Common microaggressions/homophobia in medical practice

Discussion in 'LGBTQ' started by foreverbull, Aug 18, 2017.

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  1. foreverbull

    foreverbull 2+ Year Member

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    One thing I've seen over and over when getting medical care is because some people may "look straight," medical professsionals almost always assume their romantic partner is of the opposite sex when asking basic questions about sexual history, relationship status, etc. This is such an easy fix to make the questions gender neutral and/or just not assume sexual orientation! It seems minor in the moment, but when it happens over and over for a person who is LGBT, it can be frustrating (and is considered a microaggression). I've experienced it many times and I get tired of having to correct people. Just something to think about in your practice!

    Having said that, in my experiences getting care from multiple doctors and nurses in a medical crisis, most didn't react or care when I would out myself or when my partner was with me. However, one nurse was obviously bothered by the fact that my partner was of the same sex, so much so that he told my partner to wait in the lobby while I was in the ICU while the doctor met with me (I was unaware of what was going on at the time and my partner was pissed and just eventually ignored him and came back). The other nurses apologized for him and called him "old school" which is a nice way of saying homophobic. His behavior was discriminatory, and I don't live in a small town but a metropolitan area well-known for being LGBT friendly. I wonder if I should have filed a complaint about him or could have, but it's too bad to see that this is still happening in the medical field, especially at a time when I was physically/mentally vulnerable and should've had my partner with me. I hope this can be a cautionary tale for folks to not let their personal biases be an excuse to discriminate and provide substandard (unequal) care. Also for the rest of folks, to call it out when colleagues engage in it and do your best to remedy it if you see it happening (rather than just apologize after the fact) because your patients will remember it.
     
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  3. ZedsDed

    ZedsDed Avoiding Facebook Gold Donor 2+ Year Member

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    Sorry, I don't quite follow. How did you know the nurse was bothered by your sexuality?
     
  4. foreverbull

    foreverbull 2+ Year Member

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    My partner told the nurse about being with me (my partner had sat with me in the ER office with no issues and followed me up to the ICU with a different nurse) and then was asked to sit in the lobby and given a bs reason for why that needed to happen (I don't recall his explanation that my partner reported, just that whatever he said was going to take place that required my partner to leave the room didn't really take place). The doctor just talked to me, and my partner had been present the entire time up until that point and was present the rest of the time thereafter.
     
  5. ZedsDed

    ZedsDed Avoiding Facebook Gold Donor 2+ Year Member

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    Your interpretation seems pretty uncharitable. Perhaps talk to the guy? I agree with you that discrimination has no place at work, but we have a responsibility to not throw around career-destroying accusations willy-nilly.
     
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  6. foreverbull

    foreverbull 2+ Year Member

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    I never identified him or filed a complaint, so I didn't "throw around career-destroying accusations." Keeping in mind that if he had chosen to continue to keep my partner from me and something had happened to me (i.e. death), he would have caused unnecessary suffering, and this would've been a much bigger issue. Luckily it wasn't, I'm just saying that it's inappropriate to treat patients differently based on sexual orientation when it comes to whether a loved one can be in the room or not, because he was the only nurse who asked my partner to leave, and it was under false pretenses. My point was to say that I hope folks can learn from this and call it out when they see it as medical professionals. I'm not sure how that makes my view "uncharitable."
     
  7. sb247

    sb247 wait...you mean I got in? 5+ Year Member

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    your partner should not be kept away from you because of orientation if that is why it happened

    given the percentages of the population it is actually statistically reasonable to assume someone is heterosexual, someone shouldn't be mean if they are corrected though

    *edit....shouldn't be mean, autocorrect
     
    Last edited: Aug 18, 2017
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  8. foreverbull

    foreverbull 2+ Year Member

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    True, statistically, but it's still a microaggression because it furthers the invisibility of LGBT populations by not even asking the question. "The processes of erasure in information production and dissemination and in institutional protocols, practices, and policies create a system that produces further social marginalization of LGBT people, which creates inequities in health…" (JAMA, 2009). In my psychology practice, I ask directly about sexual orientation and gender identity during intake and never assume with clients.

