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"The patient-physician relationship is a critical factor in a patient’s well-being. "Health" is a holistic concept that includes physical, mental, emotional and social well-being. It is difficult for a physician to nurture the conditions that improve health if the patient/physician relationship is based on misinformation, assumptions and bias." [1]

Culturally competent care is defined as health care that is sensitive to and knowledgeable about the health beliefs and behaviours, the epidemiology and disease risks, and treatment outcomes of specific patient populations[2] [3]. Culturally competent care, therefore, requires that physicians be:

  • aware of their own beliefs and values and how these might be affecting patient care

  • knowledgeable about the health care issues facing their patients

  • up to date on appropriate prevention and health promotion practices, and the most effective treatments.

In 1999 the Massachusetts Department of Public Health funded a project called "the Gay, Lesbian, Bisexual and Transgender Health Access Project" that developed standards of practice for quality care of the LGBT population[4] [5]. The standards are based on the elimination of discrimination, full and equal access to health care services for all patients, the elimination of stigmatization and the creation of health care environments in which all patients feel safe coming "out" to their providers. One important aspect of the standards is that they address community outreach and health promotion thus fostering the inclusion of the LGBT population in community health care decision making.

The following are some specific suggestions for health care providers.

  1. Intake forms should be inclusive and non-heterosexist. Rather than asking marital status, ask about significant supports in a patient’s life and leave space for someone to describe their family structure. Similarly the office environment should be open and inviting for all patients[6] [7] [8] [4] [5].

  2. Both nursing and physician interviewing must be non-judgemental and non-heterosexist.[8]

  3. Focus on behaviour rather than sexual orientation when treating all patients. Heterosexual individuals can engage in the same high risk behaviours as the LGBT population, and many individuals who do engage in certain risky behaviours do not self-identify as anything other than heterosexual[6] [9].

  4. You must be honest and aware of your own biases and prejudices, and if you feel you cannot provide non-judgemental, compassionate care for the LGBT population, then refer patients to someone who can[8].

  5. Acceptance, non-judgemental, open communication and trust leads to a more detailed and accurate history. This in turn will lead to better and more appropriate care for all patients[8].

  6. Include partners of LGBT patients in health care planning and decision-making[10] [11].

  7. Ask people how they would like to be referred to, and use pronouns reflective of a patients’ gender identity rather than their biological sex[12] [13].

  8. Confidentiality is especially important to the LGBT population who are still vulnerable to discrimination[2]. Discuss confidentiality issues with patients and don’t record sexual orientation in the patients’ chart without consent[11].

  9. Have inclusive health promotion campaigns: include gay, lesbian, bisexual and transgendered individuals and their families. [4].

  10. Be knowledgeable in the health care needs of the LGBT population[4].

  11. Be an advocate and challenge heterosexism and oppression of the LGBTI population whenever you see it. [14].

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1. Davis V, Christilaw JE, Edwards C, Francoeur D, Grant LJ, Parish B, Saraf-Dhar R, Steben M. SOGC Clinical Practice Guidelines. Policy Statement No. 87. Lesbian Health Guidelines. Journal of the Society of Obstetricians and Gynecologists of Canada. 2000;22(3):202-205. http://sogc.medical.org/SOGCnet/sogc_docs/common/guide/pdfs/ps87.pdf. Accessed on July 18, 2003.

2. Kaiser Permanente National Diversity Council. A Provider's Handbook on Culturally Competent Care: Lesbian, Gay, Bisexual and Transgendered Population. Oakland, CA. Kaiser Permanente; 2000.

3. Schilder AJ, Kennedy C, Goldstone IL, Ogden RD, Hogg RS, O'Shaughnessy MV. "Being dealth with as a whole person." Care seeking and adherence: the benefits of culturally competent care. Social Science & Medicine. 2001;52:1643-1659.

4. Anonymous. Community Standards of Practice for Provision of Quality Health Care Services for Gay, Lesbian, Bisexual, and Transgendered Clients. 1999. GLBT Health Access Project and JRI Health. Boston, Mass. http://www.glbthealth.org. Accessed October 21, 2003.

5. Clark ME, Landers S, Linde R, Sperber J. The GLBT health access project: a state-funded effort to improve access to care. American Journal of Public Health. 2001;91(6):895-896.

6. Peterkin A, Risdon C. Caring for Lesbian and Gay People: A Clinical Guide. 2003. University of Toronto Press Incorporated. Toronto, Ontario.

7. Tiemann AK, Kennedy SA, Haga MP. Rural Lesbians' Strategies for Coming Out to Health Care Professionals. In Ponticelli CM, Ed. Gateways to Improving Lesbian Health and Health Care: Opening Doors. pp. 61-75. Binghamton, NY. The Haworth Press, Inc.; 1998.

8. Rosenfeld, JA, Ed. Handbook of Women's Health. New York, NY. Cambridge University Press; 2001.

9. Finlon C. Health care for all lesbian, gay, bisexual, and transgender populations. Journal of Gay & Lesbian Social Services. 2002;14(3):111-118.

10. Barbara AM, Quandt SA, Anderson RT. Experiences of lesbians in the health care environment. Women & Health. 2001;34(1):45-62.

11. Saulnier CF. Deciding who to see: lesbians discuss their preferences in health and mental health care providers. Social Work. 2002;47(4):355-365.

12. Feinberg L. Trans health crisis: for us it's life or death. American Journal of Public Health. 2001;91(6):897-900.

13. Lombardi E. Enhancing transgender health care. American Journal of Public Health. 2001;91(6):869-872.

14. Hudspith M. Caring for Lesbian Health: A Resource for Canadian Health Care Providers, Policy Makers and Planners, Revised Edition. 2001. Health Canada. http://www.hc-sc.gc.ca/english/women/facts_issues/lesbian_health.htm. Accessed October 24, 2003.

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