There are many different components to creating an environment welcoming to LGBT patients, including outreach, office space, intake forms, confidentiality policies, staff training, and the patient interview. Small changes you make in these areas can have a big effect on the comfort felt by your LGBT patients, and this will translate into a more satisfying patient-provider relationship and better health outcomes.

Some providers may be unaware of the degree of discrimination a LGBT person may have experienced in the health care setting, and of his or her resulting discomfort in your office. Sometimes this bias may be very obvious and flagrant. More often, however, the discrimination is felt in many small and seemingly subtle ways that add up to the LGBT patient feeling invisible and unsafe. For example, providers commonly ask women what form of birth control they use while performing a gynecological exam. Not only does this assume heterosexuality, it forces the lesbian patient to come out to their provider at an extremely vulnerable moment.

These webpages provide simple and specific recommendations for making your practice more welcoming to your LGBT patients. 

Approximately 5 to 10% of your patient population may be lesbian, gay and bisexual and approximately 1 to 10% may be transgendered (not all will be transsexual, though). If these numbers sound high to you, it may be that you are not asking the right questions, or that patients are not comfortable disclosing. 

• Sexual behavior may change over time, and sexual orientation is not synonymous with sexual behavior. For example, a woman may state that she is a lesbian, but engages in occasional sex with men.
  
  
• Negative past experiences, provider-patient power dynamics, and societal pressures may make it very difficult for patients to disclose same-sex behavior in a health care setting. Be sensitive to your verbal and your body language to create an atmosphere of care, openness and non-judgment.
  
  
• LGBT patients are likely to be especially conscious of protecting their privacy in medical records, and the potential disclosure of their sexual orientation on medical records may be a factor in their willingness to discuss it openly with you. Be explicit with patients about how and whether you will document of sexual orientation in the medical record and obtain the patient's permission before doing so.
  
  
• Be familiar with appropriate LGBT community referrals. Referring LGBT patients to health resources in their community is analogous to referring an older client to services targeting elderly people or a person with diabetes to the American Diabetes Association. LGBT organizations in your area will be happy to provide you with brochures to hand out to patients.
  
  
• Remember that cultural competence is a learnable skill. LGBT patients will notice your attempts to be welcoming and will respond very positively.

 LGBT people are likely to respond very favorably to advertisements in local LGBT service directories and publications. This is a direct indication that you are interested in welcoming LGBT patients into your practice.

• Place advertisements in LGBT periodicals and local service directories.
• Send speakers to meetings of LGBT organizations to announce your practice.
• Promotional literature about your practice should specifically state that services are provided without discrimination based on sexual orientation or gender identity.
• Design, enforce, and publicize a system for maintaining confidentiality of client records.

• Post a sign in the waiting room that says "We do not discriminate on the basis of age, race, sex, sexual orientation, gender identity, religion, language, or disability." LGBT people notice when sexual orientation and gender identity are included in non-discrimination policies, because they often are not.
  
  
• Have an affirmative action policy for hiring "out" LGBT people. This will go a long way towards making LGBT patients more comfortable.
  
  
• Waiting room reading materials and bulletin boards should include positive items about the LGBT community and materials of interest to the LGBT community.
  
  
• Provide in-depth training for staff members on homophobia and LGBT health concerns. All staff dealing directly with clients should be able to talk comfortably about all forms of sexuality and all gender identities. Have staff practice with each other until they are comfortable.
  
  
• Friends and partners of LGBT patients should be given the respect and privileges usually given to a spouse or relative.
  
  
• Provide an evaluation form with questions concerning heterosexism/homophobia so LGBT clients can give you feedback.

• Patient intake forms should be free of heterosexual assumptions. Include options such as "Living with domestic partner" as well as standard options such as married and single. Instead of "husband/wife" use gender neutral terms such as, "partner."
• Whenever there is a sex or gender question, add a third category for transgendered with space that people can elaborate. Do not list transgendered as an alternate sexual orientation (like lesbian, bisexual, or heterosexual). Gender identity and sexual orientation are distinct.
• Questions about families should allow for alternative families including two parents of the same sex and more than two parents.
• Intake forms need to include an explanation about how confidentiality will be protected and who has access to medical records. Offer the patient the right to refuse to answer a question on the intake form if they are concerned--you can discuss it in your office.