Medical Treatment Begins and Ends with Front Office Medical Staff

Best practices for LGBT sensitivity training for front office medical staff

Front office 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.”

Medical Waiting Room Image

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).

Doctors and staff

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?”

Gender Neutral Bathroom

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.)

Doctor Rainbow Flag

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.

 

References

Alexander, V., Gerdon, E. (2012). Quality Online Courses: A Writer’s Guide. Retrieved from http://www.learninghouse.com/wp-content/uploads/2013/08/Quality-Online-Courses-Download.pdf

Bruess, C.E., & Schroeder, E. (2014). Sexuality Education: Theory and Practice (6th Ed.). Sudury, MA: Jones & Bartlett.

Burrows, G. (2011). Lesbian, gay, bisexual and transgender health. Practice Nurse, 41(4), 22-25.

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

Roher, B. (2011). LGBT patients needs underserved Medical schools provide little training on LGBT health issues. Between the Lines. (17).

Valenti, K., & Katz, A. (2014). Needs and Perceptions of LGBTQ Caregivers: The Challenges of Services and Support. Journal Of Gay & Lesbian Social Services, 26(1), 70-90. doi:10.1080/10538720.2013.865575

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

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9 responses to “Medical Treatment Begins and Ends with Front Office Medical Staff

  1. Amy – this is so very important. There have been numerous times in my personal life where I have been made to feel very uncomfortable by front office medical staff due to their insensitivity and just overall cluelessness. In writing this article, you have vocalized and intellectualized the personal discomfort I have carried for some time. Thank you. I love the suggestions you make for the LGBT sensitivity trainings and the connection you make to adult learning. I especially love that you talk about language. People don’t realize the detrimental impact heterosexist normative language can have on individuals within LGBT populations. Creating the smallest change – as in saying partner instead of husband as you suggested – can really show the LGBT community that as front office medical staff, you are there to provide comfort, respect, and inclusivity. These are great tips to help establish an efficient and impactful learning experience with front office medical staff. I hope more medical offices and institutions will incorporate trainings like this! You starting the conversation is the beginning of that 🙂

  2. I really enjoyed this article. As a sexuality educator and as a queer-identified person I have definitely thought about the importance of LGBT* inclusivity in the medical field. But, I never thought about the front office staff! I think that’s a really important part that’s overlooked because like you say, A LOT of time is spent in/near the company of the office staff. And looking back over my own personal experiences I can remember really uncomfortable experiences that I had with front office staff that could’ve been avoided if they had proper training. I think your inclusion of the importance of language and speakers is great. Thanks for this article!

  3. What a great article! There have been many times that I have been made to feel uncomfortable by front office staff, only to have the visit with the doctor and it feels like emotional whiplash! The interactions with the front office staff undoubtedly set the tone for the whole appointment. When the office staff is friendly and welcoming it really helps to put patients at ease and make the whole experience less stressful. I like the tie between the sensitivity training and adult learners. I especially like the suggested activities for the training. Last year I attended a training with my coworkers around bullying and LGBT youth. We were lectured at for the whole training, and most people left feeling that the training was counter productive. I think if the time had been taken to define terms, and do role plays it would have been much more constructive.

  4. Thank you so much for this post! One of my passions is for sexual health education in medical settings but for some reason I never thought of extending that education to the medical office staff! The fact that you state “the average time spent in the presence of the physician is about 19 minutes” gives such credence to the idea of training staff – who will be the primary face that most patients see. Personally, I think the role playing will the the most effective. The chance to learn about sexual diversity and then put that learning into practice in a safe space before having to use it in “real life” could increase comfort levels of front desk staff tremendously!

  5. I have never thought about medical staff with regards to LGBT issues! There is always much more emphasis on preparing physicians to be more inclusive and even their offices spaces but I just never considered the people behind the desk.
    I agree that I think role playing would be a great way for medical staff to work on improving their interactions. It creates a space where mistakes can be made and learned from without hurting others.

  6. Amy, thank you so much for your article. As a person who has spent much of her time in doctor’s offices over the past year, I can tell you that this can be very disheartening – when front desk staff do not represent the acceptance and views of the doctor. Last year, I went to the get a biopsy of my right breast. I was pretty scared and when I went to check in, I forgot to put my emergency contact on a form so the front desk person just asked me who it was- I said my partner (we weren’t married at the time) and the front desk person looked at me and said “what is his name?” and I said her name is Emily. Then she said very loudly, “your partner is a she?” Not necessarily something you want to deal with when you are shaking in your boots about getting a breast biopsy. You also are a bit concerned for your safety when you are outed at the front desk of a doctor’s office.
    I told the nurses of my oncologists office that I would do a free training for them about LGBTQ patients and how to be inclusive as I had some incidence there that were less than comfortable. I could really go on and on about my experiences with doctors and them not being inclusive. I mean can we talk about trips to the gynecologist?

    Again, thank you so much for this post. Much needed area for us to go to work!

  7. Nicely put! Training the office staff, as opposed to the doctors, hadn’t crossed my mind before. Thank you for writing this. Of course, doctors (and especially their patients) would greatly benefit from more human sexuality education in medical schools. You definitely bring up a good point — I feel like I spend all day with office staff, and maybe 13 minutes with the doctor before I’m rushed out the door. Training the office staff makes so much sense.

    Also, I love your idea about providing a list of terms to NOT use. That is so important. Many, if not most people do not realize that some of the common terms used to describe people in the LGBT community are derogatory. Just because these terms may appear as porn categories does not mean they are acceptable!

  8. I believe that this is a serious issue! If someone is going to see about their health, that should be all that matters. It is very unfortunate that these professionals lack the training to address patients in a respectful manner. I strongly agree that training is necessary! Your examples would be very beneficial.
    I agree that the should listen to a guest speaker. Perhaps the insight would trigger a sense of reality and ownership for the professionals.
    Providing the workers with terminology to use seems to be a fail proof method. This way there is no reason to use offensive language.
    I believe that this type of training needs to at any place that business is conducted! We need to all be respectful to one another at all times and this training could promote that! Where do I sign up?

  9. THANK YOU! This is very important for all human service professionals to utilize. I am noticing issues at my place of employment and there is stigma that need to be eliminated among the staff. This will be a great tool for me to circulate to our clinic nurse’s and other providers, including the community testing team. Something as simple as an LGBT vocabulary list can be very helpful and allow staff to be more culturally competent. When you mentioned the role-playing, I thought adding the an activity that focuses on microaggressions of the LGBT community, could possibly help the participants to empathize and respect the LGBT community. Great job.

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