In 2014, the Association of American Medical Colleges released the first guidelines outlining how physicians should approach caring for patients who are lesbian, gay, bisexual, transgender, gender nonconforming or born with differences of sex development.
LGBT patients sometimes face discrimination and mistreatment in the healthcare environment, according to the guidelines, which help physicians excel in 30 competencies within eight domains.
In 2015, University of Louisville (Ky.) School of Medicine launched the LGBT Health and Wellness Competency program. The medical school served as the pilot site for incorporating AAMC's training competencies. The school recently awarded 102 students, faculty and staff members program certificates.
Here are eight competency domains for physicians to master to enhance healthcare for patients who are LGBT, gender nonconforming and born with differences of sex development:
1. Patient care. Collect information about a patient's history by sensitively learning about the patient's "sex anatomy, sex development, sexual behavior, sexual history, sexual orientation, sexual identity and gender identity."
Make informed decisions about diagnostic and therapeutic interventions for transgender patients, which gathered patient information and scientific evidence support. Relay certain healthcare needs and available options.
Tailor the physical exam to the patient's unique needs and address specific health risks and challenges these individuals experience.
2. Knowledge for practice. Describe differences between:
- Sex and gender
- Gender expression and gender identity
- Gender discordance, gender noncomformity and gender dysphoria
- Sexual orientation, sexual identity and sexual behavior
Be aware of typical sex development as well as the main causes of atypical sex development.
3. Practice-based learning and improvement. Acknowledge shortcomings in one's knowledge, and gather scientific study evidence associated with patients' health complications.
4. Interpersonal and communication skills. Foster a comfortable environment for effective communication with patients and their families. Ensure you use current terminology and involve the patient in the decision-making process.
Be aware that "unconscious bias and assumptions about sexuality, gender and sex anatomy may adversely affect verbal, nonverbal, and written communication strategies" when caring for a patient.
5. Professionalism. Fully adhere to the confidentiality aspects of gender, sex and sexuality issues. Practice sensitivity and responsiveness to a diverse patient population and encourage policies that eliminate population care disparities.
6. Systems-based practice. Successful physicians will advocate for patients' high quality care, by helping them sift through specific legal and policy complications. Offer your patients information about support groups or legal advocates.
Also, identify how "homophobia, transphobia, heterosexism and sexism affect healthcare inequalities, costs and outcomes."
7. Interprofessional collaboration. Involve your whole care team to create "culturally competent, patient-centered care," so all patients feel comfortable. All team members should demonstrate "mutual respect, dignity, diversity and ethical integrity" among each other and with patients.
8. Personal and professional development. You are in control of your own biases when treating patients. Work diligently to remove any unintended biases so all of your patients receive equal and quality care.
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