Hidden discrimination against LGBT individuals in healthcare refers to prejudice and bias that may occur without direct conscious intent. This type of discrimination is often subtle and difficult to identify, and it affects access to care, quality of care, and patient outcomes. Here are three main contributing factors:
1. Systemic Mechanisms: Healthcare systems are influenced by policies, laws, regulations, organizational structures, cultural norms, values, beliefs, power dynamics, and social context. These can create barriers for LGBT patients and providers, such as lack of appropriate training, limited resources, unequal pay, and insufficient representation.
Many healthcare organizations do not have explicit non-discrimination policies regarding gender identity or sexual orientation, which can lead to implicit biases that impact patient care.
Some providers may be uncomfortable treating LGBT patients due to their own personal beliefs or societal attitudes.
2. Institutional Mechanisms: Organizational culture plays an important role in creating or perpetuating hidden discrimination. Lack of leadership support, poor communication, and inadequate data collection/analysis can all contribute to this issue. Heteronormative assumptions about family structure and relationships can also limit access to care for LGBT patients.
Certain practices (such as asking about partner status or using heterosexual pronouns) may reinforce stereotypes and exclusionary behaviors.
3. Interpersonal Mechanisms: Individual interactions between providers and patients can have a significant impact on trust, engagement, and quality of care. Providers who hold negative views of the LGBT community may exhibit subtle prejudice through microaggressions, language use, body language, tone of voice, facial expressions, and other nonverbal cues. This can result in missed diagnoses, delayed treatment, incorrect prescriptions, and inappropriate referrals. To address these issues, healthcare organizations should implement comprehensive training programs, develop inclusive policies, establish diverse leadership roles, collect data, analyze trends, advocate for changes, and create safe spaces for LGBT patients and providers.