Hospitalists are in a unique position to be allies for the lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other (LGBTQIA+) community because they’re on the frontlines of new-patient encounters, said Jennifer K. O’Toole (@busymomjen), MD, MEd, SFHM, program director of the internal medicine-pediatrics residency program and professor of pediatrics and internal medicine at Cincinnati Children’s Hospital Medical Center and the University of Cincinnati Medical Center, two large, urban, safety-net hospitals in Ohio. She believes that many individuals who identify as LGBTQIA+ may not seek regular health care because they may fear how they will be treated and labeled by the health care system. Therefore, when they are seen, these individuals may have advanced conditions due to delaying care.
Along these lines, Catherine Washburn, MD, assistant professor of medicine in the division of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, an urban hospital with 420 beds, said that hospitalists are the primary care providers for hospital inpatients. In this role, they are the leaders of advocacy for their patients, which should include not only making a correct diagnosis but also treating patients with dignity and respect.
Keshav Khanijow, MD, assistant professor of internal medicine at Johns Hopkins Bayview Medical Center, pointed out that LGBTQIA+ people, who comprise less than 10% of the U.S. population, have a history of being discriminated against. “Allies can help amplify this community’s voice, so the battle against discrimination can be heard, whether it’s at work advocating for equal insurance benefits, or by supporting positive resolutions through organizations,” he said.
Promoting allyship for patients
Hospitalists can support the LGBTQIA+ community in many ways, beginning with the initial patient encounter. “It’s important to make patients who identify as LGBTQIA+ feel safe because they’re in crisis mode and can feel especially vulnerable when at a hospital,” Dr. O’Toole said.
At Cincinnati Children’s Hospital, Dr. O’Toole wears a pride flag sticker on her name badge showing her support for the LGBTQIA+ community, as well as a list of her pronouns. “When patients look at my badge, they can see a physical sign that I support them,” she said. “Some have even thanked me for wearing it.”
“Another way to help put LGBTQIA+ patients at ease is to ask them about their pronoun preference so that this information can be correctly used in encounters and documented in their electronic health record,” Dr. O’Toole said. “This helps patients to feel accepted and safe within our health care system.”
Focused educational training efforts for issues that the LGBTQIA+ community face are part of Dr. O’Toole’s residency training program at Cincinnati Children’s Hospital Medical Center and the University of Cincinnati Medical Center. “It’s important to make sure that all providers are up to date with the latest information on conditions that are more prevalent in this population and how to provide the safest and most equitable level of care,” Dr. O’Toole said.
To show community support, Dr. O’Toole—along with residents and faculty from the University of Cincinnati Medical Center—has manned a booth at a local Pride Day parade, where they handed out information about the health care they recommend for individuals who identify as LGBTQIA+ and contact information for providers who welcome LGBTQIA+ patients.
“Hospitalists can serve as connectors, pointing patients to primary care and specialty providers who have expertise in caring for the LGBTQIA+ population,” Dr. O’Toole said. “In showing our support and providing these connections, the LGBTQIA+ community will feel safer about seeking health care,” she said.
Showing support for colleagues
Regarding colleagues, team leaders need to affirm and support LGBTQIA+ team members, both within the team and beyond it with patients and their families. “Learning the appropriate language to use in these situations and practicing it is critical for team leaders,” Dr. Washburn said.
“When a patient or their family member insults or questions an LGBTQIA+ trainee, a team’s leader needs to be ready with language to handle the situation gracefully while clearly affirming the value of all team members,” Dr. Washburn said. “Normalizing inclusive pronoun use will relieve a transgender team member of the burden of having to ask the team to use a particular pronoun for themselves.”
As a health care system, Johns Hopkins has events and awards that celebrate and recognize the contributions of LGBTQIA+ community members, such as an achiever’s award that is publicized to the entire Hopkins community. Dr. Washburn’s hospital medicine division supports an affinity LGBTQIA+ group and has supported career paths of members that focus on disparities for LGBTQIA+ patients and correcting those disparities.
Another way to show support for the LGBTQIA+ population is to make sure that employee benefits are applied equally to everyone, regardless of whether they are a same-sex or heterosexual couple, by working with human resources personnel and stakeholders in employee benefits, Dr. Khanijow said. “Advocating for zero tolerance of anti-LGBTQIA+ hate speech through mission statements, admission notices to patients regarding expected code of conduct, and workplace rules also sends a signal that an organization values all of its employees,” he said.
