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Lea Mollon, a pharmacy student at the University of Arizona College of Pharmacy, wrote the column The Forgotten Minorities: Health Disparities of the Lesbian, Gay, Bisexual, and Transgendered Communities which appeared in the February 2012 Journal of Health Care for the Poor and Underserved. Here, she describes what prompted her to write the column and the reaction she received to it.
I thought it was important to highlight some of the disparities for other health care professionals or anyone who may work with this community. In telling my personal story, I hope to let other LGBT students and practitioners know that they aren’t alone. It was hard at first knowing that I would be essentially coming out to the health care world. Fortunately, I have gone through the coming out process many times since I was 15.
Q. What promoted you to write this article and was it very difficult for you?
A. When I was first given the opportunity to write this article, I knew I wanted to incorporate personal stories. However, finding people who were willing to share their story with the world was difficult. Throughout my teenage and adult life, I have witnessed discrimination and prejudice toward LGBT people. In high school, gay students were often the brunt of mean jokes, especially the more effeminate guys, whether they were gay or not. In college, a friend of mine had his dorm room and car vandalized with derogatory comments about his sexuality. As I progressed through college and became increasingly interested in the health care field, I quickly realized the health care inequities that LGBT people experience, myself included.
In pharmacy school, there is minimal discussion of health disparities and no designated class on it, except for one elective reserved for students in the Rural Health Program. Outside of that class, LGBT communities are often left out of any discussion on minorities. This isn’t just at my school; some of my colleagues have mentioned that they wish they received more instruction on how to interact with other cultures and how to deliver culturally sensitive care. I thought it was important to highlight some of the disparities for other health care professionals or anyone who may work with this community. In telling my personal story, I hope to let other LGBT students and practitioners know that they aren’t alone. It was hard at first knowing that I would be essentially coming out to the health care world. Fortunately, I have gone through the coming out process many times since I was 15. I imagine some of my coworkers will be surprised when they read this interview though!
Q. What has been the reaction to the column? Did it surprise you?
A. The reaction has been overwhelmingly positive. People have told me that they appreciate that I wrote this article because there are many things they did not know. I did get a couple of comments from people who do not believe that LGBT people should be included with other minority populations like Latinos, African-Americans, American Indians, etc. Some people still believe it is a choice, which it’s not.
Q. You conclude your column stating that making changes to standard practices will improve the health status for the LGBT community. What particular changes do you believe will benefit this community? As a pharmacy student, what actions do you believe that you can do to benefit this group?
A. One of the easiest things a provider can do is use inclusive language. As I stated in my article, intake forms don’t always include a choice for “partner” or “transgendered”. Making presumptions about relationship status will affect how patients interact or answer questions. I have had to outright lie because I was afraid of how a provider would react.
Relationship status or sexual practices are important things to know about your patients. There are also the emotional and personal experiences a provider needs to take into consideration. We need to know this information so that we can better serve our patients. Besides, it lets the patient know that you are providing a safe space. Opening up those lines of communication is incredibly important. Another easy thing providers can do is be aware of the variety of resources in the community so that they can refer patients to these resources appropriately. Having this information available is good practice.
I have already begun to see important changes though—such as the mention that there is a difference between “gay” and “men who have sex with men.” These are important distinctions that will help eliminate some of the stigma associated with sexual orientation. Some people still associate HIV with the gay community. I think providers need to confront their attitudes and educate themselves on these topics. Oftentimes, patients can tell when their provider feels a certain way about them. At least that is what many of my friends and colleagues have mentioned to me—not just with sexual orientation—but with their race, ethnicity, or religious beliefs.
As a pharmacy student, I really try to bring up LGBT topics in class or make suggestions to instructors on how health disparities in general can be incorporated into the curriculum. I also point out the existence of health care inequities for all underserved and minority populations. I sometimes think that some of my classmates get tired of hearing me bring it up but, the truth is, people need to hear it. They need to know that, as future pharmacists, they are directly affecting the health and well-being of another person and that their patients are going to be from diverse backgrounds.
Q. You stated that the Affordable Care Act (ACA) addresses only two of several inequities. How pivotal of a role does ACA play in alleviating inequities faced by the LGBT community?
A. One of the main issues with private insurance is that same-sex partners and their children are not always covered. There are companies who will cover a same-sex partner but they have specific rules you have to meet, such as living together for a year with shared banking before coverage starts, or providing copies of a shared lease and utility bills. Heterosexual couples have the option of getting married. Without marriage rights, LGBT couples have to go through additional hurdles to obtain coverage that can be quite burdensome. This is especially a problem when only one partner is employed or if they have a child and the biological mother or father neither receives health care coverage through their partner’s employer nor meets the criteria for state aid. Additionally, the value of coverage received for a same-sex partner is considered as taxable income. This is a tax that married heterosexual people do not have to pay. Some people in the community refer to it as the “gay tax.” Prior to starting pharmacy school, when I worked full time, it bumped me into another tax bracket.
There is also the issue of selecting a provider. Believe it or not, it can be a real chore to find LGBT friendly providers. There aren’t online reviews that say, “Hey, this provider is inclusive!” There is limited information on websites maintained by members of the LGBT community, but often, you just have to go for your first visit and see what happens. With certain health plans, if you get a provider who does not treat you well because of sexual orientation, it’s not easy to switch. Being allowed to choose a provider who you know provides quality care would be very beneficial. It’s a need really.
Q. Do you believe that the implementation of health IT will benefit the LGBT community overall? If so, how?
A. I’d like to say yes. I am a firm believer that integrated care and continuity of care are essential for the best outcomes. Having medical records in a database that is available to all of the providers a patient sees eliminates the need for filling out a bunch of forms with every visit to a specialist or explaining your relationship status over and over again. My partner and I receive our care from an integrated system. All of our providers are aware of our relationship because it’s right there in the chart. Plus, providers will have more information about their patients, which will improve quality of care. Health IT will also allow more patients in rural communities to receive care. There aren’t as many support systems or active organizations for LGBT people in rural communities. Being able to receive counseling services or health education from providers who are aware of LGBT issues is important. Telemedicine might make that easier.
One of the downsides is that if providers know that patients are LGBT beforehand and are not comfortable with that, they will treat that patient differently. Coming out is a long and hard process. Some people don’t come out until much later in life. It’s important not to force that process on someone if he or she isn’t ready.