Barriers to Optimal Care between Physicians and Lesbian, Gay, Bisexual, Transgender, and Questioning Adolescent Patients

Abstract

The objective of this article was to identify barriers to optimal care between physicians and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) adolescents. To this end, 464 anonymous, self-administered surveys were distributed in 2003 to residents and attending physicians in pediatrics, internal medicine, obstetrics-gynecology, psychiatry, emergency medicine, and family practice at Upstate Medical University. The survey included questions pertaining to practice, knowledge, and attitude pertaining to lesbian, gay, transgender, or questioning (LGBTQ) adolescents. One hundred eight four surveys were returned. The majority of physicians would not regularly discuss sexual orientation, sexual attraction, or gender identity while taking a sexual history from a sexually active adolescent. As well, the majority of physicians would not ask patients about sexual orientation if an adolescent presented with depression, suicidal thoughts, or had attempted suicide. If an adolescent stated that he or she was not sexually active, 41% of physicians reported that they would not ask additional sexual health-related questions. Only 57% agreed to an association between being a LGBTQ adolescent and suicide. The majority of physicians did not believe that they had all the skills they needed to address issues of sexual orientation with adolescents, and that sexual orientation should be addressed more often with these patients and in the course of training. This study concludes that barriers in providing optimal care for LGBTQ adolescents can be found with regard to practice, knowledge, and attitude regardless of medical field and other demographics collected. Opportunities exist to enhance care for LGBTQ adolescents.

KEYWORDS:

• physician
• sexual orientation
• gay
• lesbian
• bisexual
• transgender adolescents
• practice
• knowledge
• attitude

I would like to thank Jud Staller, MD, Wanda Fremont, MD, and the entire Psychiatry Department at Upstate Medical University for all their support, encouragement and guidance.

Notes

1. The use of the word significant throughout this article corresponds to a p < 0.05 by chi square test and likelihood ratio unless otherwise indicated. The significant differences seen among other respondent demographic were very few and had little to no impact on the overall conclusions of this study and therefore, were excluded from the results.