Different populations have different healthcare needs, and providing optimal care to the estimated 89,000 lesbian, gay, bisexual and transgender (LGBT) individuals in Kansas City is an ongoing challenge for local hospitals and clinics.
Studies have identified the many health disparities faced by the LGBT community, and Kansas City is no exception. A 2012 report by the Missouri Foundation for Health says that LGBT Missourians are more likely to experience poor health outcomes than their heterosexual peers.
That's because LGBT individuals are more likely to delay seeking healthcare — or not go to the doctor at all — out of fear of discrimination. It doesn't help that healthcare providers trained in LGBT health issues are in short supply.
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Children’s Mercy is one hospital coping with these issues. In 2013, it was the only hospital in the city to be recognized as a "Leader in LGBT Healthcare," a designation conferred by the country's largest LGBT civil rights organization, the Human Rights Campaign (HRC).
“This has been a kind of a living document if you will, or kind of a work in progress," says Gaby Flores, director of the hospital’s Office of Equity and Diversity. "We fix one part, we find we kind of put our thumb over the hole in one area, and it opens up areas of opportunity for us in other places.”
To earn the HRC designation, which Children's Mercy is reapplying for on June 30, the Kansas City hospital overhauled its policies governing interactions with employees and patients. Among other things, it altered the wording in electronic medical records and policies, re-scripted language used with patients and trained staff on sensitive patient interactions.
“This process has been two pronged — not just looking at the patient care environment but also making sure that our LGBT employees feel welcome at work,” Flores says.
The term used in medical circles is “cultural competency” — the notion of being responsive to patients’ varying beliefs, practices and cultural needs. In Children’s Mercy's case, that has meant acknowledging differing family structures and jettisoning what Flores terms a “mom and dad kind of scripting.”
“So we’ve had to reeducate staff on the visitation process for families visiting sick kiddos, reeducate staff on how to have interactions with families that are same sex,” she says.
“Because the tendency is to kind of panic and not engage in normal conversation. So it’s been a lot of education, a lot of training, kind of at the front line and also at our executive level as well.”
As if to drive home the point, at about the same time Children’s Mercy made those changes, Research Medical Center made headlines for forcibly removing a gay man from his sick partner’s bedside.
Roger Gorley and his partner had been in a civil union for five years. After his partner’s brother demanded that he be removed, Gorley told Fox 4 News that he was ejected from the hospital.
Research disputed that account, saying Gorley was removed because he had become disruptive and belligerent.
Corrine Everson, a spokesperson for Research Medical Center, says the hospital has an “extensive code of conduct training, as well as a requirement for all staff to create a welcoming, safe and inclusive environment,” which includes members of the LGBT community. Everson declined to comment on whether any specific policy changes had been made in the wake of the incident last year.
Whatever the reason for Gorley’s forcible expulsion, cultural competency has become an increasingly important element of health care delivery, aimed at creating more sensitive patient interactions as well as ensuring provider familiarity with LGBT-specific health issues.
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Gay men, for example, run a higher risk of anal cancer caused by the human papilloma virus (HPV) than heterosexual men. But a primary care doctor not trained to recognize LGBT health issues may not think to offer the HPV vaccine to such patients.
“You can get penile cancer and anal cancer and all kinds of other cancers, if you’re a male, from HPV,” says Dr. Daryl Lynch, director of adolescent care at Children’s Mercy.
Most pediatricians routinely offer the HPV vaccine to female patients because the virus causes cervical cancer. But Lynch wants to offer it to male patients as well, noting “that’s protective against more than 90 percent of the causes of anal cancer.”
Lynch has a distinctive perspective on the issue of cultural competency; he’s not only a doctor, he's openly gay. Being openly gay, he says, has never been an issue in his chosen profession because patients know his “motivation is to keep people healthy and do the best we can to work with them for health.”
“I think that it’s very important as a physician or healthcare provider to realize that our own opinions and morals and ethics are not something that we should be pushing onto our patients,” Lynch says. “Our drive and our focus in our career should be on doing the best we can to take care of patients and meet them where they’re at.”
A list of physicians who have been identified as culturally competent physicians in the Kansas City area can be found at the website of LGBTQIA Healthcare Guild of Kansas City, under the "Find Medical Provider" tab. A list of healthcare issues specific to lesbian, gay, bisexual and transgender individuals can be found on the Centers for Disease Control’s website.
Stefani Fontana is an intern with KCUR.