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"It is unacceptable that bias in healthcare continues to this day – but there are ways to end it" writes Nicole Wadsworth of the New York Institute of TechnologyNicole Wadsworth is dean of the College of Osteopathic Medicine at the New York Institute of Technology
The pandemic has shed new light on biases in our nation's healthcare system. We've seen this most plainly in the way the crisis disproportionately affects patients of color.
Less commonly discussed is the disparate impact felt by another marginalized group – the LGBTQ+ community.
According to a recent report from the Centers for Disease Control and Prevention, LGBTQ+ Americans – including gay, lesbian, bisexual, transgender, and non-binary individuals – face greater risks from COVID-19 than other people.
This is due to the fact that they're more likely, to suffer from a number of underlying conditions, including asthma, hypertension, heart disease, and cancer that can lead to serious cases of the virus. This predisposition is also likely the result of discrimination, which often prevents LGBTQ+ patients from accessing necessary screenings and treatment.
In fact, the outsized impact of COVID-19 on the LGBTQ+ community has nothing to do with the virus itself, but with longstanding health inequities.
It is unacceptable that bias in healthcare continues to this day – but there are ways to end it. To root it out, we need to change how healthcare providers are trained.
Such bias was evident at the outset of the HIV epidemic, when gay men died in droves due to ignorance, stigmatization, and discrimination that deemed it an exclusively "gay disease." Yet, more than 40 years later, healthcare providers haven't learned their lesson about the public health impacts of prejudiced behavior.
LGBTQ+ people regularly face discrimination at doctors' offices, according to a report by the Center for American Progress.
Transgender Americans have it particularly bad.
Nearly three in 10 said a physician refused to see them because of their gender identity. And nearly one in four said a healthcare provider deliberately misgendered them – referring to them by the wrong pronoun – or called them by the wrong name.
Even the perception of bias can affect health outcomes. According to an analysis in the Journal of Women's Health, lesbians who did not get regular screenings for cervical cancer were more likely to perceive discrimination in healthcare settings. And in the most recent U.S. Transgender Survey, nearly one-quarter of respondents admitted they had avoided needed healthcare in the previous year due to concerns about mistreatment.
To rectify these inequities, medical schools, hospitals, and other training institutions need to better educate current and future professionals about LGBTQ+ needs.
Hospitals and healthcare facilities can start by implementing workplace training on diversity, equity, and inclusion. Such programs can help workers identify and address their own personal biases and also teach practical ways to reduce discriminatory treatment, such as using correct gender pronouns.
But training programs for current staffers are not enough. Educators have to change the way they teach future doctors, nurses, and other healthcare workers – starting now.
There is immense room for improvement.
A study in the Journal of the American Medical Association found that the median time U.S. medical students spent learning about LGBTQ-related care was just five hours. And in a 2021 survey of medical students, more than two-thirds had not received any training on LGBTQ+ health needs.
It's also important that the communities who make up our teaching institutions become more diverse. One recent study found that contact with LGBTQ+ faculty, residents, students, and patients was associated with lower levels of implicit bias against gay men and lesbians among medical students.
Of course, these educational efforts are just part of the solution. As long as healthcare professionals are permitted to discriminate against sexual and gender minorities, these patients will continue to suffer from adverse health outcomes.
This is why laws that attempt to ban treatments for trans youth, such as the Vulnerable Child Compassion and Protection Act proposed by Alabama lawmakers, are so harmful. Such legislation could enable healthcare workers to turn away LGBTQ+ patients and prosecute clinicians who do provide treatment.
Providing healthcare workers with the knowledge and tools to treat LGBTQ+ people competently and compassionately is an essential part of ending discrimination in our healthcare system.
To delay this work any longer would be hazardous to the health of millions of Americans.
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