They’ve partnered to guide patients to doctors and providers offering affirming care. Dustin Nowaskie of OutCare Health talks about the need to offer better care for LGBTQ+ communities.
Many members of LGBTQ+ communities don’t trust doctors, hospitals, or the health system in general.
Many LGBTQ+ individuals haven’t seen doctors for years because they expect they’ll be treated poorly, says Dustin Nowaskie, president and founder of OutCare Health.
“There is a huge body of research that has shown that many LGBTQ+ people avoid going to providers and to health systems, because of the past experiences that they've had, or the past experiences that they're hearing from their fellow LGBTQ+ friends and families and colleagues,” Nowaskie says.
“I can tell you from my own clinical experience, as a provider, I get this feedback from my patients all the time … I have had several patients tell me that I'm the first provider that they've seen in over 20 years, because of something that negatively impacted them from another provider 20 years ago,” says Nowaskie, a psychiatrist.
Now, Healthgrades is teaming up with OutCare Health to make it easier for the LGBTQ+ communities to find providers they can see with confidence. Healthgrades has launched a new LGBTQ+ “Affirming Care Designation” on its website. Healthgrades is incorporating OutCare Health’s “Outlist,” a directory of more than 3,500 LGBTQ+ affirming providers.
Nowaskie says the partnership with Healthgrades can be a valuable step in getting more people access to care.
In an interview with Chief Healthcare Executive®, Nowaskie discusses the need to offer better care to LGBTQ+ patients, the need for more education for providers to deliver affirming care and how health systems can better serve their LGBTQ+ patients and employees.
(See part of our conversation with Dustin Nowaskie of OutCare Health in this video. The story continues below.)
‘Distrust and dissatisfaction’
LGBTQ+ patients have long had apprehension about the healthcare system, and many of those concerns have been well founded, Nowaskie says.
“The level of distrust and dissatisfaction is pervasive across the entire ecosystem of healthcare,” Nowaskie says. “We know that for a very long time, there has been a lot of distrust in providers and specialists.”
Just over half (54%) of LGBTQ+ patients trust primary care physicians, compared to 70% of heterosexual patients, according to the Healthgrades/Outcare Health survey. In addition, only 16% of LGBTQ+ patients trust pharmaceutical companies, while 15% trust insurance companies.
“It's very obvious to me, these systems have not validated LGBTQ+ identities,” Nowaskie says. “They have not represented their LGBTQ+ employees. They're not talking about their LGBTQ+ members and their patients. And unfortunately, LGBTQ+ people know that they do not feel heard, they do not feel represented or validated.”
The Human Rights Campaign has declared a “state of emergency” for LGBTQ+ individuals in the United States, pointing to dozens of discriminatory measures that have been signed into law across the country. Nowaskie calls it a public health crisis.
“The disparities within LGBTQ+ people are not going down,” Nowaskie says. “And in many instances, they are actually going up.”
Because some LGBTQ+ individuals have avoided going to doctors for years, they are delaying treatment for some conditions or health issues that could have been addressed earlier.
“Many LGBTQ+ people do not get annual routine check-ups. And often they delay care for many, many years,” Nowaskie says.
Ask the questions
Many healthcare providers haven’t received any training or education in serving LGBTQ+ patients. Doctors and clinicians who want to be affirming should take the time to engage in training, Nowaskie says.
While LGBTQ+ providers understandably may have an easier time connecting with the sexual or gender diverse population, heterosexual physicians can be affirming providers if they make the effort, Nowaskie says.
However, Nowaskie says it’s important to understand “it is a longitudinal journey.”
“By no means can someone be affirming for any type of healthcare with a one-and-done training,” Nowaskie says.
“It requires a very long process of routine and updated education,” Nowaskie says. “Some of our research actually shows that a provider probably needs in the range of 40 to 50 hours, minimal, of LGBTQ+ education.”
For providers who want to build trust with LGBTQ+ patients and help them be more comfortable in talking about their health, Nowaskie says, “The best piece of advice I'd give is practice, practice, practice.”
A psychiatrist, Nowaskie asks patients how they like to be addressed and what pronouns they prefer. Nowaskie also asks non-judgmental, open-ended questions with gender-neutral language, inviting patients to talk about themselves and their lives.
“You create this very micro-environment of comfortability, and it's a great way to build rapport,” Nowaskie says. “And what you'll find for LGBTQ+ people is that they want to be asked these questions. They feel extremely empowered to talk about their identities when someone asks it in a very affirming way.”
Some providers may feel uncomfortable asking questions, but LGBTQ+ patients may be more open to sharing than they expect.
“LGBTQ+ people want to be asked,” Nowaskie says. “It's part of who they are as people, it's their identities, it's what they care about. It's how they navigate the world and their spaces.”
“More often than not, they want to deliver this information because it's very meaningful for them,” Nowaskie says.
Integrating LGBTQ+ care
Many health systems are making diversity, equity, and inclusion a high priority. Nowaskie says some efforts regarding LGBTQ+ communities are fragmented, or relegated to June, which is “Pride month,” but don’t continue throughout the year.
If health systems want to improve care for LGBTQ+ patients, they need to make it an ongoing commitment, Nowaskie says.
Hospital and health system executives need to be involved in those efforts.
“LGBTQ+ people represent everyone,” Nowaskie says. “They represent all identities. They represent all conditions, all health outcomes, and so you should always, always, always be integrating LGBTQ+ care in every single effort that you do as a hospital system. It is not a separate special topic.”
Health systems must consider the entire patient journey.
“It's not just the healthcare workers themselves,” Nowaskie says. “It's actually everything. It's the physical location. It's the building, it's the safety in and outside of the hospital and outside of the clinic. So you really do have to talk about the entire journey from someone's home, all the way to the actual healthcare institution, or organization.”
Health systems should think about how patients enter the facility and how they are greeted, and how they feel during and after the visits. Providers and staff need to use preferred pronouns and greet patients in a welcoming way.
Hospitals also need to engage in ongoing training, Nowaskie says.
“For health systems especially, training and education goes a very long way, but not just for provider training,” Nowaskie says.
“Providers absolutely need the training,” Nowaskie adds. “But all staff need trained people at the front desk, people making calls, nurses, social workers, people that are helping take vitals, everyone needs to be trained … Now, providers probably need a little bit more in-depth training in terms of clinical training, but everyone needs the foundations.”