LGBTQ+ Healthcare

LGBTQ+ Healthcare

Your guide to building an inclusive practice

Selinda Berg; Scott Cowan; and Ashlyne O'Neil

Contents

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Acknowledgements

The first version of this resource was created by Dr. Selinda Berg and can be found here.

This adapted resource was created in partnership with eCampusOntario and the University of Windsor Office of Open Learning, and in consultation with Trans Wellness Ontario and ______.

This project is made possible with funding by the Government of Ontario and through eCampusOntario’s support of the Virtual Learning Strategy. To learn more about the Virtual Learning Strategy visit: https://vls.ecampusontario.ca.

 

 

 

 

 

We would also like to acknowledge the history and guardianship of the place in which we were able to complete this project. As white settlers in the Windsor-Essex community, we live and work on the traditional lands of the Three Fires Confederacy of First Nations, comprised of the Ojibwe, the Odawa, and the Potawatomi Peoples.

You can read a brief history here: https://windsorite.ca/2021/06/honouring-indigenous-history-month/

Treaty 35 – Huron-Wendat (LaSalle/Amherstburg): https://www.ontario.ca/page/map-ontario-treaties-and-reserves#t24 & https://www.thecanadianencyclopedia.ca/en/article/huron

Treaty 2 (Mckee Purchase): https://www.ontario.ca/page/map-ontario-treaties-and-reserves#t6 & https://www.rcaanc-cirnac.gc.ca/eng/1370372152585/1581293792285#ucls4

 

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Accessibility Statement

This Pressbook and embedded content was developed to meet AODA requirements according to the W3C guidelines for web accessibility.

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Why LGBTQ+ Health?

LGBTQ+ as a health disparity population

Lesbian, gay, bisexual, transgender, and questioning (LGBTQ+) individuals experience high rates of health disparities.

As a result of social stigma and discrimination, LGBTQ+ people report higher rates of mental health challenges, anxiety, and depression:

  • LGBTQ+ youth are up to three times more likely to attempt suicide than their heterosexual, cisgender peers. In an Ontario-based study, 47% of trans people aged 16-24 recently considered suicide, and 19% had attempted suicide in the past year.
  • Racialized LGBTQ+ individuals have mental health needs nearly 5% higher compared to non-racialized LGBTQ+ people.
  • Due to the high burden of mental and emotional distress arising from the challenges and obstacles not experienced by heterosexual, cisgender population, coping behaviours that include tobacco, alcohol and drug use are more prominent in the LGBTQ+ communities.

Transgender and non-binary people populations face many of the same health-related challenges that other members of the LGBTQ+ community face, while experiencing greater barriers to social inclusion and higher rates of discrimination and stigma.

Health care providers have a role in identifying and addressing these disparities. The biases of medical providers encountered in health care settings can contribute to these disparities. Due to discrimination, harassment and barriers to equitable health services, LGBT2SQ communities experience:

  • higher rates of mental health concerns, including depression, anxiety and substance use;
  • lower screening rates and higher rates of certain cancers and chronic conditions; and
  • disproportionate rates of HIV among men who have sex with men and certain segments of the trans population. These rates are exacerbated by social and systemic issues such as HIV stigma, poverty, and anti-LGBT prejudice.

Again, transgender people face further barriers to accessing necessary transition-related care and services are associated with poorer mental health and high rates of suicidality.

 

These stories are all too common. People who identify with the LGBTQ+ community…

This video below is just to illustrate an idea! It’s not CC and we wouldn’t use it… just an idea for the intro piece! 

One or more interactive elements has been excluded from this version of the text. You can view them online here: https://ecampusontario.pressbooks.pub/inclusivehealth/?p=72#oembed-2

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Module Language and Disclaimers

dyke

As we present more about terminology, concepts, and word choice, it is important to emphasize that it is critical that health care professionals listen carefully to their patients for individual needs. As noted, each individual is unique. There is no singular experience and in turn, there is no singular term that will work for all individuals. As such, you must listen.

One specific example of this is the term “queer”. This is a term that is embraced by some and rejected by others. Historically the term “queer” was used as an anti-LGBTQ+ term. It has since been embraced by some members of the LGBTQ community; however, it is imperative to recognize that the selection to use or not to use that term, is the choice of each LGBTQ+ person.

Listen carefully to patients to the terms that they use for their identity. If you have a question, ask the individual respectfully and ensure that you follow their direction consistently.

