Metro Weekly

Health care cultural competency law hopes to ease LGBT patient angst

A gay doctor’s story of stigma underscores the need for LGBT training just enacted in the District

Georgetown University Hospital (Photo: AgnosticPreachersKid, via Wikimedia Commons).
Georgetown University Hospital – Photo: AgnosticPreachersKid, via Wikimedia Commons.

“Oh, he’s probably going to like this.”

“This should be easy.”

Some of Doctor Raymond Martins’ gay patients have told him stories of overhearing things like this just before the anesthesia kicked in for their colonoscopies. And it’s stories like this he hopes will be eradicated in the District now that  Mayor Muriel Bowser has signed the LGBTQ Cultural Competency Continuing Education Act into law.

The act, which Bowser signed Feb. 18, requires licensed clinical health care providers in the District to receive two credits of instruction on cultural competency or specialized clinical training focusing on LGBT patients. The bill is expected to pass the required 30-day congressional review period without incident.

Martins has practiced medicine for 12 years and primarily treats LGBT patients at Whitman-Walker Health, which specializes in providing LGBT-friendly health care to the greater Washington area. For the past eight years, he has also taught courses on LGBT health and cultural competency as associate clinical professor of medicine at George Washington University.

But like some of his patients, he has a prior history of his own, consisting of shame and negative experiences with health care providers just because of his sexuality.    

It started when he was investigated for violating the now-defunct “Don’t Ask, Don’t Tell” policy during his third year of medical school at George Washington University, where he received a scholarship for his military service. He was outed to colleagues and family members during the investigation, and was eventually discharged by the time he graduated.

His experience of stigma continued when he sought medical care from a respected acquaintance.

“When I went to that person, I found myself very uncomfortable when it got closer to the social history…. He got visibly uncomfortable and didn’t really know any of the questions to ask about as far as health issues that might be affecting me,” Martins said.

His patients have encountered “much, much worse,” he said.

Negative experiences in the exam room can have dangerous consequences and can contribute to the District’s LGBTQ health disparities.

For instance, some of Martins’ patients were not aware that anal cancer screenings exist or that medications can be taken shortly after exposure to HIV to prevent transmission — prevention methods for illnesses that gay men are at higher risk of contracting, which primary care physicians who treat men who have sex with men should be providing for their patients.

More than 10 percent of the District’s population identifies as LGBT and receives health care within the city, D.C. Councilmember Yvette Alexander (D-Ward 7), said during a public hearing for the bill in October 2015.

As a lead co-sponsor of the bill, Alexander also voiced specific concern for members of the trans community, who she said commonly experience being denied services by doctors due to their gender. Some transgender people, she noted, will even delay seeking care out of fear of facing discrimination and disrespect by health care providers.

“With this legislation, it is our hope that physicians within the District develop an understanding of this important population within our city and that the LGBTQ individuals receive the quality health care services they deserve,” Alexander said.

Raymond C. Martins Photo by via
Raymond C. Martins
Photo by via

While Martins took a human sexuality course that included LGBT competency while he was enrolled at George Washington University, he says most medical students do not learn about LGBT-specific health care concerns. Even students who do learn do not necessarily regularly interact with LGBT patients and, as a result, may not know how to conduct a proper sexual history.

Though his personal experience prepared him for his focus on LGBT and HIV patients, Martins says “every health care professional in D.C. should have some knowledge and ability to treat LGBT patients.”

This can be as “simple as using the right pronoun when referring to a transgendered individual, or as complex as understanding how daily discrimination and stigma can affect a person’s health,” D.C. Councilmember David Grosso (I-At-Large), the bill’s other lead co-sponsor, said during a public hearing.

Specialized health care for transgender patients, like hormone replacement therapy and sexual reassignment surgery, requires endocrinologists or specialized care centers. But the ability to connect with LGBT patients should be a trait that primary care physicians should embrace. Providers should also be willing to refer patients to a provider who is more well-versed in LGBT issues if needed.

“It’s hard not to bring your own beliefs and values to the table, but the interaction when you’re meeting with the patient is all about the patient, and you’re there to guide the patient,” Martins says. “Your values should never overrule who the person is.”

A majority of Martins’ LGBT patients find him by word of mouth. But there are several other resources available to help locate competent providers. For instance, the Human Rights Campaign maintains a national Healthcare Equality Index and the Gay and Lesbian Medical Association has an online provider directory, both containing a listing of providers that affirm commitment to nondiscrimination and to creating a welcoming environment for lesbian, gay, bisexual and transgender people.

Still, health coverage is “a very different thing from actual health access,” Alison Gill, senior legislative counsel for the Human Rights Campaign, said during a public hearing for the bill. “Just because you have insurance coverage does not mean that you can actually go down to a local provider and they know the first thing about trans people, and that they’re willing to see you, that they’ll treat you appropriately. So that’s a real gap and that’s why this bill is critical.”

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