Improving Care for LGBTQ+ and Immigrant Patients

Uchenna Umeh, MD, “Dr Lulu” emphasized that medical education has historically failed to prepare physicians for affirming LGBTQ+ care. She described conducting an informal poll of psychiatrists and finding that the majority reported receiving no formal training on the topic, with 1 respondent noting that LGBTQ+ patients had been presented in their curriculum under the category of "difficult patient” or “problem patient." Lulu argued this framing constitutes a harmful clinical bias that must be actively countered.

Both speakers stressed the importance of approaching patients without preconceived assumptions.¹ Gonzalez urged clinicians to listen carefully and avoid using patients as a source of self-education: "be careful not to use your patient as a source to educate yourself, but listen very carefully to what they're sharing and the tone of their voice." He also encouraged providers to orient therapeutic inquiry toward positive identity experiences, noting that questions about gender euphoria—not only dysphoria—can be clinically productive.

Lulu highlighted that many LGBTQ+ patients present without distress and carry a full range of emotional experiences. She cautioned clinicians that communicating hesitancy or negative energy—whether verbally or nonverbally—risks causing patients to disengage entirely, potentially deterring them and their networks from future care.

Both speakers addressed the compounded vulnerabilities of LGBTQ+ immigrant patients, noting that institutional mistrust, language barriers, and fears related to legal status create significant obstacles to disclosure.² Gonzalez underscored that clinicians enter these encounters "at a deficit of trust" and must actively invest in cultural humility and rapport-building before meaningful clinical exchange can occur. Lulu concluded with a reminder that physicians took an oath to do no harm—and that a patient encounter in which the patient cannot fully disclose who they are represents an incomplete clinical visit. Lulu and Gonzalez presented at the Black Psychiatrists of America Conference in May, titled “Ancestral Echoes Across Borders: Queer Immigrant Experiences, Complex Trauma, Cultural Humility, and Neurobiological Considerations in Psychiatric Care.”

Dr Lulu is a pediatrician and advocate for LGBTQ+ patients.

Mr Gonzalez is a lawyer working on human rights and immigration issues.

References

1. Fadus M, Hung K, Casoy F. Care considerations for LGBTQ patients in acute psychiatric settings. Focus (Am Psychiatr Publ). 2020;18(3):285-288.

2. Drescher J. Improving the approach to LGBTQ persons in mental health care settings: a clinician's perspective. World Psychiatry. 2024;23(2):213-214.