Impact of physicians' unconscious attitudes toward disabled and LGBT patients

Physicians' unconscious attitudes toward special patient populations like disabled and LGBT patients may be partially responsible for poorer overall health observed in these communities, according to a Rowan University professor of family medicine.

Physicians' reluctance to discuss disabilities, sex, work and independence with disabled patients, who comprise nearly 20 percent of Americans, deprives patients of high quality care by leaving important health concerns unaddressed, said Joshua Coren, DO. Primary care providers frequently fail to discuss contraception, sexually transmitted diseases, emotional health and basic wellness concerns like diet, exercise, smoking and alcohol use with patients who have disabilities, Dr. Coren added.

"The statistics make a very compelling case that as osteopathic physicians, we need to overcome our subconscious perceptions and make sure we see every patient as a whole person, particularly when they are living with a disability. Disabled individuals have sex, use alcohol and drugs, over eat and under exercise like other populations, yet their doctors tend to avoid those topics," Dr. Coren said.

While more commonly recognized, attitudes toward LGBT patients require physicians to examine their own behavior for unintentional biases. The LGBT population faces different challenges, primarily cultural attitudes that favor heterosexuals. Multiple studies have shown that homophobia and heterosexism occur in the practice of medicine and give rise to substandard assessment and treatment of medical problems in LGBT patients.

LGBT Affirmative Physician Attitudes

• Don't automatically assume that a patient is heterosexual

• Adopt the belief that homophobia--not sexual orientation-- is the problem

• Accept that a gay, lesbian, bisexual, or transgendered identity is a positive outcome

• Work with patients to decrease internalized homophobia to help them achieve a positive identity

• Have basic knowledge about human sexuality

• Deal with one's homophobia and heterosexist bias if it occurs

Failure to address unconscious biases decreases the physician's ability to prevent disease, which is a basic tenet of osteopathic medicine. Prevention is also a primary concern for LGBT populations, which disproportionately experience social and behavioral risk factors, including higher rates of smoking, alcohol use and depression. Physicians, particularly those with strong religious convictions, are encouraged to examine their belief systems closely and monitor their own behavior for negative reactions to LGBT patients.

Dr. Coren will present his recommendations at OMED 15¸ the annual medical conference for osteopathic physicians (DOs), to be held October 17-21 in Orlando.