“Treating Us Right: Lesbian, Gay, Bisexual, Transgender Considerations” at the 2016 American College of Rheumatology Annual Meeting

The American College of Rheumatology (ACR) is a professional organization committed to improving the care of patients with rheumatic diseases. Every year, the organization hosts a meeting attended by rheumatologists, researchers, and other rheumatology healthcare professionals – the 2016 meeting had over 16,700 attendees! While a large number of the sessions offered at the meeting cover scientific advancements and specific medical procedures, some sessions address quality of life issues for patients and are designed to educate healthcare professionals with the goal of improving patient care.

There has been a long history of bias in healthcare against members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. As recently as 1952, homosexuality was still listed by the American Psychiatric Association as a “sociopathic personality disturbance,” and this designation wasn’t officially removed until 2000. While identifying as a member of the LGBTQ community does not increase or decrease chances of developing a rheumatic condition, homophobia and stigmatization can contribute negatively to LGBTQ health outcomes. Being a member of a sexual minority is not a health risk itself, but the associated stigma can sometimes lead to psychological distress and increases in mental health issues. LGBTQ patients seeking healthcare may also face judgment and discrimination, be concerned about a perceived lack of confidentiality, or worry about their provider’s assumption of heterosexuality – all of which can create barriers to adequate healthcare. Difficulty receiving adequate healthcare can be a particular problem for individuals living with chronic rheumatic conditions.

The 2015 ACR Annual Meeting in San Francisco was the first year to have a session specifically addressing the special medical needs and concerns of the LGBTQ patient population. This session was presented by Dr. Barbara Snyder, Former Chief of Adolescent Medicine at the Robert Wood Johnson Medical School, and Caroline Hill, a licensed clinical social worker in the rheumatology clinic at UCSF Benioff Children’s Hospital. The 2015 session endeavored to give the audience a better understanding of the LGBTQ community, highlight the barriers to healthcare faced by this community, and provide practical solutions for better meeting the needs of these patients.

I was very excited to see the topic on the agenda in 2015. I think identifying barriers to healthcare is the first step to overcoming them, and I’m sure there were healthcare providers in the audience who gained more insight into what it means to identify as a member of the LGBTQ community. Still, I thought the 2015 session had a lot of room for improvement. It was sparsely attended, focused quite heavily on the needs of LGBTQ youth (leaving older generations more or less out of the picture), and didn’t offer many specific suggestions for helping LGBTQ patients manage chronic rheumatic conditions. It was my hope that the 2016 session would improve in these areas, advancing the development of better healthcare for LGBTQ individuals.

The 2016 session was entitled “Treating Us Right: Lesbian, Gay, Bisexual, Transgender Concerns” and was given by the same speakers as the previous year. Dr. Snyder and Ms. Hill strove to give the audience a clear understanding of the barriers to healthcare faced by LGBTQ patients. “Many of us may not realize how pervasive the heterosexual bias is in healthcare,” Dr. Snyder explained. The speakers then went on to provide practical suggestions for overcoming these barriers, such as: creating a welcoming environment, supplying all gender bathrooms, appropriately training staff, allowing patients to identify their preferred gender and pronouns on intake forms, and ways for doctors to be sensitive and avoid assumptions during examinations.

On the whole, I have to admit that I had mixed feelings about this session. On the one hand, I truly applaud ACR’s commitment to identifying the barriers to healthcare faced by the LGBTQ community and attempting to improve patient care for these individuals. On the other hand, with the exception of removing the focus on youth LGBTQ and being slightly better attended, the 2016 session was nearly identical to the 2015 session – right down to showing the same video and using some of the same slides. It seems to me that part of the reason for meeting annually is to work towards advancements on each topic, and I was honestly rather disappointed that the presentation was so similar to the previous year.

Though I consider myself an ally, I am not personally a member of the LGBTQ community, which means that I am certainly not the best person to offer advice or suggestions on how to improve future sessions on this topic. My own suggestion would be for ACR to speak directly with the patients this session is meant to help – and not just to individuals who identify as part of the LGBTQ community, but specifically those who also live with chronic rheumatic conditions. Perhaps incorporating a patient speaker or patient advisory board could help move this discussion along in future years?

Are you a member of the LGBTQ community living with a rheumatic condition? What would you want to see in a presentation designed to educate doctors on how to provide you with better healthcare?

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