Inclusive LGBTQIA+ Patient Care
June 22, 2020
As we celebrate Pride Month, it is necessary to address the importance of inclusive LGBTQIA+ patient care. Four members of our division — Ava Tehrani, Daphne Carcedo Cravens, Dr. Karrie Kingsley and Dr. Tessa Milman – discuss with our student ambassador, Lamoni, how heteronormativity is harmful during patient care and how we can create more inclusive environments.
Why is inclusive LGBTQIA+ patient care important?
Ava: The LGBTQIA+ community faces substantial health disparities such as limited access to healthcare. The healthcare that they have had access to may have led to bad experiences due to discrimination by healthcare providers as well as healthcare providers not being adequately trained in using inclusive language, not understanding the health needs of the individual, and making assumptions. In comparison to their heterosexual peers, the LGBTQIA+ community can experience high levels of stress due to stigma and lack of access. By creating an inclusive environment where the LGBTQIA+ community can have access to healthcare, we can start to eliminate these substantial health disparities experienced by the community and can thereby meet the needs of the community.
Daphne: Inclusive LGBTQIA+ care is important because as OTs, we are supposed to be centering the person and treating the whole patient. If we neglect those aspects of a person that may be important or relevant to them, this leads to not affirming various occupations that may be exclusive to the LGBTQIA+ community. For example, trans people who bind their chest may need that dressing task addressed during a session. Or trans people who would like to do their makeup while still in the hospital for a shoulder replacement. And even teaching an out queer or trans child with autism to advocate for themselves when using communication devices. Refusing to acknowledge or being oblivious to the fact that these things might be important to the queer and trans community goes against everything we do and stand for as health practitioners and OTs. We must be open, be inclusive, ask relevant open-ended questions, and be willing to continue learning to challenge ourselves to better serve our patients and clients in the best ways we can.
Karrie: When we use heteronormativity as our default assumption in client care we are further marginalizing our LGBTQIA+ clients. We make assumptions through our intake forms, EMR’s, interview questions and even how we score our assessment tools. When we assume all of our clients are cisgender and heteronormative we put the pressure on our clients from the sexual and gender minority populations to speak up and correct us. This creates distress and distrust creating barriers to therapeutic process and outcomes. Studies document that negative healthcare interactions can reinforce healthcare disparities and clients from sexual and gender minority populations will avoid care situations because of negative experiences.
Tessa: Inclusive LGBTQIA+ care is essential. Inclusivity makes it more likely that individuals will feel that there is a place for them in the health care environment, that providers not only accept but embrace their identities. LGBTQIA+ inclusivity makes it more likely that people will access health care, schedule appointments, come to their OT sessions, answer openly when asked about their lives, and establish trusting relationships with their providers. If individuals feel they are seen and heard for who they are, healing in health care settings is more likely to happen. Sometimes, being inclusive ensures that individuals will feel safe and willing to be vulnerable; other times it may literally save lives when it means that people access essential care.
Personally, as parent in a same-sex relationship, when my children’s providers have used inclusive forms, comfortably engaged me in conversation about my wife or the kids’ moms, I have felt safer and more fully seen, and more willing to partner up with the provider and share health related information about our family.
How might we unintentionally push heteronormativity in healthcare and what are some ways to amend that?
Ava: Some very simple yet damaging ways in which we may unintentionally push heteronormativity is through intake forms, electronic health records, and asking the patient questions while finding out information related to their sexual history. The manner in which the forms are written and the ways in which we ask the patient questions about their partner and past sexual experiences could reveal our heteronormative assumptions and biases. Change forms to include more than two genders for patients and for their partners. Similarly, modify your questions to allow for more variety. While screening for STDs and HIV, we may unintentionally push heteronormativity. In addition, we may unintentionally push cisnormativity in our practice by assuming, for instance, that transgender men do not need cervical cancer screenings due to their gender identity. The ways to amend this is by checking in with your patient, checking your assumptions, taking a thorough, inclusive, comfortable, culturally competent history, and keeping your focus on the client. Remember, if this is all new to you as you start your practice in the healthcare field, that is ok. You will not get it right and will make mistakes. This is okay. Keep trying.
Daphne: Pushing heteronormativity within healthcare involves assumptions that a heteronormative life and ideal is the default. This includes asking gendered questions with the expectation that a person is partnered as man with a woman and vice versa without consideration that there may be a variety of combinations such as man and non-binary person, woman and woman, trans person and non-binary person, etc. so that even asking a man if he has a “girlfriend . . . OR boyfriend” is not inclusive of the entire LGBTQIA+ community. Additionally, assuming a client’s partner is their spouse pushes the idea that people automatically want to get married or are married just because they’ve been together long-term. Of course there are many more examples but these are common ones that we can address by first considering why we are even asking a certain question, its importance, and how to ask it in a way that is inclusive and feels safe for the client to answer. Again, never stop learning! We must also check our assumptions, apologize when we are wrong, correct the behavior, and move on. Additionally, challenge the people around you — your coworkers, colleagues, administrators, other departments — to do the same in order to create a welcoming and inclusive team for all of our clients.
Karrie: We work in environments where it is assumed all people are cisgender and heterosexual. LGBTQIA+ people engage in additional assessment of environments to determine their safety. As a queer person I too conduct these environmental scans looking for signs that my identity is included, valued, and at minimum that I am safe to disclose. Adding safe space indicators such as pins, stickers, lanyards for your badge, and inclusive reading materials in waiting areas are very simple ways to suggest safety. Inclusive forms that allow for diverse gender identification, sexual orientations, pronouns and chosen names, and make clear anti discrimination statements are another way to communicate inclusivity. Subtle language shifts are warranted too, like “do you have a partner or spouse?” instead of making a gendered assumption like “do you have a husband or boyfriend?” Keeping your workplace culture inclusive means speaking up every time a colleague makes a homophobic, biphobic, and transphobic statement or joke.
Tessa: Given that we live in a heteronormative society, it is easy to let these ideas come out in our language, rituals and environment. For example, we might ask a woman with a ring about her husband, prioritize baby showers and engagements over other celebrations, make assumptions about how people celebrate mother’s day or father’s day, or feature only heterosexual families in our pictures on our website. Questioning our initial assumptions and being intentional about our language, rituals and environment to make sure it is inclusive is a first step to amending this.