By Wendy Sarubbi | December 9, 2013 2:34 pm

Physicians who ignore their patients’ sexual orientation and gender identity risk their patient’s health and contribute to “LGBT invisibility” in healthcare, the director of the National LBGT Health Education Center told a College of Medicine audience December 5.

Such invisibility and health disparities happen when patients are not comfortable revealing their sexual orientation to their doctor for fear of judgment or because the physician doesn’t ask, said Dr. Harvey Makadon, who leads the Boston education center and also teaches at Harvard Medical School.

He cited several examples where such communications failures had dramatic impacts on health. A transgender male was diagnosed with breast cancer but well after the disease had spread. The patient didn’t believe he needed mammograms because he had undergone gender reassignment surgery. Despite the patient’s extensive family history of breast cancer, his physician never asked about the topic.

“When you actually think about the clinical situations, you realize why we need to learn about sexual orientation and gender identity,” Dr. Makadon said. “It’s not just a nice thing; it’s something that can really make a difference in people’s lives.”

To get a complete history, physicians need to ask about their patient’s sexual orientation and gender identity, Dr. Makadon said, adding that some physicians are reluctant to ask such questions because they don’t feel informed on the topic.  “You don’t have to know everything, you just have to be comfortable giving yourself a chance to listen,” he said. “Be respectful, be empathic and be appropriately curious, and it will actually make a difference.”

Looking back on his own experiences, Dr. Makadon recounted how his identity as a gay man was practically ignored by physicians, even those with sterling reputations in primary care. “Someone like me, who had access to all this health care information, still couldn’t find a doctor who was able to do a good job taking care of a relatively healthy gay man.”

Providing medical students with a more inclusive curriculum will help improve care for LGBT patients, said Dr. Lori Boardman, assistant dean for medical education who invited Dr. Makadon to speak at UCF’s medical school and has led efforts to increase student knowledge LGBT topics.  “We need to educate not only patients but also providers and students in the health professions,” Dr. Boardman said. “That includes nursing, medical and pharmacy.” She detailed how little time many medical schools devote to LGBT topics, with the average school devoting about 5 hours to the topic over four years of medical school. In comparison, a study of the UCF medical school class of 2014 showed students received 27 hours of training on LGBT topics a year.

Dr. Makadon served as one of the chief writers of “The Fenway Guide to LBGT Health,” a book that Dr. Boardman called “practically the Bible we use to put together the curriculum here at UCF.” The text offers thorough guidelines on how doctors should address LBGT health care needs in a way that is effective and respectful.

The book addresses specific healthcare disparities that LBGT patients experience — from increased smoking rates to increased risks for HIV/AIDS, depression, anxiety and suicide.   “The disparities really come from issues that we can control,” Dr. Makadon said. “People want to talk to their doctors, but we, as doctors, have to give them the opportunity to actually do this.”

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