQ (the Q stands for persons who are questioning about their sexuality) health. The curriculum initially, which is slated for dissemination next fall, will be for second-year residents.
“We hope after it is tried and tested a little bit, to bring it to the medical students too,” Knight said. “We need a curriculum not just in the College of Medicine but throughout all the programs.”
Knight welcomes the idea of open dialogue and a more supportive campus atmosphere for patients, students, faculty and staff who identify as LGBT. An LGBT alliance, lectures and discussion groups could help “bring [the LGBT] cause out to the community,” he said. Individuals who are fearful or uncomfortable about LGBT issues “get to know people who are LGBT and talk over why they are afraid and find out what is important to LGBTs.”
“This is a conversation that would be useful, but it would have to be a controlled conversation. If so, it could open up frank, open communication. One thing that has always so amazed me is why they are so scared of LGBTs.”
Knight would also like to see changes in UAMS policies affecting LGBTs. That same-sex partners of UAMS employees are denied access to family health insurance can mean poorer health for those individuals or an added financial burden. Further, the talent pool for UAMS is made smaller, because some LGBTs may decide that they don’t want to study, train, or work at an institution with this policy.
“I know for a fact that we have lost significant talent because of a lack of domestic partner benefits at UAMS,” Knight said.