Disrespectful healthcare experience affects 33% of LGBT patients

April 04, 2024 - A third of LGBT adult patients said they’ve had disrespectful healthcare experiences, a rate that’s double that for adults who do not identify as LGBT and should be a cause for concern for healthcare providers, according to KFF, which conducted and published the survey data.

LGBT adults were also more likely than their counterparts to report that their provider assumed something about them without asking (40% versus 17%), suggested they were personally to blame for a healthcare problem (32% versus 15%), or ignored a direct request or question they asked (32% versus 14%).

These figures are staggering, Drew Altman, KFF’s president and CEO, said in a press release.

“There is no good reason twice as many LGBT adults should be reporting being treated poorly by the health system compared to non-LGBT adults,” Altman asserted. “Health professionals and health care institutions need to take a hard look at these data and themselves.”

Notably, there was some intersection between race and LGBT identity, the data showed. While similar proportions of LGBT patients of any race reported experiences with healthcare discrimination, LGBT patients of color were more likely to attribute that disrespect to their race compared to other factors, including their sexual orientation/gender identity.

Experiences of disrespect or discrimination carry with them some serious consequences, the survey data furthered. For nearly four in 10 (39%), a negative healthcare experience made them less likely to seek care, while 36 percent said it made them switch healthcare providers, and 24 percent said their health status deteriorated.

Others reported that they adopt different behaviors to avoid discrimination in the healthcare setting. For example, 55 percent said they are very careful about their appearance in order to be treated fairly, while 38 percent said they try to prepare for insults from their providers. Six in 10 said they do either of those behaviors at least some of the time.

LGBT adults were also less likely to ask their providers questions, potentially to avoid friction during the healthcare encounter. While 50 percent of LGBT patients said they felt very comfortable asking their clinician a question, 67 percent of folks who are not LGBT said the same.

Meanwhile, 9 percent of LGBT adults said they did not feel very comfortable asking their providers questions, which is almost double the proportion for adults who are not LGBT.

Despite all of this, most LGBT patients said they have good interactions with their healthcare providers at least most of the time. Eight in 10 (81%) said their providers explained things in a way they could understand, while the same proportion said their providers understood and respected their cultural values. Three-quarters said their providers engaged them in shared decision-making, and 70 percent felt that their providers spent enough time with them during their visits.

Few patients noted that their providers screened them for social determinants of health or asked about their employment, housing situations, and access to food or transportation. This comes as the KFF survey data showed that LGBT adults are more likely to experience certain SDOH ranging from stress about work or employment to politics, meeting their families’ basic needs, and exposure to violence.

LGBT adults are also more likely to experience homelessness than their counterparts, coming in at 22 percent and 11 percent, respectively.

These findings from KFF corroborate what other surveys have reported. In February 2024, the National Center for Transgender Equality (NCTE) published its US Transgender Survey based on responses in 2022, showing that healthcare is somewhat failing transgender patient populations. Around a quarter (28%) of respondents said they’d skipped necessary medical care out of fear of mistreatment from providers.

That fear of mistreatment isn’t exactly unfounded based on further responses.

Of those who’d seen a healthcare provider within the previous 12 months, 48 percent said they’d had at least one negative experience because they are transgender. Negative experiences included being refused healthcare, being misgendered, having a provider use harsh or abusive language when treating them, or having a provider be physically rough or abusive when treating them.

There is a moral obligation to provide equitable care for all patients regardless of sexual orientation/gender identity, but as noted above, there are also financial consequences as these patients skip care to avoid mistreatment.

Healthcare organizations should work to improve cultural competence and raise awareness around implicit bias while also providing continuing medical education opportunities for providing LGBTQ-specific medical care, including gender-affirming care.