In Our Own Words: A Qualitative Exploration of Complex Patient-Provider Interactions in an LGBTQ Population

Abstract

While sexual and gender minorities are at increased risk for poor health outcomes, there is limited data regarding patient-provider interactions. In this study, we explored the perspectives of LGBTQ patients and their encounters with physicians in order to improve our understanding of patient-physician experiences. Using purposive selection of self-identified LGBTQ patients, we performed fourteen in-depth semi-structured interviews on topics of sexual orientation and gender identity, as well as their perceived role in the patient-provider relationship. Coding using a modified grounded theory approach was performed to generate themes. We identified three major themes that demonstrate the complexity of LGBTQ patient experiences. The first, Lacking trust, identifies mistrust and loss of the physician-patient relationship resulting from physicians’ poor or judgmental communication, or from physicians making assumptions about gender, using incorrect pronouns, and not recognizing heterogeneity within the transgender community. A second theme, Being vulnerable, describes the challenges and fears related to comfort of patients with disclosing their sexual orientation and/or gender identity. A final theme, Navigating discrimination, outlines racial or ethnic discrimination which creates an additional burden on top of illness and stigmatized identity. Our results reveal the complex needs of individuals with multiple stigmatized identities when developing relationships with providers. By using an intersectional perspective that appreciates the plurality of patients’ identities, providers can help to improve their relationships with LGBTQ patients. Incorporating intersectional training for medical students and residents could greatly benefit both LGBTQ patients and their physicians.

Communication about sexual orientation and gender between clinicians, LGBT+ people facing serious illness and their significant others: a qualitative interview study of experiences, preferences and recommendations

“…To improve LGBT+ inclusive communication and care, it is vital to understand challenges, preferences and potential benefits for all key stakeholders—patients, significant others and clinicians 5 6 36. Although clinicians are often overlooked in LGBT+ health research,36–38 their participation is essential to understand how prior clinical experiences shape communication behaviours and inform feasible and acceptable communication strategies.…”

“…To improve LGBT+ inclusive communication and care, it is vital to understand challenges, preferences and potential benefits for all key stakeholders—patients, significant others and clinicians 5 6 36. Although clinicians are often overlooked in LGBT+ health research,36–38 their participation is essential to understand how prior clinical experiences shape communication behaviours and inform feasible and acceptable communication strategies. This study aimed to investigate experiences and preferences regarding communication about sexual orientation, gender identity and gender history in the context of serious illness (where involvement of significant others and person-centred communication and decision making are vital) and to identify best practice to inform evidence-based recommendations for clinicians and educators relevant to all clinical scenarios.…”

Improving Pharmacy Students’ Clinical Knowledge on Providing Care for Patients Belonging to the LGBTQ+ Community

“…Communication hesitancy surrounding patient-provider interactions, awareness of the risk of suicide, patient inclusivity, and the importance of privacy were topics included in the active learning exercise. Providing a context for students to understand these topic areas was important for students to develop and apply cultural competency in care [4,15,25]. The majority of participants correctly answered the privacy (68.7%) and communication hesitancy (70.8%) pre-test questions, indicating that the learning activity robustly activated prior knowledge.…”

Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs

“…Participants also discussed frustrations with providers who made assumptions and generalizations about their gender, sexuality, and race as further contributing to disappointingly inadequate treatment. Prior literature has found that provider assumptions about SOGI reduce client trust and lead to missed opportunities for shared collaborative patient-provider decision-making about general healthcare [ 72 ], suggesting that breaks in trust similarly limit patient-centered SU treatment for LGBTQ+ clients.…”