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ir William Osler, one of the fathers of modern medicine, said that medicine is '€œa calling in which your heart will be exercised equally with your head'€. Indeed, the heart to serve humanity should be the core of medical practice and health care in general. Thus, in line with the Universal Declaration of Human Rights, discrimination based on sexual orientation, gender identity and gender expression by health professionals and in healthcare facilities is grossly unacceptable.

The International Day against Homophobia, which falls on May 17 annually, should call to our attention the challenges faced by lesbian, gay, bisexual and transgender (LGBT) people in accessing and making optimal use of the healthcare system.

In many societies, including Indonesia, those in the gender and sexual minority face an atmosphere of discrimination, which often crosses the line into outright violence and abuse, not to mention threats of criminalization. Coming out of the closet entails a massive emotional toll, so the majority of LGBT patients do not disclose their sexual orientation. Consequently, they become an '€œinvisible'€ population to healthcare providers; their needs are not sufficiently documented and addressed.

Even in places where LGBT people have received relative acceptance, health disparities still exist because bias and discrimination have not been completely eliminated. Additionally, not all health professionals are sensitive and knowledgeable enough to cater to the population, despite their best intentions.

Surveys show that LGBT populations have a higher risk of experiencing substance abuse and mental health issues, including a high rate of suicide ideation among its youth, attributable to the overwhelming stigma against them. Fear of discrimination also drives the LGBT population to defer medical treatment for many diseases. This makes them less likely to get adequate information on health, including sexual health and to utilize preventive services; for example, lesbians are not as frequently screened for cervical and breast cancers compared to straight women.

Those who do seek treatment are sometimes turned away due to their sexual orientation, or often have to endure disparaging remarks from their doctors. Moreover, consultation would unnecessarily center on their sexual behavior, as if sexually transmitted infections are the only diseases affecting the LGBT population.

Ending discrimination and eliminating bias against LGBT patients in health care seems like a tall order in Indonesia, where sex and sexuality still carry negative connotations, even in the sexual majority. Being a straight ally for LGBT friends and relatives is also seen as a strange thing that often places allies as victims of bullying too.

Nevertheless, the time for compassion and fulfillment of human rights is, as always, right now and any step toward that noble goal should be appreciated.

Even as government policies continue to lag behind, medical and allied health professional communities can take the lead in several ways. First, medical schools must reaffirm a non-discrimination policy for their students and teaching staff. By instilling non-discriminatory values from early on, it is hoped that the values will carry on into their medical practices. Additionally, studies show that unsupportive campus life negatively affects the well-being and academic performance of LGBT students; hence, eliminating discrimination will bring benefit to the school itself.

Second, the medical curriculum '€” and perhaps the national curriculum too '€” must reiterate that sexuality is a normal part of personal development and embrace the diversity of human sexual orientation, gender identity and gender expression with all its complexities. Today, many doctors continue to confuse those concepts, like assuming a patient'€™s sexual orientation from the way he or she acts. The discussion of sex and LGBT must not be confined to topics like sexually transmitted diseases.

Third, physicians must develop cultural competence to serve the LGBT population with sensitivity and knowledge of their physical and mental health needs, keeping in mind that these patients are much more than their sexual orientation. Even as they are lumped together under the acronym, each LGBT patient is his or her own person with different values, experiences and preferences. Subsequently, physicians must adapt their patient communication skills to eliminate bias and assumptions, such as when inquiring about a patient'€™s spouse or sexual history.

At the end of the day, physicians can be effective allies for their LGBT patients through many ways; from running a culturally competent medical practice to advocating changes in health policies to improve the lives of Indonesian LGBT. Once again, the medical profession must prove its commitment to serve humanity to the best of its ability. Change will not come easy nor fast, but to quote Osler one more time: '€œto have striven, to have made the effort, to have been true to certain ideals '€” this alone is worth the struggle.'€
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The writer is a medical practitioner currently on an internship in Pekanbaru, Riau.