Practicing inclusivity

By Emily Margosian, Assistant Editor, July 1, 2024

DermWorld talks to Daniel Yanes, MD, FAAD, from MI Skin Dermatology and Laser Center in Washington, D.C., about how to foster a welcoming practice environment for LGBTQ+ patients.

Dr. Yanes: I practice in the heart of Washington, D.C., seeing patients of all ages and from all walks of life. My primary research interest is in laser surgery and cosmetic dermatology, which makes up a good portion of my clinical practice. Being in D.C., I am so fortunate to care for a diverse population of patients.

DermWorld: You just finished a term as co-chair of the AAD’s Expert Resource Group (ERG) on Lesbian, Gay, Bisexual, Transgender, and Queer/Sexual and Gender Minority (LGBTQ/SGM) Health. What is the mission of the ERG?

Dr. Yanes: The mission of the ERG is to facilitate communication, collaboration, mentorship, and education among dermatologists regarding LGBTQ/SGM health. The ERG works within the Academy to counsel on matters pertaining to LGBTQ+ health. The ultimate goal is to advocate for and help provide dermatology-relevant education related to issues of medical and cultural competence in caring for LGBTQ+ patients.

DermWorld: What prompted your interest in this area of dermatologic care?

Dr. Yanes: I believe that all individuals deserve equitable access to high-quality, culturally competent health care, regardless of their sexual orientation, gender identity, race, socioeconomic status, or any other factor. My research interest in this area of dermatology started when I was a resident working in the Massachusetts General Hospital Laser and Cosmetic Center doing preoperative laser hair removal under the tutelage of the wonderful Dr. Mathew Avram. I find caring for LGBTQ+ patients to be quite rewarding, as many have been marginalized or discriminated against by prior physicians and health care providers.

We often forget that a large portion of the patient experience involves interactions with office staff. I tell my staff that they are an extension of me. One negative interaction can sour the visit and sever trust.

DermWorld: What barriers can LGBTQ+ patients face when seeking care?

Dr. Yanes: Importantly, the LGBTQ+ population is not monolithic and the health care needs of LGBTQ+ people vary widely. As of 2023, 7.6% of the population identifies as LGBTQ+. Here in Washington D.C., that number is even higher.

There are several explicit and implicit barriers that exist when LGBTQ+ patients receive care. Surveys have shown that many LGBTQ+ patients have experienced discrimination in the health care setting and that this often leads to delays in seeking care. It follows that LGBTQ+ patients have higher rates of chronic disease, cancer, and cardiovascular disease. In addition, LGBTQ+ patients are more likely to be uninsured and face cost-related barriers to care.

LGBTQ+ patients have specific health care needs that are often not taught or part of routine curricula. Within dermatology, there is limited research on specific outcomes of LGBTQ+ patients, with the primary focus often being on sexually transmitted infections (STIs) and HIV. Disparities do exist within our field, though. For example, we know that gay men have higher rates of tanning bed exposure and skin cancer rates than their heterosexual counterparts. Transgender patients have a unique set of dermatologic needs related to medical and surgical gender affirmation.

DermWorld: How can dermatologists work to reduce those barriers?

Dr. Yanes: There is a need for dermatologists, as with all physicians, to provide culturally competent care for LGBTQ+ patients. Cultural competence is not something that develops overnight, and so it is important to practice humility, suspend judgment, and always be willing to learn more. It’s ok to ask — when I encounter cultural practices within any community that I am unfamiliar with, I always think it’s better to ask questions in an open non-judgmental manner rather than assume understanding. At the most fundamental level, dermatologists must remain educated to fully understand the medical needs of LGBTQ+ patients. Dermatologists must also be able to elicit a sexual history in an inclusive and non-judgmental manner when it is clinically appropriate. One can be the most well-meaning doctor on the planet, but without an understanding of the specific medical needs of LGBTQ+ patients, it becomes difficult to provide effective care and build rapport.

I believe that we as dermatologists and physicians have a duty to advocate for our minoritized patients. This can be on a governmental level, within your local societies, or even within the Academy. That is what initially led to my involvement in the AAD’s Expert Resource Group.

DermWorld: How do you define inclusivity? What does inclusivity mean to you?

Dr. Yanes: To me, inclusivity is the deliberate practice of ensuring that everyone feels respected, valued, and included, regardless of their background, identity, or circumstances. Inclusivity is not just about tolerance. It’s about embracing and appreciating the richness of human differences and actively working to dismantle barriers that may exclude marginalized groups. Put simply, inclusivity is about fostering a sense of belonging in all people.

DermWorld: How do you foster inclusivity in your own practice? How do your practice policies and/or staff training contribute to a welcoming and affirming health care experience?

Dr. Yanes: With regard to overcoming the biases that LGBTQ+ patients experience, it starts with creating a welcoming and inclusive environment within the clinic. Even something as simple as signage can go a long way to let patients know that they are welcome. Use of inclusive, gender-neutral, non-assumptive language in conversation helps to avoid uncomfortable blunders. Not every patient will be forthcoming with their personal information, so it’s important to avoid assumptions about a patient’s sexual identity. For example, rather than assuming that my patient has a husband or wife, I prefer to use gender-neutral terms such as partner or significant other. Beyond the dermatologist themselves being welcoming and nonjudgmental, it is important that intake paperwork and medical records have options to appropriately reflect the gender and sexual diversity of our patients. Staff should also be educated on cultural competence. We often forget that a large portion of the patient experience involves interactions with office staff. I tell my staff that they are an extension of me. One negative interaction can sour the visit and sever trust.

DermWorld: Why is it important for dermatologists to consider and improve inclusivity in their practices?

Dr. Yanes: I think most of us practice inclusivity daily, probably without even realizing it. However, there is always room for improvement. Everyone has implicit biases that must be confronted and overcome. Beyond the legal and ethical necessity to provide care that is free from discrimination, improving inclusivity is essential to providing the highest quality of care. It allows doctors to truly get to know patients and earn their trust and satisfaction. Open communication leads to better outcomes. When patients feel valued and understood, they are more likely to be active participants in their health. In my opinion, this is not only good for patients, but for their dermatologists as well! When my patients are excited to see me, are open with their discussions, and are eager to participate in their care, it makes my everyday interactions with patients much more fun and rewarding. It’s much more enjoyable than just going through the motions while bouncing from room to room!

Daniel Yanes, MD, FAAD, is in private practice in Washington, D.C.

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