Gender Inclusive Care Encourages a More Accessible Clinical Environment for LGBTQ+ Patients
By: Sristi Palimar
Each year, both local and national agencies report that LGBTQ+ youth in the United States are at increased risk for adverse health outcomes, including sexually transmitted disease, suicide, and unwanted pregnancy. While these reports describe a broad spectrum of health crises that affect queer youth in various ways, they reflect a common failure to overcome the exclusionary practices and stigmas that prevent LBGTQ+ individuals from accessing the healthcare they are entitled to. A 2017 literature review published in the National Library of Medicine found that the disparate quality of care affecting LBGTQ+ youth can be largely attributed to workplace stigma, limited social awareness among providers, and an overwhelming insensitivity to the specialized needs of queer patients. For nonbinary and transgender individuals, these barriers can exacerbate experiences of gender dysphoria and limit access to vital gender affirming care. Consequently, there remains an imminent need to implement gender inclusive healthcare practices for a more accessible future in medicine.
Gender dysphoria is a major driving force in what prevents transgender and nonbinary patients from seeking essential health services, from emergency intervention to routine check ups. Often a consequence of physicians’ failure to distinguish gender from sex, gender dysphoria can be understood as the mental and emotional distress that can manifest among individuals whose sex assigned at birth does not align with their expressed gender identity. Implicit bias lies at the root of physicians’ poor sensitivity to gender nonconforming patients. This phenomenon refers to the unconscious social attitudes one maintains towards people of certain marginalized identities, often resulting in their mistreatment and the perpetuity of harmful stigmas. In the hospital setting, physicians wield significant power over the gender dysphoria patients become vulnerable to, as they step into clinical environments that enable heteronormative standards of practice. While physicians may not intentionally inflict harm unto their transgender and nonbinary patients, incorrect pronoun usage, a lack of gender inclusive restrooms in office, and inappropriate assumptions of identity based on a patient’s assigned sex are among the many manifestations of harm that make doctor’s visits an uncomfortable experience for genderqueer patients.
In 2018, San Francisco University and Columbia University conducted a joint survey among nonbinary individuals regarding the satisfaction with health services among LGBTQ+ communities. Many respondents spoke to an overwhelming lack of accessible gender affirming and inclusive care, expressing the widespread sentiment that their providers lacked the knowledge and training necessary to accommodate LGBTQ+ populations. As a result, nonbinary patients were often left feeling both misunderstood and disrespected in the aftermath of their clinical encounters. When physicians are ill-equipped to provide the nuanced care LGBTQ+ populations require, trans and nonbinary individuals are not only dissuaded from the routine check-ups every individual should have access to, but are deprived of the gender affirming healthcare options they might be eligible for. Consequently, gender nonconforming communities find themselves not only overlooked, but drastically underserved by their local health services.
The apparent inaccessibility of these essential resources is leaving LGBTQ+ patients vulnerable. Access to gender affirming care is imperative to the emotional health and wellness of trans and nonbinary patients. A new study from the Williams Institute at UCLA School of Law found that transgender adults were eight times more likely to experience non-suicidal self-injury, seven times more likely to envisage suicide, and four times more likely to make an attempt at their lives, compared to their cisgender counterparts. What’s more, nearly one-third of transgender individuals engage in what they recognize as deleterious alcohol and drug use. These statistics point to an unsurprising, but nevertheless disheartening reality: when gender nonconforming people don’t feel respected or understood by their provider, they are less likely to seek out the healthcare resources they need. Thus, the exigency for gender inclusive medical care is imminent among vulnerable trans and nonbinary populations without the support to navigate mental health and substance abuse crises.
Healthcare providers must embrace the onus to establish gender inclusive standards of practice in the clinical setting. Dr. Daniel Shumer, clinical director of the Child and Adolescent Gender Clinic at the University of Michigan, outlines several key principles care teams can implement to uphold gender affirming care. Among them, using patients’ preferred names and pronouns, regularly addressing gender identity as part of patients’ routine visits, and familiarizing oneself with local LGBTQ+ resources can help build solidarity with and better support for gender nonconforming patients. Likewise, encouraging cis-gender staff to advertise their pronouns on name tags and incorporating LGBTQ+ inclusive messaging in the clinical space can help visitors feel as though their gender identity is valued by their provider.
The urgent need for gender inclusive care stems from an overwhelming lack of LGBTQ+ resources and sensitivity among clinics and their providers. Simple practices to overcome implicit biases surrounding sex and gender identity can go a long way to make healthcare more accessible to marginalized LGBTQ+ populations. In doing so, providers are able to create a clinical environment that not only welcomes all forms of gender expression, but better serves the needs of their local queer community.
Sristi is a 3rd year Human Biology and Society student and THINQ fellow.
Sources:
https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria
https://williamsinstitute.law.ucla.edu/press/transpop-suicide-press-release/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478215/
https://www.michiganmedicine.org/health-lab/putting-gender-inclusion-practice
