Have you ever avoided going to the doctor because you were worried they’d treat you differently?
One in 5 LGBTQ+ people has — and the challenges don’t stop with worry or anxiety.
Studies have shown that among the LGBTQ+ community:
- 7% have had a provider refuse to recognize their child or same-sex partner as family
- 9% have experienced providers using harsh or abusive language while treating them
- 29% of transgender patients say providers have refused to see them because of their actual or perceived gender identity
Often, you can tell right away if a provider focuses on inclusive care or not, says Julie Butterfield, a behavioral health clinical operations manager for BlueCross BlueShield of Tennessee, who married her wife in 2019.
“It starts with the paperwork,” she says. “If your paperwork is out of date — if it doesn’t list ‘partner’ as an option or mention preferred pronouns — that’s a red flag. There’s a lot you can tell before you even see the doctor.”
WellTuned spoke with Julie to learn what she thinks is crucial when evaluating LGBTQ-inclusive health care — personally and professionally.
What is LGBTQ-inclusive health care?
Butterfield: The goal of inclusive, affirmative health care is simple: everyone deserves high-quality care that makes them feel supported, regardless of someone’s race, ethnicity, sexual orientation, gender identity, age, religion, and any physical or intellectual disabilities.
- Inclusive health care centers on the idea that by removing barriers, making accommodations, and deliberately providing informed and sensitive care, we can improve the health outcomes for all people, including those who face the largest disparities.
- Affirmative health care means that providers recognize, validate and support the identity expressed by the person they’re serving.
I have a very inclusive care provider. I was there a few weeks ago with a transgender female, and I noticed how well the frontline staff cared for her. I could tell they were trained to call her by her proper pronouns, not to argue with her if her driver’s license hasn’t been updated to reflect her gender identification, and generally just not to make a big deal. One way or another, inclusive providers will communicate: You are a patient just like any other and we’re going to take care of you.
How do you know if a provider is LGBTQ-inclusive?
Butterfield: Determining whether a provider is welcoming to LGBTQ+ people isn’t always straightforward, but there are ways to gauge providers.
Before your appointment
1. Ask friends for recommendations
Butterfield: There are some great online tools to help you find an inclusive provider (see below), but if you can go to a provider your friends or family recommend, that’s ideal.
2. Find an LGBTQ-friendly provider online
Butterfield: The Human Rights Campaign (HRC) is my go-to for all LGBTQ+ resources, and they endorse this search tool from the GLMA. While they can’t guarantee all providers listed are inclusive, it’s a good place to start.
[NOTE: GLMA was previously known as the “Gay & Lesbian Medical Association” but are known today as the more inclusive “Health Professionals Advancing LGBTQ Equality.”]
3. Check the provider’s website
Butterfield: Look for inclusive language, a link to the HRC. LGBTQ+ care doesn’t have to be their specialty, but they should have some sign that they’re welcoming to LGBTQ+ people.
4. Make a cold call to the office
Butterfield: Rather than booking an appointment online, call the office. See if the person answering the phone hesitates any time they shouldn’t. For example, if I tell someone I’m on my wife’s insurance and they pause or seem awkward, the practice may not be well-versed in inclusivity.
During your appointment
5. Look for context clues
Butterfield: My provider has things in the lobby like little rainbow signs and the HRC symbol, as well as articles about inclusive care. You can also look for visual cues the American Medical Association (AMA) recommends, including:
- Brochures and educational materials about LGBTQ+ health
- A nondiscrimination statement
- Posters from nonprofit LGBTQ+ or HIV/AIDS organizations
On the flipside, look for materials that give you a weird feeling. If there’s anything in the waiting room that makes you feel unwelcome, it’s okay to find another provider.
6. Pay attention to staff
Butterfield: If the frontline staff has been properly trained, they won’t react to details one way or another. For example, if I hand in my paperwork and someone is harsh or dismissive when they see I’m on my wife’s insurance, that’s not good. If the staff has been properly trained, the reaction will be: Okay, this is your life, this is normal. Business as usual.
7. Pay attention to paperwork
Butterfield: As I mentioned before, you want to see inclusive language and options on all paperwork. If you want to see what a good sample intake form looks like, see The Fenway Institute’s.
8. Notice assumptions and attention
Butterfield: Inclusive providers don’t make assumptions. For example, if I tell a provider I have children, they shouldn’t assume that means I have a husband. Even if they don’t mean any harm, they’re not paying attention, and you deserve your provider’s attention.
9. Trust your intuition
Butterfield: There’s no substitute for intuition. A provider can shout from the rooftops that they’re inclusive, but if something feels off to you, pay attention to it and listen to your intuition.
You aren’t required to stay with a provider if you don’t get a good feeling. You have the right to feel comfortable, and to continue to try providers until you do.
If you’re the parent of LGBTQ+ youth, how should you approach healthcare conversations?
Butterfield: My kids are both straight so while that’s different from me, the most important advice I have is to create an environment where your child feels comfortable having open discussions with you.
When you’re LGBTQ+, you know from a young age that you’re different — often before you even know what’s different about you. In general:
1. Let your child lead the conversation about your child’s sexuality
Butterfield: Once you tell anyone that you’re LGBTQ+, it gets more real, and then you have to deal with that. No one should have to do that before they’re ready.
2. Don’t assume
Butterfield: The same rules I’d apply to healthcare providers apply to parents: Don’t assume your daughter will grow up to have a husband, or that your son will grow up to have a wife. Instead, say “partner,” “significant other” or “the person you end up with.” You don’t mean anything by it, and you may not even notice it as a straight parent, but your child will.
3. Trust your child
Butterfield: When it comes to healthcare providers, trust your child’s instincts too — whether that child is gay, straight or anything in between. If your child gets an odd feeling, take that into account, and be grateful they’re comfortable enough with you to be honest.
For more information
- Visit the HRC’s patient resources page
- Visit the AMA’s page on creating an LGBTQ-friendly practice
- Learn 10 LGBTQ health care needs
Get more information about specific health terms, topics and conditions to better manage your health on bcbst.com. BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also find tools and resources to help improve health and well-being by logging into BlueAccess and going to the Managing Your Health tab.