    Simple fix: "...and your partner is male/female/trans?", and let the patient identify. It's just a quick follow-up that would take 2 seconds after you asked if the person was in a relationship. I think not assuming is a reasonable request, as assumptions aren't always helpful or good practice.
     
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  9. sb247

    sb247 wait...you mean I got in? 5+ Year Member

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    I really think you are making a bigger deal of the question than is necessary, it's understandable as the person appeared to have also acted in an unreasonable manner toward your partner. I don't necessarily see the two issues as related but we may just have to agree to disagree on assumptions.

    I'm sorry you and your partner had a negative experience
     
  10. foreverbull

    foreverbull 2+ Year Member

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    I appreciate that. I was speaking to two separate issues, one was the assuming as a microaggression, and the other was the nurse, which I was not speaking to in my response to you.

    As I said, a simple fix with the question would be more friendly and inclusive of LGBT folks. Could go a long way in helping those folks feel more comfortable. Not unreasonable by any stretch!
     
  11. DizzyJon

    DizzyJon PA-C/Doctor of Health Science 10+ Year Member

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    By your own statements you said he was asked to leave the room because something (idk a procedure?) was going to take place and then this didn't take place. Is it possible the nurse was really needing the room to do something? Why did you feel the need to out yourself to "multiple doctors and nurses"? Did your sexual orientation have an association with the medical condition needing treated? Yes, I can find it annoying at times people assume I have a wife and not a husband, but I don't in any way find that to be "microaggression". I just follow up and say "I have a husband" and simply correct them. Working ER/urgent care sexual orientation is rarely relevant to the patient care unless STI/rectal/vaginal complaint. When I worked psych it was more relevant.

    Our EHR now has a section specific for sexual orientation and preferred pronouns.
     
  12. linearbbq

    linearbbq SDN Moderator 2+ Year Member

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    Just going to put it out there that by definition microaggressions are often unintentional (e.g., assuming that a patient is straight when they are not), and are so subtle that they are easy to dismiss as unrelated to bias. Any one of these incidents could be explained away, but when a person experiences similar incidents multiple times in different contexts, taken as a whole it's difficult to argue that there isn't a pattern of marginalization.

    The fact that it's possible to brainstorm alternate explanations for the nurse's behavior (maybe he thought there would be a procedure, maybe he needed the room, etc.) is what makes this a microaggression. Given that "other nurses apologized for him and called him 'old school'", it sounds like his colleagues certainly knew what was up and did not think that it was innocuous.
     
  13. 12glaucoma34

    12glaucoma34 Banned Banned Account on Hold

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    Are you serious? Asking every patient if they or their partner is male/female/trans would be viewed as a MACROagression by many many many patients, I could absolutely see this not going over well and be outright offensive to some. Additionally, it would be annoying for many others and serve as a distraction frequently for the chief complaint. The percentage of individuals in the LGBT demographic is minuscule small compared to the general population of heterosexual individuals. Your fix isn't simple and would receive pushback from many patients, unnecessarily introducing this topic would certainly take more than two seconds.
     
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  14. 12glaucoma34

    12glaucoma34 Banned Banned Account on Hold

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    Your "simple" fix would be more "friendly and inclusive" of LGBT and be considered much more offensive to many non-LGBT folks. Discussing biases, you are clearly biased to catering to this community regardless of how it impacts anyone else.
     
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  15. 12glaucoma34

    12glaucoma34 Banned Banned Account on Hold

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    Exactly. The need to "out yourself to multiple doctors and nurses" likely wasn't necessary to the medical care being provided, perhaps the OP was looking for someone who wasn't accepting. If a healthcare professional assumes wrongly, politely correct them, move on. The great majority of healthcare providers don't care. I have stated my beliefs on LGBT in another post, but it doesn't impact how I will treat you or the care you will receive.
     
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  16. 12glaucoma34

    12glaucoma34 Banned Banned Account on Hold

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    Almost certainly. Some people are jerks. An individual does not have the right to mistreat anyone else simply because they don't agree with their lifestyle. If I was an employer and could prove he acted with those intentions, I would slash his hours to the bare minimum so he couldn't collect unemployment.
     
