By Roberta Heale, Associate Editor EBN  @robertaheale, @EBNursingBMJ

In December, EBN’s Editor, Alison Twycross, wrote about living in a gendered world. I recently watched a television segment that included an interview with US ex-Navy Seal, Kristen Beck, who lived as Christopher Beck throughout most of her life before revealing her feminine identify http://bit.ly/1HnV7F2   The segment renewed my interest not only about society’s views about gender and roles, but also about healthcare and the LGBT community.

A search quickly brought up numerous articles about health risks and barriers appropriate healthcare of this group of people who simply identify differently than the rest of the population. http://1.usa.gov/19OGgbb There is a higher risk of depression and suicide, substance misuse, and violence than in the straight community. Lesbians are far less likely to have had a PAP test, or recent mammogram than straight women. Gay men have higher rates of eating disorders than straight men. Transgendered people often fight stigma every day and this ongoing battle is also reflected in their interactions with healthcare providers. These are a few of the identified issues, and added to this is the misconception that LGBT denotes a homogeneous group when, in fact, each individual is unique and has unique health concerns.

I’m much more conscious in my work as a primary health care nurse practitioner of the fact that many of my practices may not be congruent with the needs of the LGBT community. I practice with an evidence-based approach, but does this mean that following the PAP guidelines will address a patient who is a lesbian? Are assumptions I make about the patients I see a barrier to me offering routine HIV testing? Am I effective in approaching reproductive issues with LBGT patients? Is there anyone qualified in my organization to provide marriage counseling for a same-sex couple?

Improving the Health Care of Lesbian, Gay, Bisexual and Transgendered People: Understanding and Eliminating Health Disparities http://bit.ly/1uWS2ZL is an excellent resource for health providers like me who want to truly meet the unique needs of LGBT patients. The first recommendation is to start by creating an inclusive environment. A question about gender on the intake form could be developed to include a number of options.   Health care providers are encouraged to think about inclusivity when asking about relationships (are you married, do you have a boyfriend, girlfriend? What do you call your partner?). The report also recommends to follow guidelines developed for specific populations, such as annual sexual health screening for MSM.

A good therapeutic relationship involves trust, respect and mutual understanding between healthcare provider and patient. Awareness of the needs of LGBT patients, and efforts toward inclusivity, are important steps toward promotion of optimal health.  Increasing awareness and making changes to my practice is an ongoing journey, often taken with my patients who are grateful to have healthcare options that reflect their realities.