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Archive Diversity in Surgery 2019

Make Your Facility More Inclusive

Tips to help you navigate the landscape of sexual orientation and gender identification.

Shanna Kattari

Shanna Kattari, PhD, MEd, CSE, ACS


PROPER IDENTITY Asking how all patients would like to be referred to creates a culture of inclusion and respect.

Ciscentric. Femme. Polysexual. Ze. If the words and the discussion surrounding sexual orientation and gender identity make your head spin, you're not alone. I'm a member of the community that researches and teaches about gender and human sexuality, and I'm always needing to learn more. The way we talk about gender and sexuality changes constantly — it's hard even for those of us who study it to keep up. The good news is it's not necessary to be an expert in order to do a good job for patients and to be an excellent colleague to providers in the LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, two-spirit, and more) community. All it really takes is good old-fashioned common decency. Show respect. Avoid assumptions. Listen, learn and empathize. If you do, the outcomes will be positive, both in professional satisfaction and in facility economics.

A life and death matter

If you entered your profession to help people (which I hope at least part of you did!), great satisfaction awaits you in caring for this community. Few populations need healthcare help more than LGBTQIA2S+ patients.

Studies show that 30% of LGBTQIA2S+ people lack a healthcare provider (only 10% of age-matched heterosexuals do). The reasons are well-known. First, members of this population are more likely to be unemployed or underemployed due to discrimination. Despite often having higher levels of education, they often have lower incomes and may not have health insurance. If they do have insurance, their domestic partners may not be covered. If they're trans or non-binary, insurance may not cover some services they need.

Perhaps most importantly, they fear the healthcare system because they have been stigmatized or traumatized previously.1 In one study, 73% of transgender respondents and 29% of lesbian, gay and bisexual respondents reported that they believed they would be treated differently by medical personnel because of their status. When asked why, more than half reported that they had experienced outright refusal of care, that a provider refused to touch them or used excessive precautions when touching them, or were abused verbally or even physically.2

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