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  17. foreverbull

    foreverbull 2+ Year Member

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    It's offensive to not assume? I'd like to see the studies to back that up or personal experiences with testing this out with several patients instead of making assumptions that it would offend straight folks.

    Shows a complete lack of understanding of the issue. "Catering to this community" is laughable because that isn't even what I was asking for.

    I outed myself only when necessary (i.e. if I wanted my partner with me and medical professionals didn't understand the relationship). You're again making assumptions. It sounds like in your mind I'm somehow running around with a pride flag telling people that they need to be culturally-sensitive all the time and trying to get people fired. Hardly. Your extreme views are concerning.

    Please stop trolling this forum.
     
  18. foreverbull

    foreverbull 2+ Year Member

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    I didn't out myself on purpose...only when they didn't understand my partner being there. I'm actually very cautious about outing myself in general.

    I see that you have a different perspective. I'm glad to hear that EHR is more current!
     
  19. 12glaucoma34

    12glaucoma34 Banned Banned Account on Hold

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    I'm not extreme, you are more interested in playing politics and engaging in name calling than advocating for the LGBT community. And again, I'm not sure why T is in the same community as LGB as there are way way way more differences. I know people in my community and region very well, I don't need a study to tell me many of them would find this offensive and/or annoying. I also don't need a study to tell me that my female cousins and other female friends are not ok with a biological male changing in their dressing room. Not everything requires a study. Also, there is no solid evidence that sex reassignment surgery is effective in treating transgender, but that doesn't stop people like you from advocating for it.
     
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  20. mvenus929

    mvenus929 10+ Year Member

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    I work with kids. When working with adolescents, we are careful about taking a sexual history, not only because adolescents frequently lie, but also because their identity (as gay, straight, whatever) may not align with their behaviors. Most teens look at me weirdly when I ask the 'men, women, or both' question, but once I explain that I try not to make assumptions by looking at a person, they shrug and we move on. The guys tend to guffaw more than the girls.

    I'd personally rather not be in a dressing room with anyone, because I'm very self conscious about my body. But I'd feel even less comfortable with someone who looked like a man changing next to me compared to a female-appearing individual.

    There is at least one study that shows that inclusive treatment prevents a lot of the major mental health complications of trans individuals. The paradigm is shifting towards earlier treatment, which means it's difficult to make comparisons between the adult trans community and the current adolescent community that started transitioning much younger. And not everyone wants surgery.
     
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  21. 12glaucoma34

    12glaucoma34 Banned Banned Account on Hold

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    When taking a sexual history, it is important to ask about that stuff, but for other encounters not requiring that kind of information it seems best to assume heterosexual as I have had far more patients become agitated or at least annoyed because they thought I may be making judgments about them (far more than the amount of T or LGB patients seen).

    The thought of allowing teenagers to transition is terrifying and irresponsible IMO. Being a teenager alone is confusing enough and allowing these individuals to start hormone therapy on their developing body may be dangerous. The combination of being a teenager, transgender, and the associated co-morbid psychiatric conditions nearly all transgenders experience makes me think starting with addressing the transgender aspect as a teenager is the wrong approach. There are no studies showing hormone replacement in children is safe.
     
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  22. AttemptingScholar

    AttemptingScholar

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    If an anecdote can contribute to this conversation in any way, I carefully paid attention to whether my physicians used inclusive language like foreverbull is suggesting. If they did, I told them the truth and asked my pressing questions that I wanted a physician to answer. If they didn't, I lied and tried to find out the answers later through Google or my teenaged friends.

    Straight people may be annoyed for not being assumed to be straight.
    Non-straight people may receive suboptimal healthcare for being assumed to be straight.

    Just my two cents.
     
  23. Beautiful Sunset

    Beautiful Sunset Banned Banned Account on Hold

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    Suboptimal care. OMG, for realz?
     
  24. Panthersfan25

    Panthersfan25

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    What is the solution to these microaggressions? Assume everyone is LGBTQIA until proven otherwise?
     
