Training programs for PAs and nurse practitioners (NPs) in gay, lesbian, bisexual, transgender, and queer (LGBTQ+) health care are not readily accessible, leaving many advanced practice providers (APPs) ill-equipped to serve this patient population. While some APPs may gain specialized training in LGBTQ+ health care through various organizations, many are unaware of the fundamental needs of LGBTQ+ individuals and how to properly provide compassionate care.
As someone who has dedicated their career to family practice and serving the LGBTQ+ community in West Phoenix, Arizona, I am deeply grateful for the invaluable knowledge and experience gained from working with these patients. Providing inclusive and effective health care requires specialized skills and training.
For those of us who work with LGBTQ+ individuals, these skills may seem like basic knowledge. However, all APPs must possess these skills as a minimum standard of care. With the significance of specialized skills and training for APPs serving LGBTQ+ patients in mind, it is crucial to examine the key knowledge areas and competencies necessary to provide inclusive and effective care. To that end, the following highlights 5 essential skills and areas of expertise for APPs working with LGBTQ+ individuals.
1. Be Mindful of Pronouns
Advanced practice providers must demonstrate sensitivity towards gender identity and the language they use. Clinicians must inquire about the patient’s preferred pronouns and incorporate them consistently throughout the appointment. In my practice, we use an intake form to record preferred pronouns, I ask the patient their pronouns by telling them mine first at their first visit, we document their pronouns throughout the electronic medical record, and we make it an ongoing practice to continue using the correct pronoun. Refrain from making assumptions based on a patient’s appearance and avoid using antiquated or insensitive terms, such as “he/she” or “miss/mister.” By following these practices, health care providers can ensure their care is inclusive and respectful of each patient’s gender identity.
2. Use Sensitivity
Using sensitive language is crucial when treating LGBTQ+ patients. Refrain from using gendered terms such as ladies and gentlemen and instead, opt for more inclusive language such as folks or everyone. Additionally, it is vital to understand the distinctions between sex and gender and refrain from conflating the two terms. Sex refers to the biologic and physiological characteristics of a person, while gender is a social construct that encompasses one’s identity and expression. Additionally, health care professionals should also understand that sexual orientation refers to physical and romantic attraction while sexual behavior refers to the sexual acts an individual may engage in. For example, a cis woman may identify as heterosexual but may engage in sexual activity with women. As such, we must use terminology that is affirming and respectful of an individual’s gender identity and sexual orientation or behavior. By employing inclusive and sensitive language, health care providers can establish an environment that is supportive and welcoming for all patients.
3. Address the Stigma of Sexually Transmitted Infections in the LGBTQ+ Community
Sexually transmitted infections (STIs) are often stigmatized, particularly within the LGBTQ+ community, resulting in individuals foregoing medical care because of fear and shame. As health care professionals, we must recognize and confront this stigma proactively. Educating patients about the significance of regular STI testing and treatment is paramount. It is also crucial to cultivate an atmosphere that is supportive and inclusive of all patients, irrespective of their sexual orientation or gender identity. By taking steps to challenge stigmatization, health care providers can help ensure everyone has access to quality care and support for their sexual health.
4. Understand the Unique Health Needs of LGBTQ+ Patients
LGBTQ+ individuals may have unique health needs that are not typically addressed in traditional health care settings. For example, transgender individuals may need access to hormone therapy or gender confirmation surgeries and may require specific cancer screenings based on their anatomy. Be familiar with the health disparities faced by LGBTQ+ individuals, be familiar with the anatomy of your patients, and work to provide appropriate care and support. See the Table for examples of appropriate screening of individuals in this population. This table is not comprehensive of the primary care of LGBTQ+ folks.
Table. Appropriate Screening of LGBTQ+ Individuals
|MSM and transgender persons who have sex with men||HIV, genital chlamydia, rectal chlamydia (if exposed), genital gonorrhea, rectal gonorrhea (if exposed), pharyngeal gonorrhea (if exposed), syphilis||At least annually|
|MSM who engage in receptive anal sex||Anal squamous intraepithelial lesions screening (anal Papanicolaou test)||Starting at age 40 y, every 2 y|
|Transgender males with a cervix||Cervical cancer screening (Papanicolaou test)||Beginning at age 21 y with cervical cytology every 3 years|
|Transgender males||Breast cancer screening||In FTM transgender men with intact breasts, follow regular breast cancer screening guidelines beginning annually at age 40 y. In those with mastectomy, use shared decision-making as breast tissue does remain for optimal cosmetic results.|
|Transgender females with a prostate||Prostate cancer screening||Initiate discussion of screening at age 50 y with PSA test, use shared decision-making|
FTM, female-to-male; MSM, men who have sex with men; PSA, prostate-specific antigen
5. Provide Culturally Competent Care
Providing culturally competent care means understanding and respecting the cultural backgrounds, experiences, and values of your patients. When treating LGBTQ+ patients, APPs must be knowledgeable about their unique experiences and the challenges they may face. Provide a welcoming and inclusive environment, listen to your patients’ concerns, and work collaboratively with them to create a care plan that meets their needs.
This approach to care not only benefits the LGBTQ+ community but also sets a precedent for compassionate and inclusive care that can benefit all patients, regardless of their cultural background or identity. Ultimately, the provision of culturally competent care is a fundamental component of ensuring that every patient feels seen, heard, and valued in their journey toward health and well-being.
Carlos Gutiérrez, EdD, MMS, PA-C, practices family medicine at Glendale Pediatrics and Family Care with a focus on LGBTQ+ health serving a mostly Spanish-speaking community near Phoenix, Arizona. He is chair of the DEI Taskforce at the Arizona State Association of Physician Assistants, and an associate professor in the Department of PA Studies at the University of Pittsburgh and serves as the department’s inaugural vice chair for Student Success.