Subtle Discrimination Against LGBT Patients
Many healthcare providers are well aware that it is illegal to deny medical care based on someone's race, ethnicity, gender identity, religion, disability, or any other protected status; however, they may be less knowledgeable about their obligations regarding sexual orientation and gender expression. According to a study published in the Journal of Sexual Medicine, nearly half of lesbian, gay, bisexual, transgender, and queer patients have experienced discrimination from a doctor or another member of the healthcare team in the past year, and many avoid seeking healthcare because of this mistreatment. This can lead to serious delays in diagnosis and treatment for potentially life-threatening conditions. It can also create mistrust between patients and their doctors, leading to worse outcomes overall. In this article, we will examine how structural and interpersonal mechanisms perpetuate subtle discrimination against LGBT patients and discuss ways institutional reform can address them.
Structural Mechanisms
One way that structural mechanisms perpetuate subtle discrimination against LGBT patients is through the lack of inclusive policies and training programs. Many hospitals and clinics do not have explicit policies prohibiting discrimination based on sexual orientation or gender identity, nor do they offer staff training on working with these populations. Even when such policies exist, they may not be strictly enforced, leaving room for individual prejudices to come into play.
Many insurance companies still categorize services related to gender affirmation as cosmetic rather than medically necessary, making it difficult for some individuals to access care even if they can afford it.
Interpersonal Mechanisms
Another way that interpersonal mechanisms perpetuate subtle discrimination against LGBT patients is through microaggressions. These are small, often unintentional, actions or comments that demean or marginalize someone based on their identity. Examples include assuming someone's gender identity without asking, referring to a person by their deadname (the name they used before transitioning), using incorrect pronouns, or asking intrusive questions about their personal life. Microaggressions can make people feel invalidated and unwelcome in healthcare settings, leading them to avoid seeking care altogether.
Addressing Structural and Interpersonal Mechanisms
To address structural mechanisms of subtle discrimination against LGBT patients, institutions should develop explicit policies banning discrimination based on sexual orientation and gender identity, provide staff training on working with these populations, and ensure that all insurance plans cover medically necessary gender-affirming treatments. To address interpersonal mechanisms, providers should take steps to create a welcoming environment for LGBT patients, including asking patients about their preferred pronouns and using them consistently, using non-intrusive language when discussing sensitive topics, and respecting privacy boundaries.
While many hospitals and clinics have taken steps to become more inclusive of LGBT patients, there is still much work to be done. By addressing both structural and interpersonal mechanisms of subtle discrimination, we can create a healthcare system where everyone feels welcome, safe, and respected, regardless of their sexual orientation or gender identity.