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  25. Kkshake

    Kkshake

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    If it makes you feel better, at my school when taking a sexual history we are taught to ask "do you sleep with men, women, or both?"
     
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  26. Mad Jack

    Mad Jack Critically Caring Gold Donor 2+ Year Member

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    Historically, only family and spouses would be present for care conversations out of concern for privacy. Many older doctors stick to that principle today. It could have been less discrimination based on your sex and more him just thinking that wasn't your spouse so it wasn't appropriate to have a confidential conversation with them present. Until seven years ago, physicians weren't allowed to have confidential conversations in many hospitals with anyone but family or spouses present (including opposite or same sex partners that they are not married to), so many older docs still have that idea stuck in their head due to years of being forced to comply with it. You'll never know unless you address it, but I generally assume the best until proven otherwise.
     
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  27. Panthersfan25

    Panthersfan25

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    Based on what is most likely, assume non-LGBTQIA seems like the best approach unless working somewhere that has a high LGBTQIA population.
     
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  28. Mad Jack

    Mad Jack Critically Caring Gold Donor 2+ Year Member

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    Yeah, basically if you don't make the relationship of someone in your room clear to your care providers, they'll have no clue and assume they are not family or a spouse (regardless of their sex) unless you state otherwise. Avoiding both breaking HIPAA and offending patients is a difficult balancing act. These days anyone can be in your room- you could tell me the guy was your mother****ing dog walker and that you trusted them with your life because they once saved your terrier from a storm drain and you just can't bear being without them in your time of need and I'd be like, whatever dude, they can stay, that's between you and them, idgaf.
     
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  29. Mad Jack

    Mad Jack Critically Caring Gold Donor 2+ Year Member

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    I never assume. Always ask if it is okay if a person stays, as that person that looks like their grandson might be their husband for all you know, and you really don't want that egg on your face. I've seen some real foot in mouth moments by attendings back at my old job in the ICU all because of assumptions.
     
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  30. Panthersfan25

    Panthersfan25

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    Yes, but at some point we can't prioritize things like the sexual preference and gender preference of people above all else. Unless it pertains directly to care, I'm not to concerned about "egg on face" as I simply apologize and move on.
     
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  31. mvenus929

    mvenus929 10+ Year Member

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    Or just don't make assumptions. Ask who everyone in the room is. Use neutral terms--'partner' rather than boyfriend or girlfriend.

    It's not a bad practice in general. I tell people I'm an army brat all the time, and the vast majority of people assume that my dad was army, when my mom was (and my dad's a nurse). I always appreciated the people who asked 'oh, what does your parent do?' rather than 'oh, what does your dad do?' Or when someone talks about their doctor, using the singular 'they' to refer to the person, rather than assign 'he' or 'she'. Not the same as assuming sexual orientation/gender identity, I admit, but it's a more common example that straight cis people can relate to.

    Most people won't notice the subtlety, but those that care will appreciate it.
     
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  32. Panthersfan25

    Panthersfan25

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    Asking, "who is this" is the best approach. No assumptions are made and it gives the patient the option to tell you as much or little as they want.
     
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  33. AttemptingScholar

    AttemptingScholar

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    Agree with above, just no assumptions. Like statistically, assuming heterosexuality is gonna be right more often. But the solution set out in the original post works for everyone! Plus, it's more precise and better represents what we mean--and anyone with a science background can appreciate that!


    Some examples for future readers of this thread:
    "Do you have a husband?" versus "Are you in a relationship?"
    "Have you started having sex? Does he use a condom?" (I get this one from my doctor) versus "Do you understand how contraceptives and prophylactics work?"

    For both of these, it has the gender-neutralness that foreverbull and I are suggesting, doesn't assume straight or LGBT+ (so you aren't forced to pick!), and is more precise. "Is he using a condom?" is great for pregnancy worries, but if the teenage girl and her boyfriend are experimenting in different ways, she might be looking for an opening to ask about dental dams, y'know?
     
