A recent report published in the New England Journal of Medicine asserts: “There is little formal education about sexual minority groups included in medical training. As a result, otherwise knowledgeable providers are often uninformed about basic issues essential to providing high-quality care” to GLBT patients.

That is not news to many in the GLBT community, but the fact that it is being said in the prestigious New England Journal of Medicine carries more weight. The article, entitled “Improving Health Care for the Lesbian and Gay Community,” appears in the March 2 edition. It was written by Harvey J. Makadon, a professor at Harvard Medical School who also is affiliated with the gay-oriented organization Fenway Community Health.

In the article, Makadon recounts how the decision to come out to his own physician at the age of 40, nearly two decades ago, was “a huge issue, and for many people it remains so today.”

“In places like Boston and San Francisco we tend not to think about that,” he adds.

Makadon believes that for many physicians, it is primarily lack of education on aspects of how GLBT patients may differ from their heterosexual counterparts that leads to less-than-optimal care. He points out a number of those differences in the article.

Sexually active gay men have a much higher need to be vaccinated for hepatitis B because gay sex can put them at greater risk of exposure to the virus. Hepatitis B infection can lead to serious liver damage.

Many physicians assume that lesbians are at low or no risk for cervical cancer, and therefore skimp on pap smears that screen for early lesions that may develop into cancer. In fact, many lesbians have had sex with men early in their lives, and infection with the sexually transmitted human papillomavirus (HPV), which can cause cervical cancer, is quite common. It can take decades for dysplasia and cancer to develop from that exposure, so screening is essential.

“But the one that is hardest to help patients with is the process of coming out,” Makadon writes. “That is where I think physicians need to be sensitive to clues and talk about it. It doesn’t just happen by asking the question you are taught to ask in medical school: ‘Do you have sex with men, women or both?’”

It often is a difficult conversation for both parties.

Makadon says the AIDS epidemic was responsible for increasing discussion of GLBT health issues. Within the medical community and in medical training, he writes, “it opened up talking about sexuality and talking about being gay. That is very different from when I was a medical student.”

He also acknowledges that getting a comprehensive sexual history profile and teaching patients how to avoid sexually transmitted diseases can be difficult, particularly with the pressure of managed care to see a patient within a 10-15 minute time slot.

A major impediment is that there is not enough hard data on health disparities within the GLBT community, he asserts, adding, “Those kinds of things will only come to the surface when research is done on them.”

Makadon says such research has been proposed in the past, but often has been vetoed, perhaps for political reasons, by the current administration.

He urges members of the community to take an active role in their own health. Numerous resources are available through the Internet for patients to educate themselves and their doctors about GLBT patients’ needs. See accompanying “National LGBT Health Awareness Week” box for further information.