Best practices for LGBT sensitivity training for front office medical staff
The first person you interact with at a doctor’s office is the front office staff. They are the face of the medical practice. You speak to them over the phone to initiate a clinical appointment and they are the first persons you interact with when you arrive at the facility. They welcome you to the office and set the tone for your interaction. After interfacing with at least two staff members, probably more, you will eventually encounter the physician you came there to see.
Since a doctor’s time is at a premium, the majority of the patient interaction time is spent with office staff and peri-medical staff. According to the National Ambulatory Medical Care Survey of 2010 (30), the average time spent in the presence of the physician is about 19 minutes (thankfully, this number is up from 15 minutes from the 1992 survey). However, wait time for patients is still a higher number, averaging 25 minutes according to latest Press Ganey Annual Physician’s Office Report (10). More than half of the time that patients spend in a doctor’s office is spent with persons other than the doctor. This means that no matter how LGBT friendly a doctor is, if their staff is not trained to be sensitive to LGBT issues, the LGBT patients probably won’t have a positive experience. This article provides you some best practices for training medical office staff members to sensitive to the issues that LGBT patients and their families may experience. As the Gay and Lesbian Medical Association puts it, “Training for all staff is critical to creating and maintaining practice environments deemed safe for LGBT patients.”
It is important to remember that when a medical office trains the staff, they are educating adult learners. According to the Andragogy Learning Theory, Adult learners will be most open to instruction “that adds value to their life circumstances” (Alexander and Gerdon, 2012, 230). In 2014, a well known sexuality education team, Bruess and Schroeder, said this about adult learners, “For the knowledge to be retained, it must be useful. The learner must internalize this knowledge and incorporate it into his or her life” (174).
For the information to “stick” the staff must recognize the need for this type of information and the immediate applicability to their own situation. It may be helpful to start with some statistics about the number of LGBT patients. Trainers can use a phrase like, “According to the CDC, about 4% of the US population identifies as lesbian, gay, bi-sexual or transgender (Ward, Dahlhamer, Galinsky and Joestl, 2014). In our practice, we see about 300 patients a week, it is likely that at least 12 of them are LGBT. If we make an effort to be more LGBT friendly, that number will rise.” To make the most valuable use of your training time, make sure to relate all the information to the current circumstances in your medical office.
Here are a few training activities you can add to your office staff training tool belt:
1. LGBT Definitions – One thing that will immediately make an LGBT patient uncomfortable is staff unfamiliarity with language surrounding LGBT issues. Changing a persons vocabulary surrounding a sensitive issue can go a long way toward changing their attitudes about that same issue. A vocabulary exercise to familiarize your staff on current terminology is easy to do. Include terms that your staff should not use as well. For example, though many people have heard the word “transvestite”, that word is considered outdated and no longer an acceptable reference (GLAAD, 2015). Writing definitions on a white board and giving your staff vocabulary cards to match up to the definitions can be an easy activity to get them familiar with current terms. You can find up to date terms on a website like GLAAD (Gay and Lesbian Alliance Against Defamation).
2. Role Playing – Role playing often gets a bad rap. Everybody from 5th graders to grad students groan when they hear they may be expected to participate in a role playing activity. However, in a case like this where your learning objective involves staff practicing interaction with a specific population, role playing can be invaluable. This activity allows the actors and observers to develop empathy for LGBT patients as well as giving them a chance to practice their new behavior in a non-threatening, low-risk setting (Bruess and Schroeder, 183).
3. Guest Speakers – Meeting a real person and hearing their story is a great empathy building activity. However, it may not be practical to have a transgender patient come and speak to your staff about their experience in finding a safe medical community. Bruess and Schroeder (186) recommend contacting an LGBT Community Center to find a speaker on social/legal issues for LGBT patients.
4. Case Studies – “A case study is a story that can be analyzed and from which learning can occur” (Bruess and Schroeder, 182). The Huffington Post published an article last year regarding building empathy among students by exposing them to stories. “When you listen to and understand stories, you experience the exact same brain pattern as the person telling them. It’s as if you are experiencing the story yourself” (Huffington Post, 2014). Reading, understanding and processing stories about LGBT patient experiences will have an impact on attitudes toward LGBT patients among your staff.
In addition to training staff, making sure your office environment is a positive LGBT friendly space is important. Review forms for gender normative language and be sure to include appropriate phone language in your staff trainings. Giving specific language to use will make it easier for employees who are new to an LGBT aware environment. Providing scripted phrases will ease any anxiety your staff may have about saying the wrong thing. For example, instead of “What is your husband’s phone number?” train your staff to use the phrase “What is your partner’s phone number?”
Similarly, create a scripted set of instructions for first greetings that you will use with all patients. Even friends and families LGBT patients will appreciate your efforts to be inclusive to all genders. And don’t forget to make your waiting room, where most patients spend the majority of their time during their interaction with your practice (Press Ganey Annual Physician’s Office Report, 2008), LGBT friendly. Display LGBT reading materials, a nondiscriminatory statement, even a rainbow flag or pink triangle if it suits your practice. And last but not least, please make an effort to provide a gender-neutral restroom and mark it as so. (Even the White House added one!) LGBT patients often feel anxiety about using the “wrong” bathroom. Your purposeful offering of a gender-neutral restroom will send the intended welcoming message to your current and future LGBT patients. (See 10 tips for improving services for transgender people here.)
Changing the culture of your medical practice by putting LGBT sensitive processes in place, training your staff accordingly and creating a safe medical office environment will serve to improve your communication skills and foster honest relationships with your patients and their families.
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Bruess, C.E., & Schroeder, E. (2014). Sexuality Education: Theory and Practice (6th Ed.). Sudury, MA: Jones & Bartlett.
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Gay and Lesbian Medical Association. Creating a Welcoming Clinical Environment. Guidelines for Care of LGBT Patients. Washington D.C. Retrieved from: http://www.glma.org/_data/n_0001/resources/live/Welcoming%20Environment.pdf
Gender Spectrum Medical (2014). Retrieved from: https://www.genderspectrum.org/explore-topics/medical/#more-329
Gay and Lesbian Alliance Against Defamation, (2015). GLAAD Media Reference Guide – Transgender Issues. Retrieved from: http://www.glaad.org/reference/transgender
Hernandez, M., Fultz, S. L., & Shankle, M. D. (2006). Chapter 8: Barriers to Health Care Access. In , Handbook of Lesbian, Gay, Bisexual, & Transgender Public Health: A Practitioner’s Guide to Service (pp. 177-200). Haworth Press, Inc.
National Ambulatory Medical Care Survey: 2010 Summary Tables (2011). Centers for Disease Control, Atlanta, GA. Retrieved from: http://www.cdc.gov/nchs/data/ahcd/namcs_summary/2010_namcs_web_tables.pdf
Press Ganey Physician’s Office Pulse Report. (2008). Press Ganey Associates, Inc. South Bend, IN. Retrieved from: http://www.pressganey.com/Documents_secure/Medical%20Practices/Pulse%20Reports/Physicians_Office_Pulse_Report_2008.pdf
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Ward, B.W., Dahlhamer, J.M., Galinsky, A.M., Joestl, S.S. (2014) Sexual Orientation and Health Among U.S. Adults: National Health Interview Survey, 2013. National health statistics reports, 77. National Center for Health Statistics, Hyattsville, MD. Retrieved from: http://www.cdc.gov/nchs/data/nhsr/nhsr077.pdf