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.
     
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  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?
     

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