Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) persons and communities encompass all races and ethnicities, religions, and social classes. They exist in every corner of the world and deserve the same rights and privileges as any of our other patients. However, laws and regulations continue to undermine their personhood and threaten their daily and long-term well-being. Preceding the 2022 SGIM Annual Meeting in Orlando, Florida, Governor Ron DeSantis signed House Bill 1557, the Parental Rights in Education Act commonly known as the “Don’t Say Gay” bill. This and similar laws target LGBTQ+ youth by prohibiting classroom discussion about sexual orientation or gender identity and eliminating any opportunity for youth to seek support in schools related to sexual orientation or gender identity. Further, these laws put LGBTQ+ youth at risk by requiring school officials to inform parents of when youth come out at school. These laws not only restrict freedom of speech but also remove the autonomy of youth and can have long-standing detrimental effects on their mental and physical health. Our concern is that the reach of sweeping policies, such as HB 1557, extends beyond the borders of an individual state. For example, when gay marriage was legalized at the federal level, there was a reduction in high school student suicide attempts. This reduction was most profound among sexual minority students, but the trend was notable in all students.1 Adolescence is a critical period of identity building. Allowing youth to explore their identity in an inclusive and accepting environment can only benefit them. The message should be, “you are loved, no matter who you turn out to be.” Further, limiting discussion of sexual orientation and gender identity worsens stigma against LGBTQ+ people, which can result in physical and mental health consequences. Being told that one’s identity can harm others, to the point that it cannot be spoken out loud, represents a clear attack on these already vulnerable communities.
The 2022 Annual SGIM Meeting was scheduled to take place in Orlando, Florida, just one month after Governor DeSantis signed HB 1557. Thus, many SGIM members immediately began grassroots organizing to show their support for LGBTQ+ youth, families, and communities in Florida and beyond. Under the leadership of Drs. Marshal Fleurant, Jenny Siegel, and Chris Terndrup, a coalition of the LGBTQ+ Interest Group, the Health Equity Commission, and the Health Policy Commission was formed to rapidly prepare more public responses during the 2022 SGIM Annual Meeting. The efforts of hundreds of SGIM members culminated in a massive public demonstration following the Friday plenary session in which hundreds of SGIM members showed up and demanded LGBTQ+ youth and their peers be afforded the protections and right to a safe learning environment. These efforts, while covered by local news media, are only one of many steps in taking action to ensure LGBTQ+ youth, families, and communities are allowed to not only survive, but thrive.
As general internists, our advocacy for patients cannot end at the exam room door or hospital entrance. We must leverage our privilege and power to inform policies that affect individual and population health. While more than a dozen other states consider similar harmful laws, we are called to the streets and legislative chambers to stand with and fight for our colleagues, patients, and communities.2 The following are recommendations on ways each of us can work to protect LGBTQ+ people.
- Understand the current and historical health disparities experienced by LGBTQ+ people
- Leverage your privilege and resources to advocate for laws which protect LGBTQ+ people
- Examine your own implicit biases and assumptions
- Support organizations supporting LGBTQ+ rights such as the Human Rights Campaign
- Include your pronouns when you introduce yourself to new patients, and ask each patient for theirs; share them in e-mail signatures
- Ask open-ended questions and use gender-inclusive language (e.g., partner or spouse)
- Partner with local and national organizations to advance protections for LGBTQ+ people
- Engage with local community organizations, outreach to local schools/communities for health education
- Build a coalition within your organization to enact policies which protect LGBTQ+ people and their partners and families
- Form a patient and family advisory council comprised of LGBTQ+ community members to solicit feedback on making your clinic a more welcoming space
- Routinely asking patients regarding sexual orientation and gender identity (SOGI) on intake forms, and ensure forms use inclusive or gender-neutral language
- Openly display non-discrimination statements
- Ensure posters, flyers, and brochures are inclusive of LGBTQ+ people
- Advocate for documentation in Electronic Health Record which acknowledges sexual orientation and gender identity and prioritizes usage of correct name
- Advance quality improvement with an equity lens through inclusion of sexual orientation and gender identity
- Work with medical educators to integrate LGBTQ+ topics throughout medical training using the Association of American Medical Colleges (AAMC) Advisory Committee on Sexual Orientation, Gender Identity and Sex Development’s guide: Implementing Curricular and Institutional Climate Changes to Improve Heath Care for Individuals Who are LGBT, Gender Nonconforming, or Born with DSD3
- Advocate for the elimination of regressive laws that cause harm and propagate stigma
- Enact protections for marginalized populations such as gender-neutral restrooms in public spaces, anti-bullying laws, anti-discrimination in housing and employment laws
- Advocate for enhanced training for law enforcement
- Support laws requiring inclusion of gender affirming care as standard part of insurance coverage including gender affirming surgery
- Ensure access to necessary care across the lifespan, including gender-affirming care
- Inclusion of SOGI in registries/other large databases (e.g., SEERS, CAHPS, etc.)
- Advocate for the inclusion of LGBTQ+ Health topics in LCME/ACGME requirements
We recognize that some of these steps are small and some of them are large. Some can be done in an afternoon while others will take months of coalition-building and advocacy to reach fruition. Many will require the support of institutional leadership to make a reality, and engaging stakeholders at multiple levels will be a crucial step to make progress. But these harmful policies affect us personally and professionally—namely, our families and friends and the health and safety of our patients. Stand up, walk out, speak up. Take a stand with us.
As SGIM members step away from our meeting on Discovery, Equity and Impact, we encourage all to consider these steps as crucial to all dimensions of your careers in General Internal Medicine. Through new research and education approaches, through advocacy at local, state, and national levels, and by advancing the future of health care for LGBTQ+ communities, we can maintain the energy from our meeting in Orlando and create sustainable change in health care.
- Raifman J, Moscoe E, Austin SB, et al. Difference-in-Differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts. JAMA Pediatr. 2017 Apr 1;171(4):350-356. doi: 10.1001/jamapediatrics.2016.4529.
- Franklin J. Not just Florida. More than a dozen states propose so-called, “Don’t Say Gay Bill.” NPR. https://www.npr.org/2022/04/10/1091543359/15-states-dont-say-gay-anti-transgender-bills. Published April 10, 2022. Accessed May 15, 2022.
- Association of American Medical Colleges. Implementing Curricular and Institutional Climate Changes to Improve Healthcare for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD: A Resource for Medical Educators. Washington, DC: AAMC; 2014.
Advocacy, Health Equity, Medical Education, Medical Ethics, SGIM, Social Justice
Dr. Streed (firstname.lastname@example.org) is an assistant professor of medicine in the Section of General Internal Medicine at Boston University School of Medicine and research lead of the Center for Transgender Medicine and Surgery at Boston Medical Center. Dr. Nall (Ryan.Nall@medicine.ufl.edu) is an associate professor of medicine in the Division of General Internal Medicine at the University of Florida College of Medicine and associate director of the James H. Free Center for Primary Care Education and Innovation. Dr. Loeb (email@example.com) is an associate professor of medicine at University of Colorado School of Medicine, co-lead of Research and lead of the Community Advisory Board for the University of Colorado Gender Diversity Programs. Dr. Hedian (firstname.lastname@example.org) is an assistant professor of medicine at the Johns Hopkins University School of Medicine and the director of clinical education at the Johns Hopkins Center for Transgender Health. Dr. Terndrup (email@example.com) is an assistant professor of medicine at Oregon Health and Science University and co-chair of the SGIM LGBTQ Health Interest Group.
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