Making healthcare safer for marginalized communities - Lesbian, Gay, Transgender, Queer — Emily Grace Acupuncture | New York based acupuncture clinic specializing in women of color acupuncture, fertility and menstrual health, Traditional Chinese Medicine and more

“It’s everyone’s job to provide care to Queer and Trans patients, not just the job of a few specialists. This includes you.” Says Rowan Everard, L.Ac. (He/Him) of Inner Sanctuary Wellness in Portland, OR.

Rowan of Inner Sanctuary Wellness. Portland, Oregan

In Chinese Medicine, the health of a community or family directly affects the health of an individual. Injustices in society directly affects the health of the community and therefore, the individual. This is such an important concept that is often lost when we look at holistic healthcare and how it’s misinterpreted in its practice in the US. Patients of different marginalized communities, too often, hesitate when seeking care if they can’t find a provider they feel safe with. It only takes one harmful experience for someone to avoid care all together. To know this is happening, means we, as providers, especially those with privilege, need to be doing a better job. Additionally, we all, within our own communities and families, need to make space for these conversations to happen, safely. I consulted providers from the LGBTQIA+ community in order to center their voices in my learning and process of creating safer practices in my clinic. I hope this insight helps others be activated to do the same.

What Are Some Of The Ways Harm Is Caused in Healthcare Settings?

Kathryn Grooms, LCSW-R, (She/Her) of Steady NYC, a psychotherapy practice, talks about how the very nature of seeking healthcare is a vulnerable act, especially when there have been previous traumas during healthcare interactions. Harm is often caused “by not respecting someone’s preferred name, pronouns or gender identity.” When physical touch is involved, providers should be in the practice of to asking for consent.

Dr. Aaron Lee, DAOM, L.Ac (He/Him) of Box Acupuncture in San Jose, CA talks about how “healthcare has to be inherently unbiased for it to be helpful”, yet we still live in a society where “providers can impose their own religious, lifestyle and other beliefs onto patients.” This points out how providers can be using their own biases to dictate how patient is going to be treated. “Unfortunately, current research and healthcare standards are in favor of the majority of the population which are cis-het and white identifying.”

Rowan says, “26% of trans people in the US Trans Survey reported physical violence from a healthcare provider”. Subtle, yet still very damaging, levels of harm can also look like, when a provider “shows discomfort or disgust, frank lack of knowledge about a person’s body or experience. This can look like using the wrong word for someone’s anatomy (‘breast’ instead of ‘chest’ for a trans man) or asking about birth control when the person does not have opposite sex partners.”

What Can We Be Doing Better?

“Everything about a healthcare interaction can either communicate safety or danger,” Rowan says, “from obvious things like gendered signs on bathrooms to subtle things such as the language used to describe body parts or talk about romantic partners. The more tuned in to these aspects a provider becomes, the more patients will pick up on cues that the provider is a safe person that they can trust.” Rowan also emphasizes that, “patients will not share their most sensitive, and possibly most diagnostically important, information with a provider they don’t trust. Data points like childhood trauma, unsafe relationships, or drug use history can change the way a provider approaches a case and the quality and helpfulness of that care in profound ways.”

“The environment creates the safety necessary for the individual to be truly receptive to the care being offered by providers. The environment is the first step towards establishing trust,” says Kathryn. She suggests that the right signage, messaging and wall art in a waiting or treatment room can be affirming. “It’s important that the images on the walls or the waiting room materials aren’t only heteronormative.”

Dr. Aaron Lee of Box Acupuncture. San Jose, CA

Dr. Aaron says that providers can be more mindful “by realizing that although LGBTQIA+ patients identify as different from their cis-het identifying counterparts, they are just as unique and come from different walks of life and experiences, trauma, and more.” He brings up that holding space means centering the patient and to be mindful of projecting. He says, “It's not about trying to ‘identify’ with them, because as a healthcare provider you don't want to impose your own experiences on your patients, but it's about truly listening and understanding and allowing patients to tell you where they're coming from, how they want to be treated, and to respect how they identify themselves.” Dr. Aaron encourages providers to respectfully ask questions, be honest and express that you want to learn more when you might not know proper terminology. He also shares that, “oftentimes, the biggest problem between healthcare providers and LGBTQIA+ patients is effective communication, respect and misconceived notions about how my identity reflects my lifestyle. As an LGBTQIA+ identifying practitioner, I even find myself wondering if going to my general/PCP is worth it because he/she/they may not understand where I am coming from.”

