Current Gaps and Key Issues for LGBTQI2S Communities in Accessing Health Care

Healthcare Provider Guide

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“I think that there is not much of an intensive training that’s done with staff, because even for me personally, I’ve had experiences of homophobia.”- m.bodiment focus group participant  

Based on in-depth research as well as information gathered from the m.bodiment project via online survey and focus groups, we have found that there are three major trends that contribute to the health disparities that exist among LGBTQI2S populations in comparison to the general cisgender heterosexual population. 

“It would make our health care a lot easier…identification that reflected our true identity. But yet it is another barrier.” – m.bodiment focus group participant

These three key issues are:

Challenges and Barriers to Care

In addition to the lack of knowledge, training, and awareness of LGBTQI2S populations, there are further gaps, challenges, and barriers for LGBTQI2S patients in seeking competent and informed health care (Obedin-Maliver et al., 2011; Dean, Victor, and Guidry Grimes, 2016).

  • Lack of trained health care providers available in rural healthcare clinical setting, in comparison to urban setting where there are a few LGBTQI2S specialized primary health care providers available.
    “So the only reason why I got a doctor in Toronto is for transition related services.”- m.bodiment focus group participant
  • The social stigma and anxiety experienced by LGBTQI2S patient in “coming out” and disclosing their sexual and/or gender identity to their health care provider, as they are constantly encountered with the assumption of being cisgender and heterosexual (Bolderston and Ralph, 2016; Dean, Victor, and Guidry Grimes, 2016; Law et al., 2015).
  • The lack of trust experienced by LGBTQI2S patients with their health care provided stems from previous trauma or from the history of pathologization and institutionalization of LGBTQI2S communities by health care providers (Meyer, 2003; Bolderston and Ralph, 2016; Quinn et al., 2015).
    “Generally speaking, most of my experiences with medical professionals have been pretty shitty. So I actually don’t have a doctor anymore…”- m.bodiment focus group participant
  • Our research has indicated that GBTQ participants from our online survey and focus groups not only inform their peers of health care providers to avoid based on their negative experiences and discriminatory treatment but also refer their peers to health care providers to seek care from positive experiences.
    “Cause if there are newcomers coming… for me personally, I have someone who referred me to their family doctor. I referred someone else to that family doctor. And I’m sure that person then referred someone else.”- m.bodiment focus group participant
  • LGBTQI2S patients are often put in the position of self-advocacy, negotiating, and being a specialist in their marginalized identities in order to seek care from their health care provider.

    “Patients shouldn’t have to advocate for themselves to get optimal treatment from their care providers.”- m.bodiment focus group participant
  • Many LGBTQI2S patients have reported being refused care due to their status as sexual and gender minorities. “I had a GP, I had her since I was born, basically. And when I said, ‘I wanna transition’, she basically was like, ‘I’m not having anything to do with that, I’ve never put someone on hormones and I never will’.”- m.bodiment focus group participant

 

Discomfort and Discrimination

Healthcare spaces are designed to make people feel comfortable and safe, as patients see themselves and their health concerns and needs reflected in these space. However, for many LGBTQI2S people, clinic spaces renders their identities, experiences as well as their health concerns, and their needs invisible (Dean, Victor, and Guidry Grimes, 2016; Bolderston and Ralph, 2016).

Furthermore, many LGBTQI2S patients delay or avoid seeking care because of stigma, social isolation, violence, and discrimination (McClain, Hawkins, and Yehia, 2016). These forms of discrimination are often regarded as microaggressions, as theses interactions create an unwelcoming and hostile environment for patients (Dean, Victor, and Guidry Grimes, 2016).

The engagement in microaggression are underlined with the variety of subtle forms of discrimination, insignificantly seeming features, spaces, or interactions that communicate insensitivity, incivility, and animosity (Chang and Chung, 2015; Sue et al., 2007; Dean, Victor, and Guidry Grimes, 2016).

These are key examples of microaggressions – verbal or nonverbal language, actions, practices, or within the clinic include:

  • Lack of space for self-identifying gender (rather than sex assigned at birth), clients’ pronouns, and diverse sexual attraction on intake forms (Bolderston and Ralph, 2016).
    “For non-binary folks, you know, people use ‘they, them, their’ and where are they in the mix?”…“They don’t even exist in the health care system.” – m.bodiment focus group participant
  • Printed materials, posters, art, and media that solely reflect heteronormative and cisnormative people and images (Bolderston and Ralph, 2016; McNamara and Ng, 2016).
  • Deadnaming (using incorrect or legal name) trans and gender variant patients as well as using the incorrect pronouns in addressing trans and gender variant patients (Bolderston and Ralph, 2016; Kalma, 2016).
    “And again they were using my legal name, even though it said everywhere, and it states very boldly, this is a trans person, use caution.”- m.bodiment focus group participant
  • Making assumptions of patients being heterosexual and cisgender as well as denying patients the acknowledgement or space to discuss queer relationships or sexual practices in relation to conversations about their sexual health (Chang and Chung, 2015; Dean, Victor, and Guidry Grimes, 2016; Law et al., 2015; Bolderston and Ralph, 2016).
  • Engaging in unnecessary screening, testing, and physical examination or referring patients to unsuitable services.
    “I was with a Cardiologist… she asked me if I was married. I said ‘no, I will be in a few months’  she’s like, ‘and is it a heterosexual relationship?’ and I was like ‘no’ and she was like ‘and what’s your HIV status?… I only ask people who are not heterosexual about their HIV status’”- m.bodiment focus group participant
  • Engaging in procedures, treatments, and surgeries without receiving informed consent from the patient.

