Einstein Health Networks’ Pride Program: Caring for LGBTQ+ Patients
Libby Parker, MSS LSW
In 2015, Dr. Michele Style, resident physician and cofounder of Einstein Health Network’s Pride Clinic, treated a patient with advanced-stage cervical cancer. Though the patient had health insurance and lived within walking distance of the hospital, she avoided preventative care, including routine Pap smears. During her treatment, the patient disclosed that she identifies as a lesbian and was afraid she would be unfairly judged in a hospital setting because of her sexual orientation. She had avoided pursuing life-saving screenings that could have prevented the progress of her cancer. Unfortunately, her story reflects a much larger trend in healthcare access and outcomes for LGBTQ+ identified individuals.
According to national research, individuals who identify as LGBTQ+ are more likely to experience discrimination in healthcare settings. In a 2010 survey conducted by Lambda Legal, 70% of transgender respondents and almost 56% of lesbian, gay, and bisexual research participants reported experiencing at least one instance of discrimination while trying to access health services.1 In a similar analysis conducted by the National Center for Transgender Equality, in partnership with the National Gay and Lesbian Task Force, 19% of the trans-identified respondents described outright denial to health care because of their gender identity. The same survey found that 28% of respondents reported being harassed, while 2% experienced physical violence, during the course of seeking medical care2.
Avoiding healthcare settings because of concerns regarding safety, comfort, and acceptance has left a large swath of our population without adequate care. Indeed, Philadelphia estimated that 3.9% of its population3, more than 60,000 people, identify as LGBTQ+, yet competent services and resources for LGBTQ+ are limited. As a result, individuals who identify as LGBTQ+ are more likely to experience adverse health outcomes when compared to their cisgender4, straight peers.
When Einstein Healthcare Network launched its LGBTQ+ health initiative and established the Pride Program, its founders recognized that to provide quality care, staff training would be essential. Though most medical providers are well intended, they are seldom required to educate themselves on the unique experiences of their LGBTQ+ patients, leaving providers without adequate tools to offer the highest quality of compassionate care. The Pride Program has sought to ensure individuals working in LGBTQ+ health care have adequate language by which to communicate with their patients.
The Pride Program’s training introduces staff to four essential components of identity: (1) sex assigned at birth, (2) gender identity, (3) gender expression, and (4) sexual orientation.
- Sex assigned at birth refers to how an individual is categorized at birth, either as male, female, or intersex. It is important to remember that some people may change this later in life, which is why we say “sex assigned at birth” rather than “sex.”
- Gender identity refers to one’s individual, internal experience of his or her gender. We must be told how another person identifies before we know what his or her gender is. One’s gender identity may vary over time and is not inherently visible to others, as opposed to gender expression.
- Gender expression is an external manifestation of gender communicated in a variety of ways, including by name, pronoun, clothing, haircut/style, voice, or body characteristics. Society often identifies these cues as masculine and feminine, although this may change over time and varies by culture.
- Sexual orientation, akin to gender identity, is an internal sense of physical, romantic, and/or emotional attraction to another person. Our sexual orientation is not necessarily visible to others, nor is it inherently static.
Though this language is particularly advantageous in working with LGBTQ+ identified individuals, it is important to recognize that all people were assigned a sex at birth, and we all have an internal gender identity and external gender expression in addition to our sexual orientation.
Understanding these four categories helps us better communicate with all our patients regarding essential components of their identity. While there is a great deal of nuanced language specific to these broader categories (including language that is understood to be offensive and should therefore be avoided5), the Pride Program’s training emphasizes the importance of self-determination. By respecting the self-determination of our patients, we recognize that it is our job to listen and remember the patient is always the expert. As care providers, it is up to us to mirror the language used by our patients and not inset our own assumptions into our interactions. We can take steps toward cultivating a more welcoming environment by using gender-neutral language and avoiding language, policies, and practices that exclude our LGBTQ+ identified patients.
1. From When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV (New York: Lambda Legal, 2010). Available at www.lambdalegal.org/health-care-report.
2. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, J.M. Grant, L.A. Mottet, J. Tanis, J. Harrison, J.L. Herman, and M. Keisling, 2011 (Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force), accessed February 4, 2011.
3. The Metro Areas With the Largest, and Smallest, Gay Populations, David Leonhardt, Claire Cain Miller, March 20, 2015, The New York Times, accessed June 1, 2017.
4. Cisgender describes a gender identity in which a person almost always, if not exclusively, identifies as their sex assigned at birth.
5. If you are interested in learning more about terms to avoid, you utilize a variety of resources available online including GLAAD’s publication, ‘An Ally’s Guide to Language’, Available at: https://www.glaad.org/publications/talkingabout/terminology