This article is adapted from Brooke Allen's speech for the "Caring for Our LGBTQ+ Patients: Healthcare Education Seminar" at Kootenai Health on June 23, 2021. Brooke's powerful personal story and research are worth sharing to help raise awareness on the need to reduce barriers and stigma of the LGBTQ+ community in healthcare settings.
Hey, I’m Brooke, and I have the honor of talking to you about what the LGBTQIA community experiences when interacting with healthcare professionals. LGBTQIA stands for lesbian, gay, bisexual, queer/questioning, intersex, asexual/aromantic/agender, and for the duration of this speech, I will be using the "LGBTQ+ community".
First, I wanted to share a little bit about myself. I’m 41 years old and from Spokane, WA. I attended Catholic school from kindergarten to 8th grade, and in 1999 I graduated from Lewis and Clark high school. After that, I continued my education at Spokane Falls Community College, where I received my AA. During this time, I started experiencing depression and anxiety, but I didn’t know what was happening until I started college. As time went by my depression and anxiety worsened and eventually became so intense and unbearable that at 22 years old, I tried to kill myself. After a required two-week vacation at Sacred Heart Psychiatric ward, I still felt out of place and trapped.
So at 23, I decided to move to Seattle. I knew something had to change, and Seattle seemed like the best place to find that change.
During my almost 10 years living there, I found my passion for coffee while working at Starbucks. My job there was part of the fresh start I was looking for, but unfortunately, I still struggled with my depression. To cope, I did what a lot of 20-year old’s do, I used alcohol and drugs as my therapist.
In 2012 I moved back home to Spokane and continued working at Starbucks until 2017 when I was forced to quit working due to severe hip and back issues. This sent my depression and anxiety into overdrive once more. Alcohol and drugs again became my therapist, as well as my pain reliever. On March 15th, 2020, I entered rehab and have been sober ever since. I’m sharing this is because a lot of my depression, anxiety, and substance abuse stemmed from issues with my sexual orientation.
I am a lesbian and part of the LGBTQ+ community. I came out when I was 21, but I knew I was attracted to girls from an early age. In the words of Lady Gaga, “I was born this way.” Unfortunately, because of my sexual orientation, I have experienced more than my fair share of implicit and explicit bias from other people, and sadly quite a few of those people are healthcare professionals.
When I think back to my experiences with healthcare providers, there’s one instance that sticks out. In 2016 I was experiencing very painful stabbing pains in my abdomen. I decided to go to an ER in Spokane to figure out what was happening. The nurse and doctor did the usual exam: blood pressure, temp, how long had I been feeling like this, what’re my symptoms, etc. The doctor decided to do blood work and an x-ray of my abdomen. Then he asked me if my boyfriend or husband had been sick at all. I told him I had a girlfriend, and she hadn’t had any of the same symptoms. Immediately his whole attitude changed toward me. He became very cold and rude. He called the nurse back in and told her he wanted my blood work tested for STDs and a full pelvic exam done on me, including an ultrasound. I was so in shock that this was happening, that I didn’t know what to do. I left there in tears. I felt humiliated and ashamed of myself. I had put my life and trust in this doctor’s hands, and he used it to make me feel like I was a sexual deviant and less of a person, all because I’m a lesbian. And unfortunately, this treatment continues today in all avenues of healthcare towards people in the LGBTQ+ community.
I spent hours researching statistics to share with you today, and I also spent hours talking to my peers in the LGBTQ+ community. And I came to the realization that while the surveys and the statistics they provide are important, recalling my experiences and hearing about what my peers have experienced made the numbers mean so much more and come to life.
One common theme that I heard when talking to my peers was that they feel they are often forced into the role of educator when talking to their doctors. The article The State of the LGBTQ Community in 2020: A National Public Opinion Study stated “Twelve percent of respondents overall say they have had to teach their doctors or other providers about their community in order to get adequate treatment… The survey included interviews with 1,528 self-identified LGBTQ adults ages 18 or older.”
People in the LGBTQ+ community are having to spend their limited appointment time explaining their sexual orientation, gender identity, and the terms used to describe both rather than discussing why they made the appointment in the first place. Why are we as patients having to fall into the role of an educator? The answer I found is partially due to healthcare providers not receiving the much-needed education and training.
I had the opportunity to talk to a few people that attended school to become healthcare providers and actively work in the field now. I asked if they were required to take any classes or were given any extra training regarding treating patients in the LGBTQ+ community. A nurse that I talked to said she “…received some education surrounding ‘culturally sensitive’ care, but nothing specifically about working with patients who identify as LGBTQ+, unfortunately. It’s something I sought out for myself so that I could be better in my practice. The organization that I work for has made a big push to educate individuals who are interested, but again not a required part of our continuing education.” I also talked with a psychologist, and she said that unless mental health providers are going to be working specifically with LGBTQ+ patients, there is very little education or training provided and required.
