By Rachelle Monteau, Alexis Dickerson and Katherine Mendis.
Recent political developments in the United States have raised alarm that health inequity between LGBTQ+ patients and the general population—already a pressing problem—might worsen. Some initiatives specifically limit the provision of medical care to LGBTQ+ patients, while those that undermine social equality are also likely to contribute to poorer health outcomes. While the political landscape may presently be less dynamic in the United Kingdom and Europe, all liberal Western countries fail to adequately meet the health-care needs of these vulnerable patients. Against this landscape, the importance of emphasizing clinicians’ ethical duties, and expanding training to prepare clinicians to provide competent care to LGBTQ+ patients, has never been clearer.
In recent years, there has been an increase in the number of laws that grant clinicians the ability to discriminate against members of the LGBTQ+ community. Examples include the 2016 Mississippi’s HB 1523, Tennessee’s HB 1840, and the 2023 Floridian “License to Discriminate in Healthcare” bill that allow healthcare providers to deny patient care on the basis of religious, moral, and ethical beliefs; discriminate in hiring processes; and prevents medical boards from disciplining such healthcare providers. More recently, on November 5th, 2024, Donald Trump was elected the 47th President of the United States. In his previous presidency, President Trump eliminated the general prohibition of discrimination based on gender identity and sex-stereotyping for transgender individuals and other members of the LGBTQ+ community in Section 1557 of the Affordable Care Act (Note: The Biden-Harris administration repealed this in 2024).
In his 2024 campaign, while President Trump declined to state his official opinion, many of his political supporters backed Project 2025, a collection of proposals that promote radically discriminatory legislation impacting the LGBTQ+ community. One proposal would rescind the “Coverage of Certain Preventive Services Under the Affordable Care Act,” granting healthcare providers religious and moral exemptions and accommodations to refuse to provide certain preventive services under the ACA. Another would defund the Ryan White HIV/AIDS program, which provides a comprehensive system of HIV primary medical care, medications, and essential support services for low-income people with HIV. In terms of medical education, the bill supports eliminating abortion training for healthcare professionals. These laws will not only increase the already existing health disparities in the LGBTQ+ community but also restrict medical education and amplify biases that healthcare providers may already have.
Medical schools in the United States are not meeting their obligation to prepare future doctors to provide ethical care to LGBTQ+ patients. Previous studies have shown that most US medical schools only contain about five hours of content related to LGBTQ+ health. Studies have also found that this knowledge gap has led to physicians avoiding the treatment of LGBTQ+ patients or exhibiting bias against them. The inadequate curricula and subsequent bias against LGBTQ+ patients produce physicians who cannot uphold duties like beneficence, nonmaleficence, and duty to provide care. In light of the recent wave of anti-LGBTQ+ legislation, especially with regard to gender-affirming care, it is imperative that medical schools reassess their curricula to ensure proper training of future physicians. Institutions like the University of Louisville School of Medicine, Baylor College of Medicine, and Columbia University Vagelos College of Physicians and Surgeons have updated their curricula to include LGBTQ+ health. Some of the interventions these schools have explored include mandatory problem-based learning sessions, clinical elective options, and specific LGBTQ+ trainings. These innovations have had varying amounts of success in improving participating students’ attitudes, confidence, and knowledge regarding the health care needs of LGBTQ+ patients. But these curricular developments are a small step forward—researchers have found that the knowledge gap among medical students regarding the LGBTQ+ community and the disparities patients face is pervasive. It has been shown that medical students enter medical school with implicit or explicit bias against the LGBTQ+ community, and these are not fully addressed in mandatory training. We believe that medical schools should conduct needs assessments of their curriculum, identify gaps in LGBTQ+ knowledge, and institute lectures, PBLs, and OSCEs that integrate LGBTQ+ patients or their healthcare disparities into the learning.
Many of the interventions piloted at Louisville, Baylor, and Columbia were offered as electives for students. Sessions like these should be mandatory for all physicians-in-training. Taking a thorough history, showing respect for patients’ families and relationships, and ensuring patient comfort with a physical exam, are not niche professional interests. These competencies are essential to upholding beneficence and nonmaleficence. And while governments’ commitment to the rights of LGBTQ+ citizens may wax and wane, academic medicine’s commitment to the nonjudgmental care for all who need it must remain constant. A sincere dedication to this core tenet of medical ethics requires that medical students receive mandatory training and exposure to the LGBTQ+ community and the unique disparities patients may face.
Authors: Rachelle Monteau, Alexis Dickerson, Katherine Mendis
Affiliation: CUNY School of Medicine, New York, NY
Competing interests: None declared
Social media accounts of post authors:
Rachelle Monteau: X: @MonteauRachelle; LinkedIn: www.linkedin.com/in/rachelle-monteau-
Alexis Dickerson: LinkedIn: https://www.linkedin.com/in/alexis-dickerson-8364211a7/
Katherine Mendis social media: X: @katherinemendis