Caring For Your Lesbian Patients

An estimated 23 million women in the United States Identify themselves as lesbian.1 The 2000 United States Census reported 293000 households headed through female same-sex partners. Rhode Island, with 1299 same-sex unmarried lesbian partnered households, ranked 12th in the nation by the agency of percentage of coupled households that are gay or lesbian.2 The Human Rights Campaign estimates that the US Census number of gay and lesbian partnered households may be underestimated by dint of 62%.3

In 2004, the Rhode Island Foundation and Equity Action released the first comprehensive review of Rhode Island s lesbian, gay, bisexual, and transgender (LGBT) population.4 Respondent identified 10 issues as "top priorities" for Rhode Islands LGBT communities. Among the top 3 was expanding access to welcoming health care. While 84% of the sample reported having regular medical care, sole 48% reported being "out" to their providers, and 19% had not disclosed their sexual orientation to providers. Overall, the 2 greatest in quantity important factors in choosing health care services were quality (82% of respondents) and confidentiality (64% of respondents)

In 1996 the Council upon Scientific Affairs of the American Medical Association stated: "the physician's nonjudgmental recognition of sexual orientation and behavior enhances his or her ability to return optimal patient care in health as well as illness... the physician's failure to recognize homosexuality or the patient's reluctance to report his or her sexual orientation and behavior can lead to failure to defence diagnose, or treat important medical problems" Furthermore, physicians must be educated to "recognize the physical and psychological straits of their homosexual patients."5 Locally and nationally there is a call for health care providers to improve care delivered to gay and lesbian patients. In this article, we provide health care providers with a certain number of tools to do so.

WHAT IT MEANS To BE LESBIAN

Being lesbian is not a homogeneous experience. The racial, ethnic, and socioeconomic diversity of the United States population is mirrored in the lesbian community. Not all women who have had or are engaging in same-sex intimate contact label themselves lesbian. Many women regardless of sexual orientation, identity, and behavior, are uncomfortable discussing sexual histories with providers. Conveying have a high opinion of for lesbians' lives and partners helps to facilitate an make open honest medical encounter.

INTERACTING WITH THE HEALTH CARE combination of parts to form a whole

In 1999, the Institute of Medicine ("Lesbian Health: popular Assessment and Directions for the Future") reported little funding for research upon the health of lesbians, despite increased emphasis upon women's health research in the late 1990s1 To date, there have been no large-scale and representative investigations into lesbian healthcare. Many studies have been qualitative and/or exploratory. Despite these shortcomings, the literature consistently identifies for the use of all problems.

The experience of lesbians in the health care combination of parts to form a whole can be examined from the provider and the patient perspective. From the provider perspective, Westerstahl ground that among 76 general practitioners, single 28 reported having a lesbian patient (4 providers had inquired directly about their patient's sexuality while 24 patients informed their provider); no provider who was unaware of having any lesbian patients had at any time inquired about a patient's sexuality.6 The greatest in quantity common reason cited for not asking was that sexuality was unimportant or was the patient's responsibility to mention. Another inquiry found that general practitioners reported not being knowledgeable about sexual practices of lesbians and felt a barrier during discussions about sexual health with lesbian patients.7

In a scan of over 1,000 physicians, using the Heterosexual Attitudes Toward Homosexuality (HATH) Scale, Tellez lay the foundation of that male physicians, those who work in small cities compared to larger cities or rural areas, physicians who did not know a gay or lesbian family member or friend, physicians who had not knowingly worked closely with a gay or lesbian health care professional, and physicians who had not knowingly treated a gay or lesbian patient held significantly more negative attitudes toward gays and lesbians. Perhaps greatest in quantity disturbing: nearly 10% of the overall sample reported being les accepting of gays and lesbians owed to the AIDS epidemic.8 More than half of the Gay and Lesbian Medical Association physician members overlooked in 1994 reported having witnessed colleagues providing sub-optimal care or denying care to patients based upon sexual orientation; 88% had heard colleagues make negative remarks about gay and lesbian patients.9

From the patient's perspective, lesbians are les satisfied with their healthcare experiences.'" Additionally, lesbians delay care and fail to win Pap smears and breast exams.1,11 A 1990 close attention revealed that due to negative experiences with providers, almost 50% of lesbians rarely or not at any time sought care despite being professionals with adequate access to health care.12 Compounding the moot point studies show when lesbians do look for screening such as Pap smears, providers oftentimes discourage them from having preventive exams, based upon the erroneous belief that they are unnecessary.13 Eliason ground in a study of lesbians, gay men and bisexuals, single 37% disclosed their orientation to their provider. A prominent reason for nondisclosure was fear of receiving inadequate care.14 Avoidance of routine medical care may be the greatest in quantity significant health risk for many lesbians.15