An article from July 23, 2018 “You Don’t Want Second Best” Anti-LGBT Discrimination in US Health Care stated:
The creation of LGBT competency modules in physician training programs is a relatively recent development; a survey of US medical schools conducted in 2012 found that only 16 percent of respondent institutions had comprehensive LGBT-competency training, and 52 percent had no LGBT-competency training at all. Where it is offered, training on LGBT issues may be elective, or may only constitute a small portion of a larger course on serving diverse or multicultural populations.
Even where there are multiple providers in an area, material and logistical barriers may prevent LGBT people from being able to access them. When providers are not trained on LGBT issues or services are scarce in an area, LGBT people may have few options when a provider discriminates against them or turns them away.
This lack of education in healthcare has not only caused the LGBTQ+ community to fall into the role of teacher rather than a student but has resulted in patients facing discrimination from their healthcare providers and others in the field. And we often leave our doctor’s office feeling worse than when we first arrived.
Sadly, patients that are the target of this kind of discrimination, or any discrimination are less likely to seek additional medical care or medical care of any kind. According to the same article from above ”…those who had previously experienced discrimination were particularly likely to avoid seeking care. In the National Center for Transgender Equality survey, 23 percent of respondents did not seek the care they needed because of concern about mistreatment based on gender identity.
This rings true to me personally and to many of my peers that I spoke with as well. It’s not only scary, but this mistreatment wears me and others down mentally. Just because we’re part of the LGBTQ+ community doesn’t make us any less human than other patients healthcare professionals treat. Our sexual orientation and/or gender identity don’t change our skeletal makeup on the inside. If I fall and break my arm, who I choose to love romantically or what pronouns I use don’t change the fact that my arm is broken. There’s a big difference between referring a patient elsewhere because their medical needs are outside a doctor’s knowledge base vs outright refusing to treat a patient and treating them with complete disrespect because of who they are.
Unfortunately, “Discrimination deters many LGBT people from seeking care. In the Center for American Progress survey, 8 percent of LGBT respondents had delayed or foregone medical care because of concerns of discrimination in healthcare settings…” This hits home for me personally as well. I waited until I was 25 to get my first annual exam because I feared how I would be treated by the doctor and staff if they found out I was a lesbian. It may sound ridiculous to some, but one fear that I had was that the doctor would be able to tell I was a lesbian from performing a pelvic exam on me and immediately chastise me for being gay. I eventually found out this wasn’t true. But I had also read and heard many stories about people in the LGBTQ+ community being mistreated when seeking medical care. Finally, at 27, my wife at the time convinced me to see her doctor for my first annual exam, but it’s scary to think of the illnesses that could have gone untreated during that time, and for so many in the LGBTQ+ community. And what happens when we do finally decide to go to the doctor, and we’re treated like I was back in 2016? We’re forced to look elsewhere for our medical care, sometimes having to drive 30+ miles to find a doctor that will make us feel like a human being when there’s a doctor’s office five minutes from our house.
Some states offer LGBTQ+ healthcare centers or other options such as Planned Parenthood, but unfortunately, not all states do. And within the states that do offer these alternatives, not all cities in that state offer the same services. In the article from January 18, 2018 “Discrimination Prevents LGBTQ People From Accessing Health Care “Some people may go to LGBTQ community health centers to avoid such discrimination, but they are not widely available across the United States, and many do not provide comprehensive services. A total of 13 states—mainly those in the central United States—do not have any LGBTQ community health centers.” Personally, I now go to Planned Parenthood for my annual exams, because they always make me feel safe and welcomed.
From the minute I walk through the door I know I am seen as a human and not my sexual orientation. I can talk openly and honestly with the providers there and know they won’t judge me. I’m fortunate to have somewhere like Planned Parenthood to go and the transportation to get there, but many other people in the LGBTQ+ community are not as lucky. One of my peers told me that she drives the 35 miles into Spokane to receive medical care at Planned Parenthood because she hasn’t had any luck finding a doctor in Coeur d’Alene to treat her and her needs. 35 miles may not seem like a lot, but what happens when 30 miles turn into 50, 100, even 200+ miles to find a doctor that will treat us. Or even worse, what happens to our physical health when we choose to forgo medical treatment completely because we’re worried and scared about the way we’ll be treated? The discriminating treatment of people in the LGBTQ+ community is causing us to put our physical well-being at risk, and it’s not acceptable.
As I mentioned before this starts to wear on our mental health as well. For me personally, each time a doctor, nurse, MA, or medical receptionist treated me differently or abusively because of my sexual orientation my mental wellbeing has been negatively affected. Many others and I already struggle with feeling unsure and different due to our sexual orientation or gender identity and to have healthcare professionals treat us with such disrespect only validates these feelings.
On May 29th, 2020, the article Mental health and illness statistics among LGBTQ+: The prevalence of mental illness, risk of suicide, and mental health help shared the following statistics:
LGBTQ+ Population in the US
Approximately 9 million adults in the US (or 3.8%) identify as gay or lesbian (1.7%), bisexual (1.8%), or transgender (0.3%).
Prevalence of Mental Illness in the LGBTQ+ Community
LGBTQ individuals are more than twice as likely as heterosexuals to have a mental illness.
Those in the LGBTQ community are 2.5 times more likely to experience depression, anxiety, and substance abuse compared to heterosexuals.
