CME: Improving ED Care for LGBT Patients

CME: Improving ED Care for LGBT Patients
Author Information (click to view)

Sara Jalali, MD

Sara Jalali, MD}
Attending Physician, Emergency Department
University of Maryland Upper Chesapeake Medical Center

Sara Jalali, MD, has indicated to Physician’s Weekly that she has or has had no financial interests to report.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:


  • Discuss strategies for improving emergency department care for lesbian, gay, bisexual, and transgender (LGBT) patients.
  • Review legal issues, healthcare considerations, and current educational practices pertaining to the LGBT community.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at

Credit Available(click to view)


CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.


AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Sara Jalali, MD
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.


Sara Jalali, MD (click to view)

Sara Jalali, MD

Sara Jalali, MD}
Attending Physician, Emergency Department
University of Maryland Upper Chesapeake Medical Center

Sara Jalali, MD, has indicated to Physician’s Weekly that she has or has had no financial interests to report.

Many lesbian, gay, bisexual, and transgender (LGBT) patients face barriers to accessing adequate medical care, even for emergency situations. A better understanding of the disparities and healthcare risks that LGBT patients face may help emergency providers communicate more effectively with these individuals.

As the patient census has become increasingly diverse, it has become more challenging for EDs to provide quality care in emergency situations. Studies show that marginalized populations face greater social inequalities and healthcare disparities, placing them at higher risk for diseases and death. One patient group that is not immune to these disparities is the lesbian, gay, bisexual, and transgender (LGBT) community. Approximately 9 million people in the United States identify themselves as LGBT.

“It’s important for emergency physicians to better understand the disparities and health risks that LGBT patients face in order to communicate more effectively with these individuals,” says Sara Jalali, MD. “An inherent challenge with treating this patient population is that sexual orientation and gender identity are not always evident. In many cases, patients hide this information from their healthcare providers for fear of discrimination. Compounding the issue is that there are few universal standards that are specifically applicable to LGBT health education. Healthcare providers are often poorly prepared to care for this at-risk population, which in turn can result in distrust and avoidance in seeking prompt medical care.”

In Annals of Emergency Medicine, Dr. Jalali and Lauren M. Sauer, MS, had an article published that outlined strategies for improving care for LGBT patients in the ED. It discusses legal issues, healthcare considerations, and current educational practices pertaining to the LGBT community. The article also provides several tips for improving the care of LGBT patients (Table) and communicating more effectively with the LGBT community as a whole as well as transgender patients.


Legal Issues

From a legal standpoint, the laws pertaining to LGBT healthcare rights are complex and vary from state to state. Some facilities are incorporating LGBT-inclusive non-discriminatory policies, but many EDs still do not have explicit regulations in place. “To optimize care for LGBT patients, emergency providers should be informed about their state’s laws and hospital policies,” says Dr. Jalali. Clinicians should also learn about national laws and regulations so that patients are not deprived of support from their loved ones.


Healthcare Considerations

Social stigma, discrimination, homophobia, and transphobia are some of the factors that the LGBT may experience that can negatively affect their quality of life, influence their access health insurance, and impact their health behavioral choices. “There are specific healthcare risks that LGBT patients face,” says Dr. Jalali. While some progress has been made thanks to the Affordable Care Act (ACA), many states deny coverage for transgender patients seeking services related to sex changes. In addition, the ACA does not change biases among healthcare providers or ensure the quality of care.

An important factor to consider is that the LGBT community may have a heightened awareness of discriminatory behaviors from healthcare providers, even when intentions are positive. Small things like poor eye contact, infrequent follow-up care, or awkward body language may be interpreted as healthcare provider discomfort or discrimination. Some patients may avoid the ED because of these instances. “ED providers can’t make assumptions about the LGBT community,” adds Dr. Jalali. “Increased knowledge of healthcare barriers and evaluation of self-biases can help emergency providers positively change the care and outcomes of LGBT patients.”


Educational Practices

Many medical schools are behind the curve with regard to incorporating LGBT healthcare education into standard medical curricula. “Some schools teach students to ask sensitive social history questions, but many do not teach them the differences between behavior and sexual identity,” Dr. Jalali says. “In many places, there is no educational standard for teaching students how to incorporate sexual history with other aspects of patient evaluations, such as sensitivity during physical examinations.”


Resources Available

The Association of American Medical Colleges has published a comprehensive guide to address the needs of LGBT education in the healthcare system. Available for free at, this tool educates clinicians about the health needs of LGBT people, offers guidance for integrating this material into a curriculum, and assesses learner competency to determine effectiveness of change. As more institutions adopt these changes, new physicians entering residencies will be better prepared to treat LGBT patients.

The Accreditation Council for Graduate Medical Education does not currently include LGBT-related education in the emergency medicine curriculum, but residencies can benefit from having access to LGBT healthcare educational resources. The material can be presented as lectures on LGBT health in the ED or tied into various emergency medicine–related topics. Emergency medicine programs could also consider inviting expert speakers for additional education and develop methods for evaluating the effect of this education. Legislation is also supporting the notion of including sexual orientation and gender into electronic health records in order to reduce invisibility of the LGBT community.

“We need to enhance our advocacy efforts and enact effective educational curricular reform,” says Dr. Jalali. “Only then will emergency providers have the appropriate skills and empathy to help LGBT patients whenever they seek medical care.”

Readings & Resources (click to view)

Jalali S, Sauer LM. Improving care for lesbian, gay, bisexual, and transgender patients in the emergency department. Ann Emerg Med. 2015;66:417-423. Available at:

Moll J, Krieger P, Moreno-Walton L, et al. The prevalence of lesbian, gay, bisexual, and transgender health education and training in emergency medicine residency programs: what do we know? Acad Emerg Med. 2014;21:608-611.

Kosenko K, Rintamaki L, Raney S, et al. Transgender patient perceptions of stigma in health care contexts. Med Care. 2013;51:819-822.

Kelley L, Chou CL, Dibble SL, et al. A critical intervention in lesbian, gay, bisexual, and transgender health: knowledge and attitude outcomes among second-year medical students. Teach Learn Med. 2008;20:248-253.

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