What Happens during Healthcare Interactions to Compel Gender Nonconforming LGBTQ People to Avoid Healthcare?

Emily Allen Paine

Introduction

Lesbian, gay, bisexual, transgender (trans), and queer (LGBTQ) individuals experience worse health throughout their lives compared to their heterosexual and cisgender (non-transgender, hereafter cis) peers. Stress resulting from stigma and discrimination contribute to LGBTQ health disparities. Policies and social norms that discriminate against LGBTQ people on the basis of gender, sex, and sexuality negatively impact LGBTQ populations.

Compared to their counterparts, LGBTQ people who are gender nonconforming—those who do not conform to dominant biomedical definitions of binary sex, gender, or sexuality and who do not perform or embody the social or cultural expectations of what is considered appropriate for their sex assigned at birth—are more likely to be categorized as part of a stigmatized group by an onlooker and to experience stigma-related stress. Indeed, gender nonconforming LGBTQ individuals report more discrimination and avoid healthcare more often than their conforming peers.

One pathway through which stress and stigma harms health among LGBTQ groups is the underuse of healthcare. For example, fear of discrimination during healthcare interactions discourages people from seeking care.

To better understand why gender nonconforming LGBTQ individuals may avoid healthcare, this brief reports on a study that examined their experiences in healthcare encounters. The author conducted in-depth interviews with a racially diverse sample of 34 adults in a metropolitan area of the United States who do not conform to dominant biomedical schemas of sex and gender: gender nonconforming LGBQ cis women, transgender men, and nonbinary individuals (those who identify as neither male nor female).

Key Findings

  • Patients experienced embodied disruption: when providers made incorrect assumptions about or did not recognize the identities and/or embodiments of gender nonconforming LGBTQ people during a patient-provider interaction, a stigmatizing disruption occurred.
  • Providers typically responded to embodied disruption in four ways that further stigmatized patients:
    • Disengagement – for example, providers no longer talking or meeting patients’ eyes;
    • Sorting—providers attempting to sort patients into binary, medical categories of sex/gender and sexuality;
    • Denial—providers challenging the validity of patients’ identities and/or denying care; and
    • Discipline—providers chastising patients for their identities and embodiments. See figure
  • After disruption, patients typically left healthcare encounters without getting their health needs met and often discontinued care.
  • Patient experiences were similar across race/ethnicity, but patients’ ability to manage disruption varied by gender identity, with nonbinary and trans patients facing greater barriers to recognition.
  • The exception to the rule of negative experiences associated with disruption occurred when providers recognized (asked patients about their identities) and affirmed This happened most often in LGBTQ healthcare settings or with LGBTQ-identified providers.
Paine figure
This figure shows examples of the four key ways that medical providers respond to embodied disruption with gender nonconforming patients—disengagement, sorting, denial, and discipline—all of which further stigmatize patients.
Embodied disruption is a stigmatizing disruption during a patient-provider interaction that occurs after providers make incorrect assumptions about or do not recognize the identities and/or embodiments of gender nonconforming LGBTQ people.
*Participants described their identities in their own words.

Click here to expand image

Policy Implications

Structural changes are needed within the broad social institution of medicine. Medical schemas about sex and gender should be redefined to reflect the diversity embodied by LGBTQ people. Inclusive schemas should then be institutionalized across medicine so that healthcare providers are trained and supported to recognize and deliver affirming care for their gender nonconforming patients.

Reference

Paine E.A. (2018). Embodied disruption: "Sorting out" gender and nonconformity in the doctor’s office. Social Science & Medicine 211:352-358.

Suggested Citation

Paine E.A. (2018). What happens during healthcare interactions to compel gender nonconforming LGBTQ people to avoid healthcare?  PRC Research Brief 3(14). DOI:10.15781/T2736MM7F.

About the Author

Emily Allen Paine (e.paine@utexas.edu) is a PhD candidate in sociology and graduate student trainee in the Population Research Center at The University of Texas at Austin.

Acknowledgements

This study was funded in part by Grant no. 1702672 from the National Science Foundation. Additional support was provided by CLAGS: Center for LGBTQ Studies and the Urban Ethnography Lab at The University of Texas at Austin. Infrastructure support for the Population Research Center at The University of Texas at Austin was provided by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD042849).


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