31% of older adults in the LGBTQ community report depressive symptoms, and 39% report serious thoughts of suicide.
Women who identify as lesbian or bisexual are more than twice as likely to engage in heavy drinking in the past month than heterosexual women.
Risk and Rate of Suicide Among LGBTQ+ Individuals
In LGBTQ people ages 10-24, suicide is a leading cause of death.
African American, Hispanic, Native American, or Multiracial/Mixed transgender individuals have a higher risk of suicide than white transgender individuals.
The rate of suicide attempts for lesbian, gay, and bisexual youth is four times higher, and two times higher for youth questioning their sexual identity than heterosexual youth.
I and so many of my peers are part of these statistics. I attempted suicide and turned to drugs and alcohol, because I felt I had nowhere else to turn when I was coming to terms with my sexual orientation, and because I was treated like I was less than others when seeking help from people that I should be able to trust to care for my physical and mental health. Many of my peers shared that their mental health struggles due to their sexual orientation and/or gender identity have led them to seek treatment at an inpatient psychiatric unit. While there they shared that their pronouns and preferred names have been dismissed and ignored causing their mental health to suffer even more. I have been lucky enough to find healthcare providers that I can trust with my physical and mental health and treat me like a human being, but what about my peers that I just mentioned and others in the LGBTQ+ community that aren’t so lucky? What about those that feel forced to forgo medical treatment and lose their life to something that could have been easily treated had they felt safe enough to seek treatment sooner? What about those that are finally mentally so worn down that they feel their only way out is to take their own life?
As healthcare professionals, I’m sure you are familiar with the Hippocratic Oath that among other things states, “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.” To me, this means that myself and others in the LGBTQ+ community should expect to be treated as a human being and not as our sexual orientation or gender identity. We should feel safe and respected when receiving medical treatment and not have to worry and be scared that healthcare professionals will mistreat us or allow their own personal bias to interfere with our course of treatment and question the validity of our claims.
This is exactly what I experienced in 2004 while living in Seattle. I was walking home with my girlfriend at the time and some other friends on Capitol Hill after a great night of hanging out during Pride weekend. As we were making our way up Pike Street to Broadway, we passed a group of guys. We were laughing and sharing stories from the night, and I barely even noticed them. Suddenly I heard one of them shout fags. I turned around somewhat shocked as to what I had just heard, and the next thing I knew I was down on the ground being kicked. My girlfriend was also knocked to the ground with a punch to the face. One of my friends had jumped on the back of one of the guys and was doing anything she could to pull him away from our other friend. Finally, the yelling and commotion brought enough attention from others that the guys took off. This was the first time something so violent had happened to me due to my sexual orientation, but sadly my friends had experienced hate like this before. Bystanders checked to see if we were okay and asked if we wanted them to call the police. I was in such shock that I grabbed my girlfriend’s hand and started running home and our friends followed us. Physically I hurt, but that pain didn’t even come close to how I felt mentally. There was a lot of crying and anger between the four of us that night.
The next day I decided I needed to go to the ER to get checked out. I told the doctor my friends and I were targeted and jumped by four men because we were gay. The doctor then asked me somewhat dismissively how I knew it was because we were gay. I answered him that I was quite sure because as they were punching and kicking us, they were also calling us fags, dykes, queers, homos, and other awful names. The doctor still not only doubted that it was a hate crime but also questioned the validity of my claim. I came here for help, and instead of finding someone I could trust and be vulnerable with, I was treated with doubt and coldness. I didn’t think I could feel any worse after the night before, but that doctor proved me wrong. This was in 2004, but sadly 17 years later people in the LGBTQ+ community are still being dismissed and discriminated against by healthcare professionals.
When I was asked to be a part of this forum today, I was so honored. I have been given an opportunity that many people in the LGBTQ+ community will never have in their life. The opportunity to share with you the mistreatment and bias myself and others experience daily because we’re brave enough to be ourselves. My hope is that what I have shared with you today has given you some new insight into how important providing education about the LGBTQ+ community for healthcare professionals is in dispelling these biases whether they be implicit or explicit. Looking forward, my ask of you is to take the information and stories you’ve heard here today and make a commitment to further your education about the LGBTQ+ community, and put that knowledge to use when treating patients that are part of the LGBTQ+ community.
Also, share what you’ve heard here today with your peers and speak up when you see or hear of patients being mistreated. I had a Starbucks district manager that told me repeatedly there are two reasons people don’t do things: they don’t know how, or they don’t want to. Being a part of this forum today, you’ve made the choice to further educate yourselves on the LGBTQ+ community. Now the choice is whether the information you’ve heard here today will be used to better understand your patients that are part of the LGBTQ+ community or allow these biases towards and mistreatment of the LGBTQ+ community to continue within the healthcare field.
US: LGBT People Face Healthcare Barriers
Trump Administration Set to Erode Existing Protections
Article from July 23rd,2018
Discrimination Prevents LGBTQ People From Accessing Health Care
By Shabab Ahmed Mirza and Caitlin Rooney January 18, 2018, 9:00 am
July 23, 2018