Advice for trainees
Regarding future employment opportunities, Dr. O’Toole advises trainees to choose positions wisely. “Seek out institutions that support the LGBTQIA+ community,” Dr. O’Toole said. “The presence of LGBTQIA+ affinity organizations and leave policies, mission statements, and patient support initiatives that are inclusive and supportive to the LGBTQIA+ community are just a few ways to identify such environments without having to ask directly.”
Another piece of advice is to seek out allies when becoming acclimated to a new position. “Find individuals who will provide support and be a champion for the LGBTQIA+ community both inside and outside of the work environment,” Dr. O’Toole said. Lastly, “If someone identifies as LGBTQIA+, they should be proud of who they are and not settle. Imposter syndrome may creep in at times, but when that happens, seek out your friends and allies so they can reflect on the amazing qualities that they see in you.”
When looking to promote allyship with the LGBTQIA+ community among your colleagues and coworkers, Dr. O’Toole recommends starting small and building from there. “Begin with visible ways that show your support, such as wearing supportive stickers on your hospital badge or displaying your preferred pronouns in email signatures,” she said. “From there, begin to build on your efforts. Join LGBTQIA+ affinity groups within your organization or consider starting one.”
Begin conversations with colleagues who identify as LGBTQIA+ to learn about their experiences and develop an understanding of how you can become a better ally. “From there, think about how you can get involved in system-wide initiatives and/or advocacy to provide more support to LGBTQIA+ colleagues,” Dr. O’Toole said. “Advocate for fair and equitable workplace policies and procedures that support these colleagues and ensure that they are allowed to thrive and succeed at work and in their personal lives.”
For example, ensure that leave policies for birthing, adopting, or fostering a child apply to all employees equitably, regardless of their gender identity, Dr. O’Toole said. Actively sponsor LGBTQIA+ colleagues for opportunities or awards and find innovative ways to highlight their work and achievements.”
Dr. Khanijow recommended finding out if an organization recognizes Pride Month in June. “If not, treating colleagues to rainbow cupcakes or sending out an email about LGBTQIA+ medical figures in history could be a good start to bringing awareness to this population,” he said. A next step would be education. For example, encourage people to watch SHM’s LGBTQIA+ Health Series for continuing education credit or invite a guest lecturer to discuss the topic at your organization. The series includes courses on LGBTQ+ Affirming Language and Documentation, Inpatient Care of Transgender Individuals: Gender Affirming Hormone Therapy, LBGTQ+ as Social Determinant of Health, Advocacy for/with LGBTQ+ Persons: Population and Policy, and PrEP 101: A Hospitalist’s Guide to HIV Pre-Exposure Prophylaxis.
The COVID-19 pandemic and the current political climate have left many health care workers exhausted and overwhelmed, both physically and emotionally. “Many of us have little left to give after the challenges of the past few years,” Dr. O’Toole said. “But now would be a good time to revisit our own mental health and that of our colleagues, especially those in the LGBTQIA+ community.”
Another major obstacle for many hospitalists is new or proposed state laws that discriminate against the LGBTQIA+ community, such as those that restrict health care for transgender youth. “As hospitalists, it’s important to be registered to vote and partake in local, state, and national elections,” Dr. O’Toole said. “Getting involved in advocacy work both within your institution and community is a critical action that everyone can take. Physicians hold a powerful voice in our institutions and communities.”
When looking to start an initiative, Dr. Khanijow recommended being sure that it is something that your LGBTQIA+ co-workers want and need. “When stepping in as an ally, ask what the community wants and how you can best help them,” he said. Be sure to balance new initiatives with a workplace’s culture. In some parts of the country, where anti-LGBTQIA+ laws are being implemented, there may be more implicit or even explicit bias toward the LGBTQIA+ community among providers, patients, or both.
Performing a knowledge-and-attitudes survey on LGBTQIA+ health could be a good starting point to gauge clinicians’ self-perceived comfort and clinical competence regarding LGBTQIA+ health. “It’s important to distinguish between comfort and clinical competence,” Dr. Khanijow said. “Someone may want to be an ally and be comfortable working with LGBTQIA+ peers, but not feel competent about LGBTQIA+ health.”
Conducting a survey can show where a hospital community stands. “Then, determine which misconceptions or biases employees may have, and address them through education,” Dr. Khanijow said. “As an ally, it’s important to remember that some LGBTQIA+ people may keep this information confidential, so when planning events or activities specifically geared toward this community, be sure to invite everyone.”
Karen Appold is an award-winning journalist based in Lehigh Valley, Pa. She has more than 25 years of editorial experience, including as a newspaper reporter and newspaper and magazine editor.