The importance of LGBTQI affirming care and the barriers they face

Non-judgmental, thoughtful communication that fosters open and honest deliverance of healthcare is not a specifically LGBTQI desire.

Health Sexual Health Dr. Evan Goldstein

This article was published on October 26th, 2017

Dr Evan Goldstein - affirming care for LGBTI communityWhen the conversation turns to healthcare for the LGBTQI community, this quote always comes to mind: “Love and compassion are necessities, not luxuries. Without them, humanity cannot survive – Dalai Lama XIV”, because compassion, empathy, and similar core pillars of humanity are at the basis of excellent healthcare that caters to the unique needs of different groups of people – LGBTQI or otherwise. Let’s face it: Non-judgmental, thoughtful communication that fosters open and honest deliverance of healthcare is not a specifically LGBTQI desire. This principle is a human want and right for all, yet there is a clear and continued divide on how it is orchestrated and executed – one that we all should be committed to educating on and ending.

When you analyze any subset or community, the patients within demand a basic understanding of their values and ethics, and tend to surround themselves with others like themselves – it’s a natural and a very human response. What is specific to the LGBTQI community, and is imperative for healthcare providers to understand, is the need to dive deeper into our lifestyles and sexual practices with sensitivity and knowledge to truly affect positive change. The importance of medical providers who understand the intricacies and nuances of gender, sex, and all aspects of sexual relationships is paramount to the delivery of LGBTQI affirming – and most importantly, effective – healthcare.

Asking the right questions, spending the quality and well-deserved time, and leading the discussion with a high-level awareness of continued sensitivity is crucial to enhanced services for patients.

It’s imperative for physicians and specialists to have an understanding of:

  • Yearly preventative evaluations and maintenance.
  • Knowledge of the myriad types of gender and sexual identity, relationships (monogamous, open, poly), and the inherent risks of each.
  • The intricacies of anal intercourse and minimization of injury.
  • The best methods to approach safe encounters.
  • Use and management of PrEP with diverse knowledge on its appropriate indications and the controversial ethics.

These topics and more all lead to cohesive and expansive discussion—and are just a part of the important sensitivities and niche knowledge that is required by practicing LGBTQI physicians in order to serve the community’s needs to the fullest.

While seeking a healthcare provider who identifies within the LGBTQI spectrum is not essential to successfully receive affirming and thorough care, those within the community can see it as a gateway to this elevated level of care and comfort within their experience. In a recent study undertaken by Bespoke Surgical, survey respondents who identified as bisexual or homosexual were 20% – 30% more likely than those who identified as Heterosexual to rate the importance of having a physician with the same sexual identity a 9 or 10 (very important).

This statistic shows that it’s incredibly valuable for those within the community to feel that they can have open, trusting, and explorative conversations with a provider they know will have a greater level of understanding, at the very least.

Providing sensitive care doesn’t come without shortcomings or making mistakes, but analyzing these failures and addressing the issues allows for the humane side of the elevated doctor-patient relationship to develop—a lost art, yet the most crucial. This all sounds amazing in theory, but how do we do it or become a part of it? It’s not an easy fix when the problem lies in the current model of healthcare.

High-quality care with thoughtful communications equals elevated costs, and with decreasing levels of insurance, potential pending repeal of the Affordable Care Act, and the reduction of local government funding, how does one continue to provide these much-needed services? When you deliver care through a volume-based model, the deliverance becomes clinic-oriented with single-pathology office visits that only allow for a snippet of time and corrective, mostly reactive planning. Within these clinics there are enormous amounts of moving parts—the more parts, the more errors. The more errors, the more patients who come to receive subordinate care.

So, what about the aforementioned example of the quality model—the one that hits all the marks? The reality is that only a small subset of people can actually afford that model. Of course, it’s the model everyone desires, but this leaves us open to ongoing affordability issues, and the argument of class wars.

It begs the question: Can you deliver appropriate, elevated community care at all levels with the sensitivities and understanding we all need? It’s still to be answered, but education continues to be of utmost importance to all that are involved in delivering healthcare, and it’s imperative that it go further than just the provider.

With that said, the more we write and the more we talk about these issues, the hopes are that the kids themselves will stumble upon content that is medically sound, raising issues and areas of not only concern, but also remedy. This becomes individuals taking their healthcare into their own hands and demanding sex positive evaluations, risk assessments, and yes, vaccinations – yes, it is important to educate ourselves, but it is far more important that you demand more from medical practitioners!


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