Emergency care of LGBTQIA+ patients requires more than understanding the acronym

Abstract

Emergency physicians (EPs) frequently deliver care to members of the LGBTQIA+ community in the emergency department. This community suffers from many health disparities important to understand as part of comprehensive care, and these disparities are infrequently discussed in emergency medicine education. Previous data also suggest a need for broader education to increase the comfort of EPs caring for LGBTQIA+ patients. A group of content experts identified key disparities, opportunities for expanded education, and strategies for more inclusive care of LGBTQIA+ patients.

Reducing Adult Transgender Barriers to Care in the Emergency Department

“…For example, if EHRs use only binary classifications for sex and gender, a transgender woman who has a prostate may not receive a needed prostate evaluation if the EHR does not include a reproductive organ inventory, which would drive physical examination templates derived from patient history. Hsiang et al (2022) propose that mandatory diversity and inclusion training for ED providers with continual feedback from content experts is critical to help drive institutional policy change and modify provider perspectives.…”

Emergency care considerations for transgender and gender diverse youth: a review to improve health trajectories

“…There are multiple factors that contribute to the increased risk of the aforementioned conditions, but important aspects to note are familial non-acceptance, systemic discrimination in the community, bullying, and gender dysphoria [7,8]. It is important to screen all adolescents regardless of gender identity for drug use, noting there may be significant comorbidities that exist amongst TGD youth that should be considered during emergency encounters [15,16].…”

“…Electronic Medical Records (EMR) are evolving to reflect gender identity information collection. An EMR that reflects a patient's accurate name and pronouns can prevent mis-gendering or mis-naming in waiting rooms and with each provider interaction [16,25]. If this is not available, using open ended questions and gender-neutral language (their, partner, etc.)…”

“…The majority of healthcare providers express general discomfort and uncertainty in caring for sexual and gender minority populations [12 ▪ ,22]. Although there is increasing curricula at the undergraduate medical education level, it is still inadequate with up to 25% of EM residents expressing discomfort taking histories from lesbian/gay/bisexual patients and >40% noting challenges in history taking from transgender patients [16]. Education needs to extend to all levels, especially more experienced faculty, who, given their seniority, may have a greater knowledge gap and higher level of discomfort [16,28].…”

Systematic Review, Quality Assessment, and Synthesis of Guidelines for Emergency Department Care of Transgender and Gender-diverse People: Recommendations for Immediate Action to Improve Care

“…[1][2][3] Care of this population presents unique challenges in many practice settings, including emergency departments (ED). 4 While ED avoidance has been high among TGD people due to systemic discrimination, 5,6 ED use has also been found to be higher because of a lack of access to TGD-competent health services in primary and specialist care. 7 As a result of these barriers and compounded by minority stress, [8][9][10] The TGD populations experience a higher disease burden throughout their lifespan, including much higher rates of mental illness, self-harm, and substance use disorders.…”