This is the third post in my series about trans-inclusive healthcare. Given the content covered in the accessibility blog post, I thought it would be helpful to begin a conversation about what healthcare professionals can do to hold space with their LGBTQ2SIA+ (lesbian, gay, bisexual, transgender, queer, Two-Spirit, intersex, asexual, plus) clients during health encounters and while providing health services. I imagine it is important to follow-up inclusive medical spaces with inclusive medical practice. If heterosexism and homophobia is a problem when accessing healthcare services (Brotman & Ryan, 2001), then cissexism and transphobia must also be an issue for practitioners to consider. But how do we create spaces for LGBTQ2SIA+ clients, particularly trans and gender non-conforming folks, to feel that they can trust their care providers and gain access to appropriate healthcare? Brotman & Ryan (2001) cite cultivating an environment of safety and trust as immensely important when creating space for people to come out to their healthcare providers which, of course, significantly increases the satisfaction of LGBTQ2SIA+ clients. This seems quite obvious but how do we actually succeed in doing this?
Mandatory training and education about hetero/cis-sexism and homo/trans-phobia in academic programs and professional settings begin to address the harms around discriminatory practices when providing healthcare services that follow dominant models of medicine (Brotman & Ryan, 2001). Acknowledging that there are practitioners who will not change their negative attitudes about the LGBTQ2SIA+ community is achieved by creating a directory of practitioners in each community who provide affirming healthcare services (Brotman & Ryan, 2001). Acknowledging that well intended practitioners can still have an unintended negative impact on their LGBTQ2SIA+ clients is crucial. This requires gaining feedback from the LGBTQ2SIA+ communities about the impact of well intended actions and admitting that even if we are a member of the LGBTQ2SIA+ communities, this does not afford us a universal understanding of the diversity in lived experiences of those who also identify as LGBTQ2SIA+.
Communication is always a key factor. Using gender neutral language is important however conveying an understanding of the complexities around identity and the associated barriers is necessary to effectively open up spaces that may be experienced as harmful and hostile. This could be achieved by sharing with your clients an ongoing initiative in your practice to be inclusive of the many intersections of identity including (but not restricted to) people of conforming and non-conforming genders, people of colour and the many ways of identifying oneself along the continuum of sexuality (Brotman, & Ryan, 2001). It also includes using neutral language when referring to body parts, such as “monthly bleeding” in place of historically gendered terms that have potential for detrimental impacts such as “menstruation” (Vancouver Coastal Health, 2016). These are interventions that could begin to open up a space for those clients to embody their difference(s) during their health encounters. It is also suggested that practitioners convey an understanding to their clients that sexuality and gender can be experienced as fluid and that self-identified labels may change over time by acknowledging that previously articulated preferences may change over time (Brotman & Ryan, 2001). Asking clients to share their preferred pronouns as well as what terms they use to describe their gender and sexual identities while having an understanding and sensitivity about how age, ethnicity, race, class, ability and other intersections of identity (The Centre, 2006) can provide insight into how a person may interpret their individual context and understand their lived experiences. This will create an opportunity for an ongoing conversation (Brotman & Ryan, 2001) that could foster strong therapeutic relationships between clients and their practitioners.
Creating networks of support for LGBTQ2SIA+ clients builds capacity both individually and on a community level. Making referrals or reaching out to other practitioners who provide affirming healthcare services, validating non-traditional forms of family and offering to include them in the circle of care as well as advocacy in the form of systemic restructuring, policy change and collaborating with a diverse group of members from the queer community are all strategies to achieve the goal of capacity building (Brotman & Ryan, 2001). An awareness around the health concerns of different LGBTQ2SIA+ populations is important if practitioners wish to have a basic understanding of the unique needs of the members of each group. Qmunity (formerly The Centre) (2006) created a training resource that outlines specific health considerations for LGBTQ2SIA+ clients which begins on page 102 of the document. While I noted some outdated language in the document that is undoubtedly related to the age of its publication, it does serve as a good resource for healthcare practitioners to inform their care of lesbian, gay, trans, bisexual and Two-Spirit clients.
As a white queer healthcare professional, I have a unique combination of privilege and marginalization that can be used as leverage to inform future practice, change policy and challenge a structure thats operation relies upon systemic oppression and domination. This series of blog posts has provided me with a new understanding of the role I can play (and I imagine you too) by situating myself within the system to create networks of care that act to center members of vulnerable populations. It has challenged me to be uncomfortable and use my own experiences as a teaching tool and as a means to disrupt spaces that protect those who are more centered than myself. I am so privileged to be able to consider this as my future life’s work and will continue to develop a practice of solidarity throughout my career. I invite you to join me and together we can make this a mass based movement!
Brotman & Ryan (March, 2001). Critical Issues in Practice with Gay, Lesbian, Bisexual, and Two-Spirit People. Retrieved from: http://www.rainbowhealthontario.ca/wp-content/uploads/woocommerce_uploads/2014/08/Critical%20Issues%20in%20Practice.pdf
The Centre (January, 2006). LGBT Health Matters. Retrieved from: http://www.rainbowhealthontario.ca/wp-content/uploads/woocommerce_uploads/2014/08/LGTB%20Health%20Matters.pdf
Vancouver Coastal Health (2016). Glossary. Retrieved from: http://transhealth.vch.ca/trans-101/glossary