Disclaimers:

We acknowledge that there is no way to represent the entirety of all healthcare experiences for those who identify as part of the LGBTQ+ community. It is our hope that this resource be used, adapted, revised, and updated as much as possible for, and by, those that use it to keep the work moving forward.

The LGBTQ+ community is diverse. While L, G, B, T, and Q are usually tied together as a single homogeneous entity, each letter represents a wide range of people of different races, ethnicities, ages, socioeconomic statuses and identities (National LGBT Health Education Centre, 2019). Unfortunately, experiences of stigma and discrimination are a common theme that transcends across the entire LGBTQ+ community. While discrimination exists across the community, the manifestations of oppression and discrimination are not a singular occurrence or experience. One area in which there is a long history of discrimination and lack of awareness is within the health care sector.

The content presented here was created by and in collaboration with members of the LGBTQ+ community. The faculty lead and all collaborators have shared their experiences as members of this diverse community, building a starting point for medical students to consider how they can build an inclusive practice. Because of the incredible diversity within this vast community, the context is presented from not all experiences and perspectives of the LGBTQ community are captured here. The creators have done their best to incorporate feedback from others and are committed to continuing to learn and improve.

At this time we are working with an expanded community to move this content forward in an informative, respectful, well-informed, and meaningful way. Those creating this content are reflected here and are deeply committed to making this content stronger. We truly welcome feedback about how we can continue to evolve this module to further strengthen this content.

– Sincerely, 

Dr. Selinda A. Berg 

Progress Pride Flag

Red, orange, yellow, green, blue, and purple rainbow pride flag with an additional a chevron along the hoist that features black, brown, light blue, pink, and white stripes.

As discussed above, those in the LGBTQ+ community who are members of further marginalized groups (e.g., transgender people, people of colour, people with disabilities) experience greater disparities. Increasingly the Progress Pride Flag (image below) is being used to bring focus on diversity, equity and inclusion within the LGBTQ+ community. This flag designed in 2018 brings focus to those who experience further marginalization within the LGBTQ+ community.

Alternative Pride Flags 

In 2021, there was an update made to the Progress Pride Flag to better represent the intersex community. The update, in multiple forms, further increases visibility and works towards better inclusivity within the community.

Intersex-inclusive pride flag with additional yellow stripe with purple circle, to the right of the black Intersex-Inclusive progress pride flag with purple and yellow circle looping through the trans, brown, and black chevrons Intersex-inclusive pride flag with additional yellow chevron and purple circle to the left of the trans chevrons

Media Attributions

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Module Outline

There is no such thing as a lesbian knee, or a lesbian armpit, or a lesbian neck — at least I’ve never dated one — but each human being comes to health care with context and a story, and they are both vitally important.

The above quote from Kelli Dunham emphasizes that one of the key elements to ensuring inclusive and culturally sensitive care to members of the LGBTQ+ community is understanding and respecting their context and story.

For many members of the LGBTQ+ community, their gender and sexual identity are key elements influencing their stories.

Using four (4) case studies, this module will:

By the end of this module, successful students will be able to:

  • describe how physicians’ understanding and respect for patients’ sexual and gender identity can improve care and decrease disparities for members of the LGBTQ+ community.
  • explain the differences between gender identity, gender expression, biological sex, and sexual identity and terms related to these concepts.
  • identify strategies for providing more inclusive and culturally sensitive care for members of the LGBTQ+ community.

 

Each case will illustrate the experience of someone who identifies as LGBTQ+ seeking health care in Canada. You will be presented with some background information about the patient, and then observe an interaction, identifying red flags that may be addressed. An alternative experience will be presented to help identify inclusive practices, followed by the key takeaways.

 

Infographic depicting the four stages of the cases as described above.

Media Attributions

  • CaseStructure2 © Ashlyne O'Neil

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Key Concepts

An interactive H5P element has been excluded from this version of the text. You can view it online here:
https://ecampusontario.pressbooks.pub/inclusivehealth/?p=100#h5p-2

 

Reflective Exercise

Looking at the concepts above consider your own identity and expression within these categories.

  • Is this a difficult exercise?
  • Can you find the words to capture the nuances of your identity?

Consider also those in the case studies. Each individual is unique and valid. The identity, expression, sex, and orientation of an individual must be respected and cannot be criticized.

