Making Assumptions, Making Space: An Anthropological Critique of Cultural Competency and Its Relevance to Queer Patients

Abstract

Despite increased attention to "culturally competent" practice with diverse populations, lesbian, gay, bisexual, transgender, and queer (LGBTQ) people remain relatively invisible within medicine and other health professions. Health care providers (HCPs) frequently dismiss sexual and gender identity as irrelevant to care. This study uses interviews with 24 physicians and 38 LGBTQ-identified women to explore how routine practices in health care can perpetuate or challenge the marginalization of LGBTQ women. While physicians avoid making assumptions to reduce judgment, a "neutral" stance reinforces the hetero- and gender normative status quo. Cultural competence with LGBTQ patients requires learning with, rather than learning about, LGBTQ people's particular health care concerns as well as paying explicit attention to pervasive power relations and normative contexts.

Mastering wellness: LGBT people’s understanding of wellbeing through interest sharing

“…LGBT patients as active agents in mastering wellness (Baker and Beagan, 2014), providing opportunities for promoting wellbeing and destigmatising mental health with LGBT communities.…”

One in three: challenging heteronormative assumptions in family planning health centers

“…Clinic staff engaged in personalized conversations with all new contraceptive clients, regardless of sexual identity or behaviors. In other settings, providers may exclude some sexual and reproductive health information based upon assumptions about sexual-minority women’s needs [9]. The increased odds of selecting Copper T380 among sexual-minority women is also of interest as it does not provide non-contraceptive benefits, which we hypothesized may be of interest to sexual minorities, especially lesbian-identified women.…”

“…Such negative interactions with healthcare providers in clinical settings serve as a deterrent to seeking care among sexual minorities [7,13,14]. Third, although ACOG has issued formal statements and guidelines for how to treat lesbian, bisexual, and transgender (LGBT) individuals [15,16], a lack of LGBT-focused training in clinical health sciences educational programs often results in low levels of cultural competency among providers working with sexual minorities [7,9,17]. While gender minorities (i.e., transgender men, genderqueer individuals, and others whose gender identity does not correspond with their assigned sex at birth) are also an understudied and underserved population, this paper is about the relationship between sexual-minority women and method choice and does not address the role of gender identity.…”

Tips for research recruitment: The views of sexual minority youth

“…We are unaware of any studies published by researchers that have sought to obtain the views of sexual minority youth in relation to what would encourage their participation in research. More sexual minority research participation is required, as it is rare for there to be any sexual minority consumer consultation in the development of health interventions, policies, or guidelines (McNair & Hegarty, 2010), possibly because many health care providers frequently dismiss sexuality (and gender identity), as they view this as being irrelevant to clinical care (Baker & Beagan, 2014). …”