Midday Special: Why hospitals must prioritise inclusivity and non-discriminatory care for LGBTQ+ patients

A recent qualitative study conducted by Lakshya Arora, P.M. Bhujang and Muthusamy Sivakami has brought to light the prevalent discrimination against the LGBTQ+ community (lesbian, gay, bisexual, transgender, queer, intersex, asexual and others) in the healthcare domain.

The study revealed that "Most administrators and doctors in Indian hospitals were not familiar with the varied needs of the LGBTQIA+ spectrum and treated them as a homogenous group." Additionally, some administrators believed that serving the minuscule LGBTQIA+ population may adversely affect business in private hospitals.

Consequently, disparities in healthcare delivery have led to a reluctance among the queer community to seek medical services. With a lack of accountability at the systemic level, the report underscores the need to implement inclusive practices in order to create a non-discriminatory environment for LGBTQIA+ patients.

Profile of the study participants from "Understanding discrimination against LGBTQIA+ patients in Indian hospitals using a human rights perspective: an exploratory qualitative study" published in the National Library of Medicine

To develop guidelines for more inclusive and non-discriminatory healthcare, Midday.com spoke to experts from the healthcare and legal fields about how hospitals can better serve LGBTQ+ patients. Here are the key takeaways from interactions with Dr Sonal Anand, a psychiatrist at Wockhardt Hospitals, Mumbai and Dr Preeti Rawat, Professor K J Somaiya Institute of Management (KJSIM).

How can healthcare providers be trained to ensure non-discriminatory care for LGBTQ+ patients?
Anand: Healthcare providers must ensure that they are unbiased and treat every patient equally, irrespective of their gender, economic and social status. This requires creating a safe and welcoming space for LGBTQ+ patients to develop a better understanding of their health concerns.

Healthcare providers can take up comprehensive education programs that focus on cultural competence, inclusive communication and the specific health issues prevalent within the LGBTQ+ community, such as higher rates of mental health disorders, substance abuse and sexually transmitted infections like HIV, Syphilis and Hepatitis B.

Training should include modules on recognising and addressing implicit biases, creating welcoming environments, using inclusive language and understanding the unique challenges and stressors faced by LGBTQ+ individuals due to discrimination and social stigma. Regular workshops, sensitivity training and updates on best practices can equip healthcare providers with the knowledge and skills needed to offer empathetic and equitable care to LGBTQ+ patients.

What are the unique health needs and challenges faced by LGBTQ+ individuals that healthcare providers must be aware of?
Anand: LGBTQ+ individuals often find it challenging to deal with social stereotypes, which can adversely impact their mental health. This further leads to experiencing mental health problems like depression, stress, social anxiety, self-harm and even suicidal thoughts which can also contribute to bad habits like excessive consumption of alcohol, drugs and tobacco.

These mental health challenges can be compounded by experiences of bullying, family rejection and the stress of concealing one's identity. Additionally, LGBTQ+ youth are particularly vulnerable and may require tailored support services to navigate these difficulties. Understanding the mental health landscape for LGBTQ+ patients is crucial for healthcare providers, who should be trained to offer empathetic and affirming mental health care and referrals to LGBTQ+-friendly therapists.

Another significant health challenge is the higher prevalence of sexually transmitted infections (STIs) within the LGBTQ+ community, especially among men who have sex with men (MSM) and transgender individuals. Some of them are at higher risk of developing STDs like HIV, Chlamydia, Gonorrhoea and Syphilis.

Health experts should take cognisance of the specific sexual health risks and needs of LGBTQ+ patients, including the importance of regular STI screenings, PrEP (pre-exposure prophylaxis) for HIV prevention, and safe sex practices. Moreover, transgender individuals may face unique health needs related to hormone therapy and gender-affirming surgeries, requiring specialsed knowledge and sensitivity.

What role does patient feedback play in training healthcare providers to deliver more inclusive and non-discriminatory care to LGBTQ+ individuals?
Anand: Patient feedback plays a crucial role in training healthcare providers to deliver more inclusive and non-discriminatory care for queer people, by offering direct insights into the experiences and challenges faced by these patients within the healthcare system. This can be accomplished by having meaningful conversations and encouraging them to share their experiences

Through feedback mechanisms such as surveys, focus groups and patient interviews, doctors can identify areas where biases and gaps in care exist. This real-world input allows for the development of targeted training programs that address specific issues, improve communication skills and promote understanding of LGBTQ+ health needs.

Incorporating patient feedback into training ensures that the curriculum remains relevant and responsive to the evolving needs of LGBTQ+ patients, ultimately fostering a more welcoming and supportive healthcare environment.

What strategies can be implemented in medical training to address and eliminate biases against LGBTQ+ patients?
Anand: To address and eliminate biases against LGBTQ+ patients in medical training, one effective strategy is to arrange panel discussions or invite LGBTQ+ individuals to share their personal experiences and healthcare challenges.

These firsthand accounts provide invaluable insights into the barriers and biases LGBTQ+ patients encounter, fostering empathy and understanding among healthcare providers. Hearing directly from LGBTQ+ patients helps humanise their struggles and underscores the importance of non-discriminatory care. Additionally, these discussions can highlight practical examples of inclusive practices, such as using correct pronouns and names, which can significantly enhance patient comfort and trust.

Another essential strategy is to incorporate comprehensive LGBTQ+ health topics into the medical curriculum. This includes detailed modules on the specific physical and mental health issues faced by LGBTQ+ individuals, such as higher rates of mental health disorders, the need for regular STI screenings and the particular requirements of transgender patients undergoing hormone therapy or gender-affirming surgeries.

Encouraging an open mindset and curiosity about the LGBTQ+ community helps healthcare providers stay informed and compassionate, ultimately leading to unbiased and equitable medical care.

Edited excerpts from the interview with Dr Preeti Rawat, Professor K J Somaiya Institute of Management (KJSIM):

How can healthcare institutions implement training programs that address the unique needs and rights of LGBTQ+ patients within the legal framework?
Rawat: Learning to care for members of the lesbian, gay, bisexual, transgender or queer/questioning community involves understanding and being open to multiple special considerations and avoiding unconscious and perceived biases. Maintain an open mind and avoid judgment regarding sexual orientation and practices.
1. They need compassionate care.
2. The hospital admission form should include transgender as an option.
3. The staff is to be trained to refer to patients by their names and chosen descriptive pronouns.
4. Healthcare professionals should be trained to use gender-neutral terms such as ‘significant other' or ‘partner.'
5. Include members of the LGBTQ community as part of their staff and the hospital notice boards should communicate its inclusiveness towards LGBTQ+ patients and staff.
6. They should be sensitised to avoid using language or words that are derogatory or discriminating.

What legal protections exist for LGBTQ+ patients and how can healthcare providers be educated to uphold these rights and avoid potential discrimination?
Rawat: From a legal standpoint, homosexuality has been legal in India since 2018. Transgender individuals have a constitutional right to change their legal gender and a third gender (non-binary) is officially recognised. The Supreme Court has ruled that the Fundamental Right to Privacy is intrinsic to life and liberty, falling under Article 21 of the Indian Constitution. Additionally, the Court has declared that bodily autonomy is an integral part of the right to privacy, which includes an individual's sexual orientation.

These legal protections should be integrated into the curriculum and practical training for healthcare providers. It is crucial that healthcare providers assure patients that their communication and medical records, including tests and results, are kept confidential. This approach ensures respect for the legal rights and personal privacy of LGBTQ+ patients, fostering a more inclusive and trustworthy healthcare environment.