James March Mistler, MS, MLS(ASCP)CM, ASCLS-CNE President, Diversity Advocacy Council Chair
When one thinks of LGBT+ rights, one may automatically think of marriage equality, political movements, employment rights, or even education. But one issue that is often overlooked is healthcare. There are many issues that concern the LGBT+ community in terms of healthcare, as it is not just access to equal, accessible care that is a problem, but also getting the right care at the right time. Before we delve into some of these issues, lets go over some common terms: LGBT+ individuals are those that do not identify as part of heteronormative society. Heteronormativity is the belief that everything is tied to normalizing societal expectations into heterosexual relationships and traditional gender roles. LGBT+ is also sometimes referred to as LGBTQIA (Lesbian, Gay, Bisexual, Transgendered, Queer, Questioning, Intersex, Asexual, Allies). 
The health disparities that affect LGBT+ individuals are caused by discrimination, stigma, and ignorance. Some of these disparities are increased sexually transmitted infections, lower rates of Pap testing and mammographies, and higher rates of substance abuse, smoking, depression, anxiety, and violence victimization.1 In many parts of the country, providers simply refuse to treat LGBT+ individuals, with 19% of transgendered individuals stating they have been refused care.2 Many receive harassment by insurers or providers when applying for care and even receive mistreatment from phlebotomy staff. This, sadly, is not an uncommon issue and isn’t portrayed in the news or media outlets; however, it is something pervasive in our society, even in socially progressive areas of the country such as Massachusetts, where I live. My husband and I often encounter ignorant healthcare professionals when seeking care or simply going for a blood test. And it gets worse when we travel outside of our home state.
When visiting friends in North Carolina a few years ago, my husband had a severe asthma attack and couldn’t breathe, so we ended up at the emergency room. They rushed him right in; however, I wasn’t allowed in with him. Since the U.S. Supreme Court had not ruled marriage equality legal at the time, I was left at the reception area while my husband went in alone. When the shifts changed about 30 minutes later, I told reception that I was his brother so that I could get in to see him. When they finally let me in, I found my husband sitting on a hospital bed, still wheezing and unable to breathe. When I found the physician assistant treating him, he had said that they were extremely busy and that “they had sicker individuals that needed help,” so we could wait. I was stunned. When I was finally able to find his nurse, she took her time finding someone else to order a breathing treatment. About two and half hours after arriving, we finally had the breathing treatment and my husband was feeling better. I was shocked and frustrated. Not only because of how we were treated, but it made me think of how many others are treated this way and how often? It also perpetuated the fear that we would be dealing with this type of ignorance and malice our whole lives. And if this is how we have been treated, how many other LGBT+ individuals experience the same thing, or worse?
Many LGBT+ individuals do not disclose their sexual orientation or gender identity to providers for fear of harassment or ridicule; however, this reduces the likelihood of receiving proper and adequate care, specifically for those that identify as transgendered. How does a laboratory scientist, the provider, or even the lab information system (LIS) interpret hormone levels for a trans male (female to male)? What are the correct levels for a trans female (male to female)? How about a simple CBC result or liver enzymes that are specific to gender and age? It is even harder if patients do not feel they can be honest with providers. With at least 9 million Americans that openly identify as LGBT, and less than five hours of training in medical schools on LGBT care, we need to be sure we are giving the access to care they deserve but also interpreting the results properly according to their orientation or gender identity.1
All members of the healthcare team, from physicians to nurses, radiology technicians to laboratory staff, are important providers ensuring patients are getting quality, equitable healthcare. The U.S. Department of Health and Human Services helps fund LGBT+ sensitivity training for healthcare professionals. The Fenway Institute, part of Fenway Health, runs the National LGBT Health Education Center. To learn more about LGBT+ healthcare and to find resources for care, visit their website at www.lgbthealtheducation.org.
In terms of gender identity and transgendered individuals, there is a lot of work that needs to be done for accurate healthcare, and the laboratory is one place where it can start. Laboratories should work with administration, patient advocates, medical staff (ID, pharmacy, radiology, gastro, etc.), and information technology, among others, to find the best way to interpret laboratory results for these individuals. It is also important to ensure that those interpretations move correctly from instrument, to LIS, to electronic health record, to provider, to patient for proper diagnosis, management, and treatment. Even though we in the laboratory may not always see patients, we have a profound effect on them and their healthcare.
REFERENCES
1. Ard, Kevin. Understanding the Health Needs of LGBT People. Fenway Institute. March 2016. Available from: http://www.lgbthealtheducation.org/wp-content/uploads/LGBTHealthDisparitiesMar2016.pdf
2. Grant J, Mottet L, Tanis J, et al. National Transgender Discrimination Survey Report on health and health care. October 2010. Available from: http://www.thetaskforce.org/static_html/downloads/resources_and_tools/ntds_report_on_health.pdf