Are LGBTQ+ Canadians Equal Citizens at the Doctor's Office?

This post was co-authored with Trent University student Kerri Mozessohn.

Recently, the Mental Health Commission of Canada released a report highlighting the toll the COVID-19 pandemic has taken on LGBTQ+ Canadians. Not only did twice as many LGBTQ+ respondents report moderate-to-severe anxiety symptoms, but alarmingly only one in four reported excellent or very good mental health through the early days of the pandemic, compared to almost half of non-LGBTQ+ Canadians who reported excellent health. The suggestion of a disproportionate impact of the pandemic on LGBTQ+ Canadians raises important questions about the relationships between healthcare providers and the LGBTQ+ community.

In general, individuals tend to seek out a doctor who is attentive, includes them in the decision-making process, is competent, and provides a safe space. Members of the LGBTQ+ community may also place additional value on whether the healthcare provider is knowledgeable about LGBTQ+ health issues and comfortable interacting with LGBTQ+ families.

Data collected early in the pandemic indicated that the healthcare needs of Canada’s LGBTQ+ population were already woefully underserved. For example, 1 in 10 LGBTQ+ respondents indicated that they did not have access to a family doctor, a rate that was double what non-LGBTQ+ Canadians reported.

As we hopefully begin to emerge out of the COVID-19 pandemic, it is an important time to begin considering what can make the Canadian healthcare system more accessible and supportive for the LGBTQ+ community.

Removing Systemic Barriers and Creating Safe Spaces

According to a recent study that surveyed healthcare practitioners, students, and community members interested in improving LGBTQ+ services, a key component of an LGBTQ+ safe space is one in which there are cues in the environment to indicate acceptance and safety. Cues can be visual, such as a small rainbow pin worn by a provider, or they can be verbal, such as using a patient’s correct pronoun and name. Another key indication of safety is the demographic information collected by a healthcare provider—if standard forms do not allow for sexual and gender minorities to adequately represent themselves and their family members (e.g., not everyone has a mom and a dad), then they may feel like the healthcare provider will be less willing or able to treat their family.

Experiences seeking LGBTQ-friendly healthcare can be even more challenging in rural areas. A recent study with rural LGBTQ+ individuals indicated that heteronormative assumptions in the collection of patient information were a barrier to healthcare access.

One participant explained that “if a form doesn’t have what you identify as … the message is, you don’t actually exist,” while another participant pointed out that even after they legally changed their name, their healthcare provider continued “calling me by the wrong name … in front of the rest of the waiting room.” Alienating experiences like these prevent many LGBTQ+ individuals from accessing the healthcare they need and from feeling comfortable and safe in an already vulnerable situation.

Avoid Judgments, Do Not Make Assumptions, and Ask Necessary Questions

Unsurprisingly, individuals of any sexual or gender identity want to have a healthcare provider who listens to them, who is attentive, and who includes them within the medical decision-making process. The unsatisfying experience of visiting a doctor who avoids eye contact, rushes, and appears to be preoccupied with other issues during a visit is perhaps more common for Canadian patients than we would hope. Yet, while many can relate to this type of experience, specific research on LGBTQ+ healthcare underscores additional factors for LGBTQ+ patients that can make or break their healthcare experience.

Matsuzaka and colleagues specifically found that LGBTQ+ patients’ perceptions of their healthcare provider as being empathetic, affirmative, and open were important to their levels of comfort while seeking care. Many LGBTQ+ individuals experience rejection of some part of their identity on a day-to-day basis from a wide range of sources, including friends, family members, and co-workers. When it comes time to address a healthcare need, these day-to-day experiences of stigma and rejection can create feelings of apprehension concerning how they will be treated within the healthcare system. One participant stated their perspective on seeking healthcare quite directly: “You're not here to judge me. You're here to [serve] me. Render a service worthy of me. Why am I worthy of that service? Because I'm a human being."

Even today, when it is much easier for LGBTQ+ to be out and open about their sexual and gender identities, the daily experience of coming out to strangers can still be stressful and filled with uncertainty. Attempting to avoid additional unnecessary experiences of “coming out” can result in LGBTQ+ individuals avoiding medical care. For example, even if someone feels comfortable disclosing their identity to a primary doctor, they may have more complicated feelings about how much of their identity is shared with other doctors, nurses, and practitioners sharing the same space.

Concerns about coming out can be further amplified in unfamiliar settings, such as emergency rooms. As another participant pointed out, “... every time you go to the doctor it feels like a risk, whether it’s a different doctor or a nurse that you don’t know or whatever, right?”

An Old Problem, Still Not Addressed

Unfortunately, calls for more LGBTQ-inclusive healthcare are not new. The research has repeatedly identified relatively simple changes that could make healthcare environments more open and accepting (e.g., updated forms, rainbow pins, respectful questions, and pamphlets about LGBTQ+-relevant health issues). Indeed, many of the sentiments expressed in these very recent articles continue to reflect the types of struggles that LGBTQ+ individuals reported in a study that I conducted over a decade ago and which was published in 2016.

Patient care begins at the front door, providing indications to patients that they will be respected, treated with dignity, and that their healthcare needs will be adequately addressed. The pandemic has highlighted that the Canadian healthcare system still has a long way to go before it will be considered well-equipped to meet the needs of the LGBTQ+ population. It does not seem like a big ask, but as one participant points out, “the dream is [for] healthcare providers to understand how our sexuality, or gender, our race, our class, our economic level, are all part of our health, you know? How they all intersect.”