Chapter 3.
Accepting Care of LGBTQIA Patients: A Clinical Perspective

Michael A Greene, MD

Program Director, Creighton University Department of FamilyMedicine

In the longitudinal care of any patient, there are four principles and one attitude that are helpful in establishing the healing therapeutic provider-patient relationship that is foundational for primary care. These principles acted upon by an experienced clinician -well versed in navigating the sometimes turbulent waters of any committed human relationship, have the capacity to grow both the patient and provider in their respective self-actualization. Having a meaningful relationship with a primary care provider and the opportunities that arise from that can provide healing to person wounded by the inadvertent word or deliberate action. The attitude opens the space for the healing to occur as long as the patient feels safe and motivated to step into it. These four principles together and one attitude together act in synchrony to create a clinical culture that attracts persons seeking release and maintains persons seeking growth. While this culture is of universal benefit to all patients, LGBTQIA patients may especially benefit from the inherent inclusivity

The first principle is that the longitudinal care of the LGBTQIA person (indeed any person) takes time. In order to grow the relationship two people must spend some time together. In this time, they get to know each other, they find common interests and learn through trial and error preferences and dislikes. The healing of the provider-patient relationship often comes over time. The longer the time, the deeper the healing. On the first visit the patient presents with the broken wrist, which is cast. the next visit ends with a cast and some tears. the next visit brings xrays, and some revelations about unhappy relationships. fracture healing is followed by some veiled discussion of domestic violence. further visits culminate in a safe house and introspection. healing begins while health care maintenance is performed and after years, personal growth by both the patient and provider reveal the creation of support groups an blossoming of new relationships and safe spaces. The time of the provider-patient relationship is unique in its brevity. Often taking place in 15-minute intervals, this relationship is the Haiku of structured human relationships. Yet over time, those 15-minute intervals become years of shared experience and mutual reward. Keeping the principle in mind that a commitment to a long-term relationship occurring in fifteen-minute intervals over time is one way to bring health to a LGBTQIA person

The second principle is Trust. For the relationship to grow each party must have a reasonable belief that the other party is trustworthy. As is so often remarked trust must o