Members of the lesbian, gay, bisexual, transgender and queer community have long experienced prejudice in healthcare. These experiences could be anything from microaggressions, like assumptions based on an individual's appearance, to outright discrimination like denial of care. As a result of these biases, many queer and trans people do not disclose their identity to healthcare providers. And worse, some fail to seek care at all.
Heteronormativity
According to the European Institute for Gender Equality, “heteronormativity is what makes heterosexuality seem coherent, natural, and privileged. It involves the assumption that everyone is ‘naturally’ heterosexual, and that heterosexuality is an ideal, superior to all other sexualities.” Heteronormativity is the standard across the globe. Naturally, these biases creep into all institutional care including medicine.
According to the National Library of Medicine:
- LGBTQIA2S+ individuals are more likely to experience grave psychosocial stressors throughout their lives that compromise their cardiovascular health.
- There is significant evidence that LGBTQIA2S+ individuals are more likely to use tobacco as opposed to cisgender heterosexual adults.
- Sexual minority women have been reported to have higher BMI than heterosexual women
- The National Health and Nutrition Examination Survey shows that bisexual men have 69% higher chances of obesity than heterosexual men.
With all these health concerns, it is critical that health practitioners take a holistic approach. The Cleveland Clinic defines holistic care as a medical professional who “treats people using a whole-body approach. They focus on your body, mind, spirit and emotions when diagnosing and treating you.” They also consider your upbringing and life experiences. This all helps in how healthy practitioners approach minorities.
Mental Health for LGBTQIA2S+ People
LGBTQIA2S+ individuals have also been determined to have more mental health issues than their cisgender and/or heterosexual counterparts. Social and legislative support has been proven to reduce risk of suicide or suicidal ideation within this community. Furthermore, "community connectedness and other protective factors [such as a safe environment within healthcare] can reduce risk.”
What You Can Do as a Practitioner
There are a number of ways medical providers can create an environment that is welcoming to members of the LGBTQIA2S+ community. The National Library of Medicine provides an extensive list of considerations, including specific needs for gay and bisexual women as well as gay and bisexual men. They also provide a list of ways to create a practice that welcomes members of the LGBTQIA2S+ community including:
- Advertising your practice as an accepting and safe space for LGBTQIA2S+ folks
- Provide professional development for your staff that specifically focuses on discussing sexual orientation, gender orientation, and sexual practices
- Hire LGBTQIA2S+ individuals as part of your staff
- Train your staff to refer to patients by their name and chosen descriptive pronouns.
- Do not assume you understand the patients’ experiences and maintain an open mind around sexual orientation and practices
- On intake forms, include the terms partner in addition to the spouse
- On intake forms, include transgender as an option
- Provide patient brochures on sexually transmitted infection prevention, substance abuse, safe sex practices, and hormone therapy
- Support observance of LGBTQIA2S+ Pride Day, World AIDS Day, and National Transgender Day of Remembrance
- Provide continuing education on the care of LGBTQIA2S+ patients specifically
Being LGBTQIA2S+ Is Not a Disease
At one point in time, being LGBTQ was considered a psychiatric disorder. This only changed in 1973. Sadly, at that time homosexuality was changed from a classification as a disease to “sexual orientation disturbance” which reclassified LGBTQ people as “in conflict with their sexual practice and orientation.” It wasn’t until 1987 that homosexuality was removed entirely from the Diagnostic and Statistical Manual of Mental Disorders.
Biases and The Future of LGBTQIA2S+ Care
Unless you are a practitioner who outright denies care to LGBTQIA2S+ individuals either for religious reasons or because of heterosexism and homophobia, you as a provider will interact with members of this community. It is critical that medical professionals foster a safe and welcoming environment for LGBTQIA2S+ individuals to be able to seek gender and/or sexuality affirming care. Facing a practitioner who allows biases to predetermine care creates many risks for this community. The health disparities for LGBTQIA2S+ are undeniable, both physically as well as mentally. By creating a safe space, providers are fostering a future where all people can seek quality care, no matter their identity.
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