The American College of Physicians (ACP) is the second largest group pf medical doctors in the nation, behind the AMA. This past week the ACP has issued its positions on how best to support and serve the nation's LGBT people.
The ACP recognizes that LGBT people have significant disparity in the health care we receive, ranging from coverage to culturally competent care to state and federal policies that systemically reify social stigma, marginalization and discrimination. That results in LGBT people being discouraged from seeking preventative health care, as well as increasing anxiety, suicidal ideation and substance and alcohol abuse.
So the ACP adopted nine positions:
1. Add gender identity to nondiscrimination and anti-harassment policies.
Though transgender people have found some employment protection under Title VII, discrimination against transgender people is still otherwise legal in most states. The ACP observes that transgender people are particularly vulnerable to discrimination, and thus recommends that medical schools and facilities not rely on state laws to protect this community.
2. All public and private health benefits should include comprehensive transgender health care services and provide equal service to transgender people.
Transgender people are often denied insurance coverage for treatments like hormones and surgeries, even though their doctors have deemed them medically necessary to treat their gender dysphoria.
They can also be denied coverage for some sex-specific procedures (such as mammograms, Pap smears, and prostate exams)
The ACP wants to see transgender people receive all of the care that they need.
Providing coverage, conversely, does little to burden businesses. Not only have employers found that covering transition-related procedures added no cost to their plans, but “the inclusion of transgender-related health care services within a health plan may also result in an overall reduction of health care costs over time because patients are less likely to engage in self-destructive behaviors, such alcohol or substance abuse.
3. The definition of "family" should not be limited to legal and biological relationships.
“The term ‘family’ as it is seen in society is changing and no longer means married heterosexual parents with children.
To ensure that LGBT people are treated equally in the hospital setting, “family” should be defined expansively to include “any person(s) who plays a significant role in an individual’s life.”
4. Visitation policies should allow patients to decide who can visit them regardless of sexual orientation, gender identity or marital status.
5. Marriage equality is good for the health of LGBT people.
The ACP endorses marriage for same-sex couples, noting that they would experience the same health benefits from the institution that different-sex couples already enjoy. For example, “research suggests that being in a legally recognized same-sex marriage diminishes mental health differentials between LGBT and heterosexual persons.” Additionally, “a comparison study on the utilization of public health services by gay and bisexual men before and after Massachusetts legalized same-sex marriage found a reduction in the number of visits for health problems and mental health services.”
Furthermore, research has shown that marriage bans hurt the overall health of the LGBT community. “A study of LGBT individuals living in states with a same-sex marriage ban found increases in general anxiety, mood disorders, and alcohol abuse. The denial of marriage rights to LGBT persons has also been found to reinforce stigmas of the LGBT population that may undermine health and social factors, which can affect young adults.”
6. The LGBT community should be identified and included in data collection and research,
One of the biggest obstacles to eliminating LGBT health disparities is identifying them. So often, doctors either do not ask or do not have a way to catalog patients’ sexual orientation or gender identity. As a result, there is not the plethora of demographic information about LGBT health as there is for, as an example, racial and ethnic minorities, whose identities are already uniformly recorded in patients’ records.
As the ACP notes, though there is already a lot of data about LGBT health disparities, including questions about these identities in patients’ medical records would be a gamechanger both for national research and for individual patient care. “In addition to obtaining information from population surveys, including gender identity and sexual orientation as a component of a patient’s medical record (paper or electronic) may help a physician to better understand an LGBT patient’s needs and provide more comprehensive care.” The ACP also recommends flagging transgender patients’ charts to indicate their preferred name and pronouns.
7. Medical schools should recruit snd support LGBT students and incorporate LGBT health into their curricula.
Educating doctors about how to talk about LGBT issues can help them create the safe atmosphere that helps patients share important information.
To better understand the unique health needs of the LGBT community, physicians and medical professionals must develop a knowledge base in cultural and clinical competency and understand the factors that affect LGBT health; this should begin in the medical school setting and continue during practice. Exposure to LGBT people also makes a big difference, and some still feel that medical schools are not welcoming institutions. In one study, 30 percent of respondents did not reveal their sexual orientation when applying for residency positions for fear of not being accepted. Making medicine more inclusive for LGBT professionals will benefit both other physicians as well as their patients.
8. No LGBT person should be subject to "conversion," "reorientation" or "reparative" therapy.
9. Blood donation policies for men who have sex with men should continue to be reviewed.
The ACP describes lifting the lifetime ban on gay and bi men as an important first step toward creating equity among those wishing to donate blood, but urges the FDA to continue reviewing the policy and narrowing it with more specific criteria in the future.
Breitbart.com didn't like this at all, so searched for doctors opposed to LGBT inclusion and discovered two of them:
Jane Orient is head of the Association of American Physicians and Surgeons, which believes that HIV doesn't cause AIDS but being gay reduces life expectancy because God. Orient says the ACP believes in "cultural marxism".
Michelle Cretella is head of the American College of Pediatricians (not to be confused with the mainstream American Academy of Pediatricians), Cretella calls the ACP shameful and says, "the science is clear: no one is born gay or transgender." Cretella's organization opposes same-sex parenting and has been classified as a hate group by the SPLC.
It’s incumbent upon us as healthcare professionals, as general internists and internal medicine subspecialists to provide the LGBT community the best possible culturally competent and relevant healthcare which addresses their needs.
--Wayne J, Riley, president of the ACP
Meanwhile New York Attorney General Eric Scheiderman
has introduced a new initiative to improve the health care of transgender people.
My office is committed to ensuring equal and respectful access to medical care for all New Yorkers, regardless of their gender identity.
We are proud to partner with hospitals and health care centers across New York State to help educate and raise awareness around the specific needs and challenges transgender individuals face when seeking basic medical care.
--Schneiderman
As part of the initiative, the Attorney General’s Civil Rights Bureau will provide programming to hospitals and medical centers about legal requirements for transgender individuals in New York, as well as best practices in providing care to this patient population. The goal of the initiative is to promote best practices in the provision of medical care to transgender individuals.
We were thrilled that the Attorney General spearheaded this first-of-its kind initiative in New York to discourage gender identity discrimination in health care. We look forward to continuing to work together to help hospitals meet the needs of transgender patients across the state.
M. Dru Levasseur, Lambda Legal
By encouraging adoption of the best practices developed by Lambda Legal, the New York City Bar Association’s LGBT Committee, and the Human Rights Campaign, the Attorney General’s groundbreaking work will promote trans-affirming policies in the medical context and help to ensure equal access to health care.
--Erin Meyer, co-author with Levasseur of Creating Access to Quality Health Care for Transgender Patients: Transgender-Affirming Hospital Policies
Discrimination in this world preloads trans people with a bunch of health problems that are much worse than the general population. Our smoking rates are super high. Our addiction rates are super high. Obviously our suicidality is higher. Our mental health problems are really high. Anything that’s a stress-related mental health problem, you’re going to see us pretty much go off the charts on.
--Scout, director of LGBT HealthLink
There are so many wonderful people in the industry, it's important to have access to the cultural competency piece to treat all populations who walk through your door.
--Levasseur
[We are] proud to work alongside Attorney General Schneiderman to promote best practices to ensure that all patients receive the best care, regardless of sexual orientation and gender identity.
---Kenneth E. Rake, president of Greater New York Hospital Association