The power of pronouns: Caring for LGBTQ veteran patients in eye care
LGBTQ VA patients may miss appointments due to fear of discrimination
Image credit: AdobeStock/PhotocreoBednarek
Two years ago, a new transgender patient presented to my clinic at the Department of Veteran Affairs (VA). During this encounter, I asked them to let me know whether they had a preferred name, salutation, and pronouns. I did not give this encounter much thought until their routine follow-up this past summer, when I noticed they had missed several appointments at the VA. When I inquired as to why these appointments were missed, the patient shared with me that they did not feel comfortable coming into the VA. They felt judged every time they walked into the building and said that other veterans made comments about their appearance, such as their clothing not matching their sex assigned at birth. The veteran patient shared that I was the only provider who made them feel comfortable by simply asking whether they had preferred pronouns and by not treating them any different from a cisgender patient. Although this compliment was intended to make me feel good, I was appalled. This was a veteran who had served the country, a debt that can never be repaid, but who feels uncomfortable at a place that should feel welcoming. I was able to provide my patient with information on LGBTQIA support groups available at the VA along with an LGBTQIA care coordinator, but I knew more had to be done.
The VA treats all veterans, regardless of race, ethnicity, gender, religion, and sexual orientation. According to the department, 1 million veterans identify as lesbian or gay.1 In 2014, results from the National Transgender Discrimination Survey found that more than 149,800 military service members identified as transgender, with 134,300 as retired/reserve and 15,500 as active duty/active reserve.2 However, these numbers may be an underestimation due to fear of bullying, retaliation, or dishonorable discharge while in service.3,4 This fear is based on a history of discrimination in the military; for many years, under the “don’t ask, don’t tell” policy, service members were not allowed to join the military if they were openly gay, lesbian, bisexual, or transgender. In 2011, this policy was repealed and LGTBQIA members could serve openly without fear of being discharged. The VA now recognizes that LGBTQIA veterans are more vulnerable to physical and mental conditions as a result of discrimination, such as anxiety, depression, increased suicidal thoughts, and substance use disorder.5,6
The VA has a strong commitment to welcome and improve the health care of LGBTQIA veterans. When registering for services, veterans can document their sexual orientation and gender identity information. This means veterans can now record their sex identified at birth, gender identity, preferred name, and pronouns. This is how the information will also display in their electronic medical records when they are seen by their provider. Pride flags are not only on display during the month of June; they are proudly displayed throughout the year as a reminder that we treat all veterans. The VA also displays posters and electronic bulletin boards with supportive messages such as “Health care is for all veterans,” symbolizing that the VA is a safe place for veterans. Employees can further demonstrate that they are an ally or that their office is a safe space by wearing a rainbow lanyard, pin, or lapel. To continue to make veterans feel welcome, instead of calling out “Mr” or “Mrs” in the waiting area, calling out “Veteran” is more appropriate because it is gender neutral. There is also gender-neutral restrooms available at the VA, and the optometry clinic has gender-neutral frames. Additionally, there are not only support groups available to veterans but also LGBTQIA Veteran Care Coordinators available through Veterans Care Coordination (VCC). The role of VCC officers is to promote a safe environment for LGBTQIA veterans and employees, incorporate inclusive language and values into program/office policies and resources, and promote best practices in LGBTQIA health care. VCC officers also provide education and training to veterans and employees regarding LGBTQIA sexual health, mental health, and suicide prevention.
Separate from VCC officers, the VA offers additional educational tools. PRIDE In All Who Served is a 10-week health education group for LGBTQIA veterans that discusses topics such as the coming out process, identity development, and military culture with the goal of reducing identity-related stress and symptoms of anxiety/depression. One of the large areas of emphasis of this program is minimizing risk factors for suicide by providing information on access to wellness services at the VA. PrideVA is an employee-specific resource for gender and sexual minority individuals as well as for allies who support the mission and vision of PrideVA. The mission of this program is to create a discrimination-free workplace based on sexual or gender identity; be a point of contact/resources for employees at the VA regarding LGBTQ issues, resources, programs, and activities; provide mentorship between senior and junior employees in the same field; and foster a sense of community by connecting members through social media and other outlets.
The national LGBTQIA optometry group PRIDE ODs believes that all veterans should feel welcome at the VA. As eye care providers, it our duty to ensure that all eye examinations offer a safe, inclusive space for our patients. Not everything has to be a large educational initiative; even small things, such as a pride flag or a rainbow pin on the lapel of your white jacket, can make a big difference in fostering a supportive environment for all.
References:
LGBTQ+ veteran health care: female veterans: lesbian, bisexual, and queer health care. US Department of Veterans Affairs. Accessed October 17, 2024. https://www.patientcare.va.gov/LGBT/docs/va-pcs-lgbt-factsheet-lesbian-bisexual-women.pdf
Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. National Center for Transgender Equality. 2011. Accessed October 17, 2024. https://transequality.org/sites/default/files/docs/resources/NTDS_Report.pdf
Osgood V. Two WACs to fight probable homosexual discharges. Boston Globe. June 4, 1975. Accessed October 5, 2024.
Army discharges homosexual WACs. Atlanta Constitution. July 6, 1975. Accessed October 5, 2024.
King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. 2008;8(1):70. doi:10.1186/1471-244X-8-70
Flentje A, Heck NC, Brennan JM, Meyer IH. The relationship between minority stress and biological outcomes: a systematic review. J Behav Med. 2020;43(5):673-694. doi:10.1007/s10865-019-00120-6
