On the Front Lines

On the Front Lines 150 150 Anne FitzSimons

Pediatricians can reverse health disparities among the LGBT population.

A recent position paper from the American College of Physicians (ACP) examines health disparities experienced by the lesbian, gay, bisexual and transgender (LGBT) population in the United States and includes recommendations for improving access to care.

The ACP found that some policies and accompanying social stigma of LGBT persons has led to significant health disparities compared to the heterosexual population, including fewer physician visits, lower rates of preventative care and higher rates of mental illness.

“Pediatricians see not only LGBT teens but also the children of LGBT parents, so the report is impactful,” says Gayathri Chelvakumar, MD, who is a physician in Adolescent Medicine and the THRIVE program at Nationwide Children’s Hospital. The THRIVE program specializes in differences in sex development, complex urological conditions and gender concerns. Dr. Chelvakumar says pediatricians may find these ACP recommendations most useful:

The ACP encourages …. physicians’ offices and other medical facilities to adopt gender identity as part of their nondiscrimination and anti-harassment policies. Physicians and their staff should understand the difference between gender expression and gender identity. “Many people have never considered how gender can be defined. Education for all members of the health care team is important,” says Dr. Chelvakumar.

[The ACP] recommends that…health benefit plans include comprehensive transgender health care services…“Coverage of puberty suppressing hormones and transgender surgeries has improved recently so it’s helpful to know what coverage is available to better advocate for patients,” Dr. Chelvakumar says.

The definition of “family” should be inclusive of those who maintain an ongoing emotional relationship with a person, regardless of their legal or biological relationship. Dr. Chelvakumar notes that it is very important not to assume anything, and ask patients to clarify relationships at the beginning of the visit.

Medical schools, residency programs and continuing medical education programs should incorporate LGBT health issues into their curricula…. [and develop programs to] recruit LGBT persons into the practice of medicine. “Our understanding of LGBT medical needs is evolving rapidly,” says Dr. Chelvakumar. “If we don’t deliver accurate and relevant care – people will get it through illegal channels or not at all. Continuing to educate ourselves and our trainees on these topics is important to provide best level care.”

The ACP opposes the use of “conversion,” “reorientation” or “reparative” therapy. While there are still a few places across the nation that offer this type of service, the practice has been widely condemned by medical organizations.

Dr. Chelvakumar says the single most important step physicians can take is to create a safe, nonjudgmental environment for patients and families. This can be done in small ways with rainbow stickers, a visible nondiscrimination policy and posters that encourage respect for differences.



Daniel H, Butkus R for the Health and Public Policy Committee of the American College of Physicians. Lesbian, Gay, Bisexual, and Transgender Health Disparities: Executive Summary of a Policy Position Paper From the American College of Physicians. Annals of Internal Medicine. 2015 Jul 21;163:135-137.