For Teachers & Professionals

LGBTQIA+ Community and Health Care Services

Lesbian, gay, bisexual, queer, trans, intersex and asexual people are still marginalized in Europe and internationally, despite the efforts and progress made in the last decades, leading to significant barriers in terms of accessing health and social care services. LGBTQIA people are more likely than the general population to report unfavourable experiences of healthcare including poor communication from health professionals and dissatisfaction with the treatment and care received. HCP hold negative stereotypes or biases that lead to thinking that LGBTQIA status is not, or is no longer, relevant in healthcare. 

Furthermore, even if healthcare professionals see themselves as non-discriminatory individuals and express a desire to assist LGBTQIA patients, they unknowingly maintain and reproduce LGBTQIA healthcare inequalities through widely held assumptions that patients are heterosexual, cisgender and non-intersex by default.

There are 3 major themes about the complexity of the physician-patient interaction that must be noticed:

1. Lack of trust

The patient-provider relationship can be damaged through poor communication, misgendering, and disrespect. Using medical jargon and a paternalistic or condescending tone of voice can further damage the relationship. Many transgender patients cite misgendering – making assumptions about gender without clarifying patients’ identity or verifying a patient’s previous documentation – as disrespectful. A more respectful and appropriate approach to transgender or gender-variant patients would be asking “What’s your pronoun? How would you like to be addressed?’. These simple questions give the patient a sense of comfort. For many transgender or gender-variant individuals, much of the physician-patient relationship hinges on mutual respect that often is expressed in the physician’s understanding of gender identity and the patient’s preferred pronouns. Providers also need to recognize that there is heterogeneity among sexual and gender minorities, for example in sexual orientation.

2. Disclosing one's sexual identity

Many patients are concerned about disclosing their sexual orientation and/or gender identity to their healthcare professionals. These concerns contribute to their comfort in discussing personal issues with their providers. It’s important that providers don’t assume a sexual orientation. Questions like “do you prefer men or women?/Do you sleep with men or women?” should be replaced by “Are you sexually active and with whom?”. Patients are often hesitant to disclose their sexual orientation because they are concerned about the provider’s response and eventual change of attitude. Disclosing gender identity might feel even worse. Nowadays sexual orientation is at least known, while concepts such as being transgender or gender-fluid are not understood.

3. Other sources of discrimination

Other sources of discrimination may be affected by HIV and ethnic/racial prejudices. In the first case, examples of wrong behaviours are invalidating the emotional burden the patient might feel and being afraid to touch him. 

Racial/ethnic identities also can influence patient experiences, for example reinforcing stereotypes about drug-seeking behaviour in racial/ethnic minorities in a context of inadequate pain management.

Although cultural competency is encouraged and medical student training is improving, cultural sensitivity is still lacking with regard to LGBTQIA patients which may require additional training, such as differences between behaviour and identity, among other aspects of LGBTQIA care. This is an important step in improving provider empathy, understanding, and connection.

REFERENCES

Malik, S., Master, Z., Parker, W., DeCoster, B. & Campo-Engelstein, L. (2019). In Our Own Words: A Qualitative Exploration of Complex Patient-Provider Interactions in an LGBTQ Population. Canadian Journal of Bioethics / Revue canadienne de bioéthique, 2(2), 83–93. https://doi.org/10.7202/1062305ar 

McGlynn N., Browne K., Sherriff N., Zeeman L., Mirandola M., Gios L., Davis R., Donisi V., Farinella F., Rosińska M., Niedźwiedzka-Stadnik M., Pierson A., Pinto N. & Hugendubel K. (2020). Healthcare professionals’ assumptions as barriers to LGBTI healthcare, Culture, Health & Sexuality, 22:8, 954-970, DOI: 10.1080/13691058.2019.1643499