The Importance of LGBT Training for Emergency Physicians Taking Care of Veterans

Abstract

We applaud the recent article by Moll et al.,1 highlighting an important issue regarding the training of emergency medicine (EM) residents on issues related to the care of lesbian, gay, bisexual, and transgendered (LGBT) patients. Gaps in training will ultimately lead to a lack of understanding of the unique health issues related to the LGBT population. The results of their survey indicate that further efforts are necessary to increase the number of residents receiving this education.We would also like to highlight the importance of this training for the emergency physicians who will take care of the veteran population in the United States. In 2011, a survey of 120 Veterans Health Administration (VHA) emergency departments (EDs) revealed that 7.5% had rotating residents training in EM, and this number will likely increase.2 Gender identity disorder (GID) prevalence in the VHA is higher (22.9 per 100,000 persons) than in the general U.S. population (4.3 per 100,000 persons). In addition, the prevalence of GID diagnosis has nearly doubled over 10 years among VHA veterans.3 Emergency physicians are often a patient's first encounter with the health care system, and the experience in the ED may directly affect future engagement in health maintenance and long-term continuity of care. A recent survey of LGBT veterans demonstrated that approximately two-thirds were not asked about sexual orientation by their VHA health care providers. 4 In another survey, approximately 25% of sexual minority veterans avoided some aspect of VHA care because of concerns of stigma.5 If patients feel accepted in their ED experiences, the likelihood for successful linkage to preventive and follow-up care is increased. An excellent impression of the ED's sensitivity, inclusivity, and knowledge of the LGBT community will hopefully change previous negative perceptions of health care. The environment of acceptance in the ED rests not only on the physical environment (e.g., posters, privacy), but also on staff exhibiting appropriate behavior and significant knowledge.We agree with the importance of LGBT health education and training in EM residency programs. In light of the information provided above, we would also like to emphasize the importance of expanding this to the veteran population obtaining care in both VHA and non-VHA EDs.