Validation of rights to preventive care and responsible primary preventive care for LGBTQ patients

LGBTQ persons tend not to seek care as often for services, such as pap smears and mammograms. Their reproductive organs may not serve their gender identity and therefore are neglected in terms of medical seeking behaviors.  One meta-analysis supported the fact that “health and utilization of healthcare services among LGBTQ individuals are adversely affected by marginalization; and

approximately 30% of LGBTQ adults do not seek healthcare services or lack a regular healthcare provider compared to 10% of age-matched heterosexuals.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609168/

Many transgendered patients, however, do seek primary care services.  These services are protected by the Affordable Care Act which states: “An individual’s sex assigned at birth or gender identity also cannot limit them from a recommended preventive service that is medically appropriate for that individual; for example, a transgender man who has breast tissue or an intact cervix and meets other requirements for mammography or cervical cancer screening must receive those services without cost sharing regardless of sex at birth.” 

https://www.kff.org/health-reform/fact-sheet/preventive-services-covered-by-private-health-plans/

 

Paps for Chaps

The current laws that provide pap smears and mammograms for transgender males are being threatened by publicly announced attitudes held by the highest seat of federal power this year.

One physician shared the frustration she experienced while navigating transgender healthcare for her patients on the heels of these public announcements this summer on the AAFP blog:

http://www.aafp.org/news/blogs/freshperspectives/entry/20170803fp-transgendercare.html

This problem could be avoided if legally, and in the electronic health care records, people can be identified by their biological reproductive organ status in compliment to their gender status. Some EHRs have transitioned to this holistic approach but insurance companies and the government have not yet adopted this strategy to better serve the health of its constituents.  Medical provider and healthcare societies such as the AAFP, AMA, APA, ACOG and many more  have supported the equality of rights for transgendered individuals which is a promising step in the right direction.

http://www.lambdalegal.org/sites/default/files/publications/downloads/ll_trans_professional_statements.rtf_.pdf

 

Educating the Medical Workforce

Further efforts have been made by the Association of American Medical Colleges (AAMC) to create a database to educate medical providers on how to create and maintain trusted physician patient relationships so as to appreciate the diversity of medical needs and risks within the interplay of gender identity, biological sex and sexual orientation that comprise individuals.  Particularly important to medical education is assessing how well providers are motivated to acquire knowledge and retain the skills to provide competent care for LGBTQ patients.

https://www.aamc.org/initiatives/diversity/431388/videos.html

https://www.aamc.org/initiatives/diversity/450606/clinicalvignettes.html

 

One resource for medical education tools in assessing Trainee Competence in LGBT Patient Care is the MedEdPortal.org, a peer-reviewed, open-access journal that promotes educational scholarship and dissemination of teaching and assessment resources in the health professions.

Learning modules created and sponsored by the Fenway Institute for the National LBGT Health Education center can be found here for interested students and providers.

https://www.lgbthealtheducation.org/topic/transgender-health/

Practice guidelines for endocrine treatment of LGBT individuals have just been updated this year by the Endocrine Society. This step is significant in providing structure for interdisciplinary collaboration, evaluating patient outcomes, and further highlighting the validity and appropriateness of medical treatments for this patient population.

https://jamanetwork.com/journals/jama/fullarticle/2654242?resultClick=1

My hope for my graduate medical training and for the students entering medical school is that institutions will embrace awareness of the need for climate change around LGBT health and implement a curriculum to suit these needs. We must be the outspoken advocates for protection of patients’ rights to care.

Lindsey Lee  DUCOM 2018