Lesbian, gay, bisexual, and transgender patients face the compounded impact of decreased access to care coupled with clinician bias toward those LGBT patients who do receive medical attention. As noted by the widely respected Healthy People 2010 Companion Document for Lesbian, Gay, Bisexual, and Transgender Health, “… a significant barrier to LGBT people accessing needed care is the lack of provider LGBT competency and the discrimination toward people of other sexual orientation or gender identity that frequently is encountered in the health care system.”

LGBT patients thus face two distinct challenges:

(1) There is documented and consistent evidence of lack of equal access to medical care for LGBT patients when compared to non-LGBT patients. Barriers to care can vary widely and include financial, personal, structural, and cultural obstacles. According to the Healthy People 2010 document, “these barriers tend to alter the individual's behavior and attitudes toward health care services, if available, and probably adversely affect health outcomes.”

(2) Even when LGBT patients can assess care, the specter of clinician bias can both compromise care and drive patients away from the medical system. Provider bias toward LBGT patients is repeatedly evidenced in numerous studies, as discussed in the Healthy People 2010 document. In response to bias, many LBGT patients withhold information from their providers, further increasing the likelihood of receiving suboptimal care.

Despite the well known evidence about the negative outcomes related to unequal access to care and provider bias toward patients who do access care, little progress has been made in creating systemic changes in medical training to increase the culturally competent care of LGBT patients.

The national Gay and Lesbian Medical Association offers many resources for assessing and addressing unequal treatment of LGBT patients. One of their current projects, in conjunction with the Human Rights Campaign, is the Healthcare Equality Index, focusing on the creation of metrics to measure care of LBGT patients and addressing inequalities on institutional levels. The GLMA Web site also offers a variety of related resources for clinicians, including tips on creating a welcoming environment for LBGT patients, as well as a “top ten” list of issues for LGBT patients to discuss with their providers.

Jim Anderson is the PA-NP Supervisor, Department of Orthopedics, Seattle Children's Hospital, Seattle, Washington. He is a former chair of the AAPA's Committee on Diversity and a member of the JAAPA editorial board.