Healthcare Professional Stigma Against LGBTQ+ Individuals
- Pink Project
- Jul 10, 2022
- 4 min read
The Pink Project
Photo from Deborah Heart and Lung Center
Introduction
Although there have been great strides over the past few decades in advancing the acceptance of the LGBTQ+ community, many still face challenges in several aspects of life - particularly in healthcare
“That's what I always hear from my previous PCP is, ‘Oh, we'll see if it gets better or take some over-the-counter medication for this’ or, ‘Oh, you know, just change your diet or exercise more.’ But I didn't feel like he was really paying attention to, you know, what I actually was going through.” – PT01, BIPOC & LGBTQ+ Man (Casanova-Perez et al., 2022).
“I saw written down ‘high-risk homosexual behavior’. She asked me if I ever had sex with men. She didn't ask me the last time I had sex with men, and it couldn't have been because I hadn’t had sex in like months, (…) I just dislike for her to make that assumption, that I was out there having unprotected sex” – PT23, BIPOC & LGBTQ+ Non-binary (Casanova-Perez et al., 2022).
“After discharging me, (the physician) wrote in the chart notes that I had refused care. And I said, ‘That's not true, this is what he told me, and I wasn't going to stay there for things to get worse’” – PT06, BIPOC & LGBTQ+ Woman (Casanova-Perez et al., 2022).
This is only a snapshot of what participants had to say in a study by Casanova-Perez et al. that investigated biases experienced in healthcare by BIPOC and LGBTQ+ individuals. Participants all expressed everyday experiences of being ignored and mistreated by healthcare providers, which sheds light on the lack of quality care that these LGBTQ+ individuals are receiving.
Heterosexism in Healthcare
Heterosexism describes the assumption that it is “normal” for one to be heterosexual (being sexually attracted to only the opposite sex) while identifying as any other sexual orientation is “abnormal”. Inevitably, this leads the heterosexual majority to intentionally or unintentionally be biased and discriminatory towards the non-heterosexual minority through laws, the media, and healthcare.
In healthcare specifically, barriers to LGBTQ+ quality care in the Arctic regions include remote healthcare facilities, a shortage of trained providers in LGTBQ+ health, a lack of patient anonymity and confidentiality, as well as long and costly wait and treatment periods (Logie et al., 2019). Such barriers can have significant negative consequences on individuals who identify as LGTBQ+.
For example, Human papillomavirus (HPV) infection is a common risk factor for anal cancer and is suggested to be present in 90% of anal cancers (Canadian Cancer Society, n.d.). Dr. Tinus Wasserfall, a Family Doctor at Spectrum Health, stated that 45 per 100,000 gay, bisexual and other men who have sex with men have anal cancer compared with 1.5-2 per 100,000 for the general population (Canadian Cancer Society, n.d.). Read more here. This disproportionate rate of gay and bisexual men facing a much greater risk of HPV exposure can be explained by the lack of an HPV diagnosis or treatment, likely because the healthcare provider fails to conduct an accurate patient analysis or because the patient is not seeking care.
Ways to Improve Healthcare Professional to LGBTQ+ Patient relationships
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Knowing that our current healthcare system puts the health of LGTBQ+ individuals far more at risk than the general population, it is important to implement ways to change the healthcare provider to LGTBQ+ patient relationship.
Healthcare providers should take specialized training/certificates for sexual orientation and gender identity (SOGI) care.They should be knowledgeable in:
LGBTQ+ terminology and pronouns,
patient rights and confidentiality,
various forms of contraception and STI prevention (ex: dental dams, condoms, oral contraceptive, IUD, depo etc.), as well as PReP clinics,
resources specific to LGBTQ+ health (ex: specialized care clinics, informational pamphlets), and
patient-specific assessment (do not assume a patient's lifestyle and experiences)
Examples:
DON'T SAY: | SAY: |
“Hi XYZ [patient's legal name], my name is ABC.” | “Hi my name is ABC, what name and pronoun would you prefer to be referred to as?” |
"I am going to begin your appointment by conducting a ....." | "Before we get started, is there anything you want me to be aware of? You are welcome to ask any questions and correct me if I say something that you find inappropriate." |
"What is your main form of pregnancy contraception?" | “Tell me about your sexual encounters” or “How do you practice safe sex?" |
In addition, healthcare facilities need to and can create more accepting environments by placing positive pride related stickers or posters on the walls of their offices (ex: the pride flag, diverse same-sex couples), providing access to unisex restrooms, and having informational pamphlets in waiting rooms (ex: about sexually transmitted infection prevention and safe sex practice) (Bass and Nagy, 2021).
These actions will promote more open communication among patients and providers, reduce the patient-provider power imbalance, increase patient comfortability in seeking health care, and guide providers in offering more appropriate and patient-specific treatments.
The Takeaway Message
Focusing on how our institutions are built is just as important as individual care. These structures greatly influence and shape the individual risks for negative health outcomes. Addressing both social and structural factors, like homophobic and transphobic stigma and discrimination, especially within our health care systems is necessary.
Resources
For more resources, click here.
References
Bass B, Nagy H. Cultural Competence in the Care of LGBTQ Patients. [Updated 2021 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563176/?report=classic
Canadian Cancer Society. (n.d.). Risk factors for anal cancer. https://cancer.ca/en/cancer-information/cancer-types/anal/risks#Risk1
Casanova-Perez, R., Apodaca, C., Bascom, E., Mohanraj, D., Lane, C., Vidyarthi, D., Beneteau, E., Sabin, J., Pratt, W., Weibel, N., & Hartzler, A. L. (2022). Broken down by bias: Healthcare biases experienced by BIPOC and LGBTQ+ patients. AMIA ... Annual Symposium proceedings. AMIA Symposium, 2021, 275–284.
Logie, C. H., Lys, C. L., Dias, L., Schott, N., Zouboules, M. R., MacNeill, N., & Mackay, K. (2019). “Automatic assumption of your gender, sexuality and sexual practices is also discrimination”: Exploring sexual healthcare experiences and recommendations among sexually and gender diverse persons in Arctic Canada. Health & Social Care in the Community, 27, 1204-1213. https://doi.org/10.1111/hsc.12757
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