When lesbian, gay, bisexual, transgender (LGBT) patients seek medical care, they may find healthcare settings uncomfortable or unsafe. Doctors can help patients who are in the sexual minority feel more welcome in a variety of ways, from waiting room design to the ways they talk to their patients.

“There is a long history of bias in healthcare in the United States against LGBT people and there are also significant healthcare disparities in these populations,” said Caroline Hill, a social worker at the UCSF Benioff Children’s Hospital rheumatology clinic.

Hill and Dr. Barbara Snyder, chief of the adolescent medicine division at Rutgers’ Robert Wood Johnson Medical School, spoke at the 2016 ACR Annual Meeting in Washington, D.C., on a panel titled “Treating Us Right: Lesbian, Gay, Bisexual, Transgender Considerations.”

Although the United States has come a long way since homosexuality was listed by the medical community as a disease, there is still a lot of work to be done, according to Dr. Snyder. “Many of us may not realize how pervasive the heterosexual bias is in the healthcare system,” she said. “The effects of long-standing stigmatization of sexual minorities can lead to barriers to care and risk factors for poor health outcomes”

When Hill asked attendees, including physicians, nurses and other health professionals, how many were trained in school about LGBT health, no one raised a hand. A 2011 study of more than 150 medical schools found the median time devoted to LGBT issues was five hours, Hill noted.

In a video that Hill showed, a patient said, “You don’t want to go into a clinic and then have to educate your own doctor.”

Both Hill and Dr. Snyder addressed a number of health challenges facing LGBT patients. Those who experience homophobia may internalize that hatred, which could lead to lower senses of self-worth, substance abuse, risky behavior, shame or even suicide, Dr. Snyder said.

A key recommendation for doctors was that the only way to know which gender patients identify with is to ask.

“When you think about a clinic visit for your patients, I encourage all of you to think really broadly, from the point at which your patient walks through the door to the time they leave,” Hill said.

She advised doctors to place signage in their waiting rooms that convey support or allegiance. “Basically anything rainbow will get the point across, even if it’s tiny,” she said. “You don’t have to be an expert on LGBTQ issues to provide sensitive and respectful care to people in these populations.”