Dr. Zena Sharman on making health care more inclusive for LGBTQ patients
A new anthology, edited by Sharman, brings marginalized voices together to discuss their need for empathetic and dependable doctors, nurses and therapists
Sean Saifa Wall is a black intersex man, born with ambiguous genitalia and raised as a girl, whose testes were removed at the age of 13 without his input.
Xeph Kalma is a trans woman who walks out of a hospital emergency department despite feeling suicidal because she is humiliated by the very professionals from whom she sought help.
Caitlin Crawshaw is a self-described queer cisgender woman who asks for a referral to a fertility clinic, only to be told by her doctor, "I don't think they treat lesbians."
Their voices join in a call for respectful and compassionate care in a new anthology The Remedy: Queer and Trans Voices on Health and Health Care, edited by Dr. Zena Sharman, a Vancouver-based health researcher. The stories in the book are diverse and complex, and as the contributors explain, their health and well-being depend on the willingness of doctors, nurses and therapists to understand them.
In her introduction, Sharman cites a 2010 survey by the U.S. non-profit LGBTQ organization Lambda Legal, which found that the majority of LGBTQ respondents had experienced some kind of discrimination, such as having health-care providers refuse to touch them or blame them for their health status.
Moreover, she emphasizes, most respondents said they expected to experience discrimination from their health-care providers.
The Globe and Mail spoke with Sharman about how to make health care more inclusive.
What does proper health care for all look like?
Proper health care for all people, regardless of their sexual orientation or gender identity, really meets people where they're at. It accounts for and honours and respects the specificity and breadth of their identities. The reason I give that kind of big answer is it's really important to learn the tools, as health-care providers, to get to know all your patients, not just the folks who might be queer or trans, but to really understand them as individuals. And I know that can be hard to do in a medical system that often has to move people quickly through doctor-patient encounters.
Given that many LGBTQ patients expect to face discrimination, what can health-care professionals do to earn their trust?
I think one of the pieces of advice that [is often] given is to do your own learning. So that's really about spending the time to learn more about the lives and identities of LGBTQ patients, and also the specific health disparities or health concerns those folks may have.
Another really great tip is to think about how to make the practice environment – maybe it's your doctor's office or clinic – more inclusive to patients who might be LGBTQ. Some examples might be on your patient intake forms, giving people the opportunity to select from more than male or female options, or to specify if they have a chosen name that's different from the one on their ID, and having gender-neutral washrooms.
What are some of the specific health concerns of LGBTQ patients?
One thing I will say as context is to underscore the fact that there's nothing about being queer or trans that's inherently bad for anybody's health. Health is rooted in complex structures of privilege and oppression.
People who are lesbian or gay or bisexual or trans do frequently experience stigma, discrimination and violence because of their sexual and gender-minority status. It can create health issues because we know that stress and violence can affect people. We tend to see higher rates of tobacco and substance use among LGBT populations.
And we tend to see higher rates of some mental-health issues among LGBT populations. For example, lesbian, gay and bi adults seem to experience more mood and anxiety disorders and depression than their heterosexual counterparts. And lesbian, gay and bisexual youth are twice as likely as their straight peers to have suicidal ideation and four times as likely to make suicide attempts that require medical attention.
You cited a poll of straight, first-year medical students that found 86 per cent held some kind of unconscious bias against gay and lesbian people, and nearly half had a conscious bias. What can be done to change that?
One opportunity would be to see more inclusion of LGBTQ content in medical education and the education of our health-care providers. There was a big survey done fairly recently of medical schools in Canada and the U.S., trying to get a sense of how much time they spent teaching med students about LGBTQ health. They found it was about five hours across their entire training. And when you think about the complexity of queer and trans lives and health disparities, five hours really isn't enough.
In that same poll you referenced, it also showed when there was more frequent and positive contact between med students and people who might be sexual minorities, it did actually result in more positive attitudes towards them. That's certainly something I observed when I was part of a group doing some LGBTQ health education at the medical school here at the University of British Columbia. I'm a queer person as well as a person who does work in this area, and I was very moved by the questions the students had for me as an individual, not just as a researcher or an expert, and by the great intentions and enthusiasm they had for really wanting to learn how to be caring, knowledgeable and empathetic health providers.
What advice would you give to young LGBTQ people who are just starting to navigate the health-care system?
The first piece of advice is to get to know what a good health-care encounter feels like for you. What are the key ingredients to that good health-care encounter? That can look different for different people. Maybe for a trans person, it's really about getting a health-care provider who is able to respect their gender identity. Perhaps for a lesbian who is trying to get pregnant, it would really be working with a health-care provider who really has an understanding of their specific fertility issues and questions.
The second piece of advice is to gather as much information as you can. Do your research about what programs and services and providers are available to you. A lot of this kind of information does circulate informally in queer and trans communities. So ask around. Ask your peers. Ask your community.
The third piece of advice is to remember that you are the expert on your body and your health. So bring that expertise and knowledge into your conversations with doctors and nurses and other people who might be caring for you. And absolutely respect their knowledge and expertise and training, but know that you also have a voice and a really valuable perspective in that encounter.
This interview has been condensed and edited.