 

An interactive H5P element has been excluded from this version of the text. You can view it online here:
https://ecampusontario.pressbooks.pub/inclusivehealth/?p=100#h5p-1

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Cases

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Case #1: Non-binary Teen

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Case #2: Lesbian Woman

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Case #3: Gay Man

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Case #4: Transgender Person

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Addressing Attitudes, Beliefs and Biases

As underlined early in this module, the LGBTQ+ community experiences significant health disparities, including higher rates of depression, anxiety, suicidality, tobacco use, and substance use disorders.

An important way for physicians to reduce disparities is to recognize and address their own biases. We need to acknowledge that we are all vulnerable to biases. The most detrimental response is to deny or avoid our biases because they make us feel uncomfortable. In contrast,  the only way to “change our thoughts and behaviour is to acknowledge our biases, become curious about them, and practice ways to transform them” (National LGBT Health Education Center, 2018).

When we notice prejudicial attitudes and beliefs arise in ourselves, we should pause and really consider:

  • why do I hold these beliefs?
  • how do these beliefs serve me?
  • how might it benefit me and others to change this perspective?

The National LGBTQIA Health Education Center provides two exercises to assist health care professionals to reduce implicit bias.

Individuating

Individuating is the process of focusing on specific information about an individual, as opposed to categorizing someone based on their social, racial, or other group belonging. The example used by the LGBT Health Education Centre is

“when we learn that a new patient is a transgender man, do we only think about his gender identity and when he transitioned, or can we think about how he is new to town and started working at the local library? “

Consider how assumptions can be set aside in order to get know a person just as they are right now.

Perspective -Taking

In contrast, perspective-taking involves taking another person’s viewpoint intentionally. For example, try to imagine what it might feel like to be this particular patient who is LGBTQ+.

  • What might this person be worried about?
  • What might they be anxious about?
  • What are they looking for?
  • What might they be hoping to receive from me?

 

*Source: National LGBT Health Education Center. (2017). Learning to address implicit bias towards LGBTQ Patients: Case Scenarios. Boston, MA. Available at http://www.lgbthealtheducation.org/publication/learning-to-address-implicit-bias-towards-lgbtq-patients-case-scenarios/

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Additional Readings and Resources

General Resources:

Canadian Centre for Gender and Sexual Identity. (2020). CCGSD Queer Vocabulary. Available at: https://ccgsd-ccdgs.org/wp-content/uploads/2020/11/CCGSD-Vocabulary.pdf

LGBT Health Education Centre. (2018). Learning to Address Implicit Bias of LGBT patients. Fenway Institute. Available at: https://www.lgbthealtheducation.org/wp-content/uploads/2018/10/Implicit-Bias-Guide-2018_Final.pdf

Wittlin, N. M., Dovidio, J. F., Burke, S. E., Przedworski, J. M., et al. (2019). Contact and role modeling predict bias against lesbian and gay individuals among early-career physicians: A longitudinal study. Social Science and Medicine, 112422. Available at: https://www-sciencedirect-com.proxy1.lib.uwo.ca/science/article/pii/S0277953619304162

Case One:

Singh, A. A., Meng, S. E., & Hansen, A. W. (2014). “I am my own gender”: Resilience strategies of trans youth. Journal of counseling & development, 92(2), 208-218.
Available at: http://resolver.scholarsportal.info.proxy1.lib.uwo.ca/resolve/07489633/v92i0002/208_amogrsoty.xml

Case Two:

Wilkens, J. (2015). Loneliness and belongingness in older lesbians: The role of social groups as “community”. Journal of Lesbian Studies, 19(1), 90-101.
Available at: http://resolver.scholarsportal.info.proxy1.lib.uwo.ca/resolve/10894160/v19i0001/90_labioltrosga.xml

Case Three:

Perrin, E. C., Hurley, S. M., Mattern, K., Flavin, L., & Pinderhughes, E. E. (2019). Barriers and stigma experienced by gay fathers and their children. Pediatrics, 143(2), e20180683. Available at: https://pediatrics-aappublications-org.proxy1.lib.uwo.ca/content/143/2/e20180683

Case Four:

 

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Appendix

This is where you can add appendices or other back matter.

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Glossary of Terms

dyke

a word historically used as a slur against masculine, butch, or androgynous lesbians.

has been reappropriated by some queer or lesbian woman to imply assertiveness and toughness.