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Building Bridges in Healthcare: Equipping Our Team for Inclusive Patient Care

By: Dr. Cynthia Horner, Chief Medical Officer, Amwell

Amwell is on a mission to improve the healthcare experience for all. As part of this effort, we are committed to continuous education to ensure we can enable our clients and our teams to provide inclusive and equitable care to all people, and we work to emulate that commitment within our own employee population as well.  

In honor of Pride Month, we’re spotlighting our partnership with The Fenway Institute, which works to optimize health and well-being for sexual and gender minorities and provides education, training, and technical assistance across the U.S. and Puerto Rico. Amwell Medical Group (AMG) leverages the Fenway Institute and its expertise to train its network of providers and clinicians on the best ways to provide care to the LGBTQIA+ population. 

Practicing inclusive healthcare isn’t just the right thing to do; it can be the difference between life and death in some cases. At Amwell, we know, and research confirms, that LGBTQIA+ people experience significant unique health needs. According to KFF, LGBTQIA+ people are more likely to be in fair or poor health than non-LGBTQIA+ people despite being a younger population overall. Additionally, there is a higher prevalence of mental health problems among the LGBTQIA+ population, which can manifest into a lack of self-care, and decreased engagement in primary care, leading to more serious health conditions later.

Sexual and Gender Minority Health Framework

Ultimately, it’s paramount to understand the unique health needs of this community and how they may evolve so we can ensure all patients can experience the highest quality of care. This also applies to the terminology and language we use when addressing LGBTQIA+ patients, which is continuously changing. Pronouns are foundational to building a safe, inclusive, affirming care environment for trans and gender-diverse patients, so it's important clinicians continue to educate themselves on the evolving language. 

As we think about providing inclusive care to the LGBTQIA+ community, there are a few important best practices to remember:  

  • Always ask. At the start of all visits, clinicians should systematically and sensitively ask patients for their preferred pronouns, their gender identity and gender at birth.  When you ask a patient how they identify, you can then “mirror” their language back to them. Studies have shown that patients are happy to answer these questions. Don’t worry about being rude or offending someone. As Dr. Alex Keuroghlian, Associate Director of the Division of Education and Training at The Fenway Institute says, “The rudest thing we can do is not collect this critical health-related information and end up with a really unfortunate adverse health outcome.” While you always want to refer to a patient in their preferred manner, it’s important to also know a patient’s legal name as that’s often what is used for insurance. 

  • Have a process grounded in cultural humility. Clinicians should start visits by introducing themselves and their pronouns. This signals that we aren’t making assumptions and normalizes the process of sharing pronouns, helping patients to feel empowered to do so as well. It's important for clinicians to document a patient’s pronouns in their chart so other people at the practice are aware and patients don’t have to repeat themselves.

  • Understand the stress and vulnerability that can be present, especially during healthcare interactions. The external stress that can be present during gender or sexual exploration can contribute to internal stigma-related stress, like internalized transphobia or expecting rejection because that’s what a patient is accustomed to. All clinicians need to understand this, and approach every care interaction with sensitivity, inclusion and openness.  

Healthcare providers are responsible for creating safe environments for all patients, including those engaged in gender identity exploration, discovery and self-acceptance. Amwell wholeheartedly believes this and is proud to partner with The Fenway Institute to provide ongoing training to our AMG provider network to support them in delivering high-quality care to LGBTQIA+ people. Specifically, these trainings ensure that AMG providers are: 

  • Understand LGBTQIA+ concepts, terminology, and health considerations, Amwell’s policies regarding sexual orientation and gender identity, and workplace expectations to value diversity, equity, inclusion and justice; 
  • Equipped to deliver telehealth-appropriate, high-quality and culturally responsive health care for LGBTQIA+ patients in a welcoming and inclusive environment; 
  • Prepared to facilitate engagement and open communication with patients, staff, and key stakeholders. 

So far, we have delivered four live training sessions for our AMG providers in partnership with The Fenway Institute. We will continue with more of these education sessions later this year to further our commitment to ensuring that LGBTQIA+ patients have positive, affirming, and healthful experiences.