Few relationships are as intimate as those between patients and their health care providers. But for many lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) individuals, health care settings may have felt less than welcoming.
Amy K. Weimer, MD, an internal medicine and pediatrics specialist who codirects the UCLA Gender Health Program, notes that among individuals who identify as transgender or gender diverse, suboptimal experiences are all too common. “Many people have stories about providers or institutions that are ignorant, in large part because there hasn’t been much education of health care providers about gender transition, or about general health care delivered through the lens of a person’s gender experience,” she says. “Many patients also feel actively discriminated against, or are reluctant to speak about their gender status because of discomfort.”
Dr. Weimer notes that when people are uncomfortable in health care settings, they are less likely to seek general preventive care services such as cancer screenings and vaccinations, and may be more likely to engage in unhealthy behaviors. Transgender individuals might delay seeking hormones, surgeries and other gender-affirming services, increasing the risk of poor health outcomes, including untreated depression and suicidality.
The Santa Monica-based UCLA Gender Health Program was established in 2016 to provide a place where children, adolescents and adults who are transgender or gender diverse can receive primary care and chronic disease management, as well as care specific to their gender or gender transition, in an environment where providers and staff are knowledgeable and sensitive to patients’ needs. Comprehensive staff training ensures that everyone who interacts with patients — from office staff to the network of UCLA Health specialists who see patients in coordination with the program’s primary care providers — are respectful and sensitive to their desires, including calling them by their chosen name and personal pronouns.
The program is part of a purposeful and proactive effort by UCLA Health to ensure equitable, affirming and supportive environments for LGBTQ patients and their families. In its 2018 Healthcare Equality Index, the Human Rights Campaign Foundation awarded each of UCLA Health’s four hospitals the distinction of “LGBTQ Healthcare Equality Leader.”
At the UCLA Center for Clinical AIDS Research and Education (CARE), which provides state-of-the-art care to patients with HIV and AIDS, the vast majority of patients are gay and bisexual men, says Emery H. Chang, MD, an internal medicine and pediatrics physician and HIV specialist at the center. Dr. Chang notes that even in a city as diverse as Los Angeles, many of his patients complain about experiences with other health care settings. “There is still a stigma, both around HIV and LGBTQ issues, and that results in patients not feeling comfortable disclosing information that would be important to their care,” Dr. Chang says.
At CARE and elsewhere, Dr. Chang says, the UCLA Health system is taking extra measures to ensure that interactions with LGBTQ patients at both the staff and provider levels are inclusive and welcoming. In the CARE hiring process, he notes, candidates are closely vetted to ensure that they are not only well-versed in issues of importance to LGBTQ patients, but also able to connect in a way that allows them to deliver compassionate services. “When patients see these efforts,” Dr. Chang says, “it sets a tone that not only improves their experience, but allows us to deliver higher-quality care.”