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  34. Nephro critical care

    Nephro critical care 2+ Year Member

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    Best to assume heterosexuality unless the person in front of you is obviously LGBTQ. And although I am straighter than an arrow I can pretty much always tell who is LGBTQ. I also live in a very conservative area of the United States and if I asked an obviously straight person if he was married to a woman or a man I would get punched in the face.
     
  35. Kkshake

    Kkshake

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    Since my school requires it, I just phrase as these are mandatory questions that we are required to ask everyone and are not meant to offend you
     
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  36. fantasty

    fantasty 10+ Year Member

    Not picking a fight... but you *think* you can pretty much always tell who is LGBTQ. I *think* I can pretty much always tell what race someone is. But, sometimes I'm wrong. So, it's best not to make assumptions, regardless of how conservative the area or the obvious the straightness.

    Note: I don't always practice what I preach, but I try to... and yes, I've been physically threatened by asking the question in the "wrong" way... but in my defense, it was a freakin' STD clinic... It was vital information pertinent to the visit *AND* obvious that we asked everything in the same way for everybody.
     
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  37. sb247

    sb247 wait...you mean I got in? 5+ Year Member

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    That’s really crappy. No one deserves to be physically threatened like that
     
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  38. fantasty

    fantasty 10+ Year Member

    Well, it's hardly the worst thing that's ever happened to me at work. A homophobic guy with an STI saying "I'm gonna pound you" is better then being spit on, pushed, or punched. (Granted, most of that was from intoxicated or psych pts).
     
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  39. Nephro critical care

    Nephro critical care 2+ Year Member

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  40. foreverbull

    foreverbull 2+ Year Member

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    People wrongly assume I'm straight all the time, hence why I posted this thread. Stereotypes don't always work and can be damaging if that's the only way people believe LGBT people can look/act. I would be very careful about making assumptions.
    If I wrongly assumed gender/sexual orientation in my line of work (psychology), I could easily lose clients because I would appear uninformed and unaware of gender/sexuality issues, and building rapport quickly is hugely important in therapy.
    The medical field may be different in terms of cultural competence education/expectations than clinical & counseling psychology, but I think that the medical field is starting to catch on, which is promising.

    As far as asking questions go, I think there are multiple ways around it other than just having to ask if the partner is female/male/etc. to avoid making assumptions. That's just one option that is more direct. You could let the patient identify the gender of their significant other in more indirect ways.

    It's interesting to hear about everyone's experiences, for sure.
     
  41. ZedsDed

    ZedsDed Avoiding Facebook Gold Donor 2+ Year Member

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  42. foreverbull

    foreverbull 2+ Year Member

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    In the field of psychology, microaggressions are difficult to study, but that doesn't negate their existence or potential for harm. Just as a side note, the article you refer to is more of an opinion piece of one scholar, but it does highlight some of the difficulty in researching microaggressions due to their subtlety. However, Lilienfeld makes an overly-reductive argument that essentially attempts to invalidate the existence of microaggressions simply because they are harder to study.
    Derald Wing Sue, an eminent scholar and theorist in multicultural counseling/psychology, offered a rebuttal here: https://rampages.us/jlelswick/wp-content/uploads/sites/7277/2017/02/Derald-Wing-Sue-article.pdf
    Other scholars offer another rebuttal: https://static1.squarespace.com/sta...f314f1a9a13/1504505800667/ong-burrow-2017.pdf

    While microaggressions are challenging to study, psychologists are working on better ways to quantify and research them. Qualitative research is probably the easiest way to study them at present because it is more in-depth, but scholars are also creating scales/psychometric measures for quantitative analysis (i.e. this measure for bisexual microaggressions: http://dc.etsu.edu/cgi/viewcontent.cgi?article=4735&context=etd).

    LGBT Microaggressions Research Review (not freely available, but an example): Microaggressions Toward Lesbian, Gay, Bisexual, Transgender, Queer, and Genderqueer People: A Review of the Literature

    If the science community simply denied existence of something because we can't currently fully measure it in every way, but can still measure aspects of it, science would never advance. It's when people continue to examine and refine the methodologies that science advances.
     

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