Improving the Critical Care Experience of LGBTQ Patients and Families

Kimberly D. Acquaviva, PhD, MSW, CSE

When a critically ill or injured person needs the services of a critical care team, they are at their most vulnerable. Their life is in the hands of a group of healthcare professionals they have probably never met before. They may not have the ability to ask questions, express their wishes, or register a complaint about the way they are being treated. Even if they are able to speak, they may feel voiceless.

For lesbian, gay, bisexual, transgender, gender-nonconforming, queer, and/or questioning (LGBTQ) people, that feeling of voicelessness may be compounded by fears of discrimination. Those fears are not unfounded. In 29 states, there are no public accommodation nondiscrimination laws preventing hospitals from discriminating against patients based on sexual orientation or gender identity.¹

However, you do not have to change the nondiscrimination laws in your state before you can make a difference in the lives of LGBTQ patients and families. Here are six simple strategies that trained intensivists and critical care specialists can use to improve the critical care experience of the LGBTQ patients and families they serve:

1. Educate yourself about the differences between sex, gender, gender identity, gender expression, sexual orientation, and sexual behavior. Even if you think you already understand each of these concepts, take a few minutes to review them. I have posted free, easy-tounderstand infographics on my website: www.kimberly-acquaviva.com 

2. Ask every conscious and communicative patient these
seven questions during the intake process:

• What name would you like me to call you?
• What sex were you assigned at birth?
• What gender do you identify as now?
• What pronouns would you like us to use when we refer to you (e.g. she/her, he/him, they/their, ze/hir)?
• Who are the people you consider to be your family?
• What information would you like me to share with ____________ about your illness, condition, and/or care?
• What information would you not like me to share with them?

3. If your hospital’s intake form and/or electronic health record does not have space for you to document these questions and answers, advocate persistently and politely to change the form. In the best hospitals, forms and fields do not drive care; care needs drive forms and fields. While you are pushing to change the form, keep asking the seven questions listed above. These questions—and their answers—are key to providing quality care to any patient, regardless of gender identity or sexual orientation.

4. Have a conversation with every conscious and communicative patient about their wishes and advance directives. If a patient (of any gender or sexual orientation) says they would like their spouse, wife, or husband to make decisions for them should the patient become unable to make their own decisions, follow up in a gentle, nonjudgmental way. For instance, you might say: “I want to make sure you have the documents you need to protect your right to involve [individual’s name] in your care. Sometimes couples choose to formalize their relationship through a legally recognized process such as a marriage or domestic partnership. If you haven’t done that, don’t worry—there are easy ways I can help you put things in writing if you choose to, so that [individual’s name] or someone else can act on your behalf if need be.”²

5. Find your hospital’s nondiscrimination statement on its website. Does it include the phrases “gender identity” and “sexual orientation”? If it does not, LGBTQ patients and families will not—and should not—feel safe seeking out your services. Advocate to revise the nondiscrimination statement so that LGBTQ patients and families know you are committed to providing them with the same high-quality care you provide to other patients and families.

6. Finally, work as hard to master the use of genderneutral pronouns as you worked to master pathophysiology. If a patient wants you to use “ze” and “zir” in referring to them, do it. It takes practice but the effort is worthwhile. Your patient wants to be seen and respected; using the right pronouns is a powerful way to convey both to them.

As you implement these six strategies to improve the critical care experience of the LGBTQ patients and families you serve, remember that providing LGBTQ-inclusive care is an ongoing process. There will always be more that you and your hospital can do to strengthen your service to LGBTQ patients and families. A great way to jump-start your hospital toward providing the best care possible to LGBTQ patients and families is through participation innthe Healthcare Equality Index (HEI). You can learn more about HEI and its scoring criteria for hospitals at:hrc.org

Editor’s Note: ze, hir, and zir are gender-neutral pronouns.​

References
1. Movement Advancement Project. Non-Discrimination Laws. http://www.lgbtmap.org/equality-maps/non_discrimination_laws​. Accessed July 5, 2017.
2. Acquaviva KD. LGBTQ-Inclusive Hospice and Palliative Care: A Practical Guide to Transforming Professional Practice. New York, NY: Harrington Park Press; 2017.