    “He [was] just like, ‘I was just sexually harassed!’… Because he went for a headache… And the doctor told him to take off his clothes… And the doctor basically touched his penis. And he said he felt funny after but he never really, cause he is a newcomer too…” – m.bodiment focus group participant

Improper Health Care

  • Due to the lack of education, training, and cultural awareness of LGBTQI2S communities that health care professionals receive (Obedin-Maliver et al., 2011), LGBTQI2S patients often experience improper care. Improper care causes harm, which puts patients at risk of stigma, discrimination, trauma and above all their health concerns unfortunately continue to go untreated (Bauer, Zong, Scheim, Hammond, & Thind, 2015).

Some core examples include:  

  • Conflating ideas related to sex and gender identity (McNamara and Ng, 2016).
  • Assumptions of sexual practices based on queer identities (sexual attraction and gender identity) (McNamara and Ng, 2016).
  • Creating a dynamic of distrust between the health care provider and patient, which prevents LGBTQI2S patients from sharing relevant information related to their health concerns.

    “The doctor wasn’t able to give him directly what was needed to help him correct the problem… he was just jumping, hopping around because he felt shame to come out and to say, what he was doing.” – m.bodiment focus group participant
  • Pathologization of LGBTQI2S and asexual people in treating patients in a dehumanizing manner (Lim, Brown & Jones, 2013; Meyer, 2003).

    “One of the clients was telling me that when he went there [a hospital], a staff member was double-gloving her hands…he had to ask her ‘why are are putting on two gloves?’ and she’s like, she has to be safe. And he felt bad. He didn’t really talk about it anymore. He said from that point on, he didn’t go back and he doesn’t want to go back.”- m.bodiment focus group participant
  • Lack of inclusive practices in asking patients about their health concerns.

    “There was a 40 year old guy who was at his birthday party. He was having a heart attack, when he was at [a hospital], he was with his partner. And because the nurse thought, okay, gay and party, this guy must be on drugs. He’s not actually having a heart attack… When he was clearly stating chest pain, and otherwise that would be a huge red flag like get him into the ER, stat, right?”- m.bodiment focus group participant

  • Not listening to patients in addressing their specific health concerns and solely asking patients about their sexual practices in order to suggest treatment for HIV and STIs.

    “I went all the way to Kitchener, spent all this money for a 15 minute appointment, maybe under 15 minutes appointment… But one of the fucking question was, she was asking me ‘do you ever have sex as a female?’ I said, ‘come again?’” – m.bodiment focus group participant


The ongoing discrimination and lack of training of health care professionals contributes to the continued widened disparities of health among LGBTQI2S communities. In highlighting these gaps and key issues impacting LGBTQI2S patients in accessing competent and informed health care illustrates the current need for health care providers to work towards more LGBTQI2S inclusiveness within our Canadian health care systems. 

 

References

  • Bauer, G., Zong, X., Scheim, A., Hammond, R., Thind. A. (2015) “Factors Impacting Transgender Patients’ Discomfort with Their Family Physicians: A Respondent-Driven Sampling Survey.” PLoS ONE. 10(12).
  • Bauer et al. (2015) “Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada” BMC Public Health 15:525.
  • Bauer, G., Boyce, M., Coleman T., Kaay, M., Scanlon, K. (2011) “Who are Trans People in Ontario?” Trans PULSE e-Bulletin, 20 July, 2010. 1(1).
  • Bolderston, A. and Ralph, S. (2016) “Improving the health care experiences of lesbian, gay, bisexual and transgender patients.” Radiography (22): e207-211.
  • Chang, T. and Chung, B. (2015) “Transgender Microaggressions: Complexity of the Heterogeneity of Transgender Identities.” Journal of LGBT Issues in Counseling. 9: pp 217-234.
  • Dean, M., Victor, E., and Guidry Grimes, L. (2016) “Inhospitable Healthcare Spaces: Why Diversity Training on LGBTQIA Issues IS Not Enough.” Journal of Bioethical Inquiry (July 7, 2016).
  • Kalman, Xeph (2016) “Mind Your Words” in Sharman, Z. eds. The Remedy: Queer and Trans Voices on Health and Health Care. Arsenal Pulp Press: Vancouver.
  • Law, M. et al. (2015) “Exploring lesbian, gay, bisexual, and queer (LGBQ) people’s experiences with disclosure of sexual identity to primary care physicians: a qualitative study.” BMC Family Practice 16: 175.
  • Lim, Brown & Jones. (2013) “Lesbian, Gay, Bisexual, and Transgender Health: Fundamentals for Nursing Education.” Journal of Nursing Education Vol. 52, No. 4, pp 198- 203.
  • McNamara, M. and Ng, H. (2016) “Best Practices in LGBT care: A guide for primary care physicians.” Cleveland Clinic Journal of Medicine. 83 (7): 531-541.
  • Meyer, I.H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, pp 674–697.
  • Obedin-Maliver et al. (2011) “Lesbian, Gay, Bisexual, and Transgender-Related Content in Undergraduate Medical Education.” Journal of the American Medical Association. Vol. 306, No. 9, pp 971- 977.
  • Quinn et al. (2015) “Cancer and Lesbian, Gay, Bisexual, Transgender/ Transsexual, and Queer/ Questioning (LGBTQ) Populations.” CA Cancer Journal for Clinicians: 65, pp 384-400.
  • Sue, D. W., Capodulipo C. M., Torino, G. C, Bucceri, J. M., Holder, A. M., Nadal, K. L. and Esquilin, M. (2007) “Racial Microaggressions in everyday life: Implications for clinical practice.” American Psychologist. 62 (4). 271-286.
Intro Situation Key Issues How can you help Resources Glossary