Confronting unconscious bias, listening to patients’ needs necessary to create safe spaces
“If you want to be an ally, then you already are.”
Dr. Claire Heslop said this willingness is the first step for physicians who want to support their LGBTQ patients.
But achieving real health-care equity happens when physicians engage in deeper discussion around identity, sexual health and well-being, which can help patients get quick and effective care.
Dr. Heslop, an emergency physician at Toronto Western Hospital, was one of four LGBTQ physician panellists speaking at an internal Ontario Medical Association Pride event on how doctors can be better allies for the LGBTQ community.
“Learn about your patient. Listen to their needs,” she said. “It takes longer to provide care that’s effective if you don’t.”
“We need an approach that allows us to take care of everyone, because we're doctors who take care of everyone” — Dr. Thomas Dashwood, an HIV, infectious disease and addiction medicine physician.
Dr. Thomas Dashwood, an HIV, infectious disease and addiction medicine physician, said he sees some of his colleagues struggling to talk to their patients about sexual health and the unique health-care needs of the LGBTQ community.
“I’ve had patients land in my lap with severe HIV on the doorstep of death because a physician missed conducting an HIV test 10 years ago due to discomfort or lack of questioning,” said the member of the Sexual Health Team at HQ Toronto, a clinic that provides inclusive care to the LGBTQ community. “After just a few questions, you would realize that they’re suffering from HIV, and yet it's missed for years.”
Dr. Tehmina Ahmad, an endocrinologist and transgender health-care specialist who works at Toronto Western Hospital, has also treated patients who feel their health-care needs were not met.
She once received a referral for a patient experiencing abdominal pain and diarrhea. The patient, who was taking gender-affirming hormone therapies, was given a sexually transmitted infection test that came back negative. The physician then concluded their symptoms were related to the hormones.
But Dr. Ahmad determined early the two weren’t linked. She felt the patient experienced a gap in care and was disappointed further diagnostic tests weren’t requested.
Inclusive care requires physicians to look at their patients in a holistic way that is not assumption-based or influenced by unconscious biases, Dr. Dashwood said.
“People that we care for have more than one identity that may affect their care in some way,” he said. “Whether it’s race, ethnicity, immigration status, income, mental health, substance use or religion — we need an approach that allows us to take care of everyone, because we're doctors who take care of everyone.”
Toronto hematologist Dr. Michael Scott treats patients who are taking hormone therapies or experience complications from the use of recreational substances.
To provide better care for his patients, he sought further training to better understand how LGBTQ health care intersects with his scope of practice — an extra step he recommends to all physicians.
“In your area that you practise — especially if you're a specialist — educate yourself on how the unique needs of the 2SLGBTQ+ community might come up when deciding treatment,” he said. “Your patients will look to you as the expert.”
LGBTQ physicians recognize that some doctors may not have the knowledge and tools to immediately provide effective and inclusive treatment for LGBTQ patients. But there are simple steps doctors can take to show their practices are safe spaces, Dr. Heslop said.
“You could put a sticker on your badge or put something on your website that labels you as an ally, or simply have your pronouns in your email signature,” she said. “It’s these little things that can make your patients feel safer.”
“Learn about your patient. Listen to their needs” — Dr. Claire Heslop, an emergency physician at Toronto Western Hospital.
For their colleagues who are uncertain about the path forward, physicians who belong to the LGBTQ community want them to know it’s OK to not have all the answers.
“Do I know everything about every culture in the world? Absolutely not,” Dr. Dashwood said. “Can I approach a patient in a humble way asking appropriate questions using trauma-informed approaches to ensure that they feel supported and able to talk to me? Yes.”
Ontario’s physicians are invited to parade alongside the Ontario 2SLGBTQ+ Doctors and Allies Pride March group on June 25. Visit Pride Toronto’s Facebook page for more information.
Alexa DiFrancesco and Shreya Menon are summer interns with the OMA’s Advocacy, Marketing and Communications team. DiFrancesco is a master of journalism student at Toronto Metropolitan University. Menon is a fourth-year undergraduate student at Western University, majoring in political science and media studies.