Positive Changes We Can Continue To Build On

Sometimes in community organizing or activism, it can feel like we take steps forward only to be setback again. Pausing to take stock in what has been accomplished is also an important practice.

Dr. Aaron mentions that “I've seen accessibility of prevention options like PrEP, STI testing, and more, be free for all income requirements, which is great.”

Rowan mentions that in Portland, a small group of trainers and advocates have accomplished better access in terms of trans care.

“Since I came out 30 years ago,” Kathryn recalls, “I have seen a lot of positive change in the healthcare industry and I still think there’s a long way to go. Back then, we were just beginning to advocate for providers to not make assumptions regarding sexuality when taking a medical history. I’m happy to say that I can’t recall a time in the last decade when a provider has made a hetero assumption about me when taking my history. That’s a change from my initial experiences with the healthcare world.”

What Do We Want For The Future of Healthcare?

Kathryn Grooms, LCSW-R, Steady NYC. New York, NY

Dr. Aaron hopes for inclusivity, but more specifically, “diversity in healthcare when aimed at the LGBTQIA+ community. White cis-het men and women are not the face of health nor should white LGBTQIA+ male/female models be the face of the LGBTQIA community.” He would like to see more LGBTQIA+ healthcare practitioners, and if they feel safe and comfortable with being labeled as such, so that patients can more easily find providers that they can feel safer with. Dr. Aaron would “also like to see more affordable healthcare options”.

Rowan believes that “more training in medical schools about queer experience and common healthcare access needs”, is important, and that this type of training shouldn’t be optional.

Kathryn emphasizes further education as well and to “develop sensitivity regarding the need for providers to get curious, inquire and be willing to take the time to develop trust with the clients, so the individual can share honestly which is key to any provider being able to do their best to help.” Developing trusting relationships in healthcare is a win-win. She says “I think this is true for the queer community as well as society overall.”

Allyship

Doing better is not necessarily allyship. We cannot simply call ourselves allies, but instead, we should consistently practice being one.

Dr. Aaron sees allyship in “education, effective open communication and listening,” to those of the LGBTQIA+ community. “Be respectful in your words, your thoughts, and your actions.” He also adds and important reminder that although Pride is a celebrated as a season, “it's always important to uplift and support these communities year around. Your words, your actions, and your financial support when it comes to politics is just as important when it comes to voting. If you support politics that don't support the LGBTQIA+ population or BIPOC, then don't be two-faced about it like most large corporations.”

Kathryn sees importance in “calling out homophobia, transphobia, heteronormativity when it’s witnessed. “ She encourages people “to join the rallies and campaigns to combat anti-queerness and to watch, invest in, donate to, share on social media material that celebrates the LGBTQIA community. To also be willing to be curious about one’s internalized phobias that are out of awareness.”

Rowan says, “doing the research to understand someone else’s experience can be a deep, lifelong process.” He also suggests seeking trainings that are queer led, watching documentaries and reading books as ways to gain understanding about people’s lived experiences and “politely asking your queer friends, if they would be available to answer some of your questions so that you can better serve your patients.” He also states that we are all responsible for giving good care to anyone and everyone, including Queer and Trans people. This should not have to be a specialty. Rowan also encourages patients to seek out trainings in self-advocacy. This can give patients tools to improve their experiences in healthcare.

Educating on injustices, though helpful for all communities, can affect the emotional and spiritual selves of the ones doing the educating. I wholeheartedly thank Rowan, Dr. Aaron and Kathryn for taking the time to share their knowledge, experience and stories. Though this post only covers three people’s experiences, I hope their words activate us all to make changes in how we provide care and how we make space for those in the LGBTQIA+ community in our work, clinics and personal lives.