Case study: Let’s talk about LGBTQ+ inequity in healthcare

By Jenny Warmington, Senior Pharmacy Technician and Equality, Diversity & Inclusion Champion

A quick search on the internet shows many reports on how the rainbow community (LGBTQ+) continues to face discrimination in the UK. This inequality is leading to poorer healthcare, later diagnosis and worse treatment for people with marginalised gender identities or sexualities. 

I would like to share some of my own experiences and views of healthcare, with the intention of sparking conversation so we can work towards addressing this gap. 

Think about the melting pot theory of multiculturalism which assumes that various groups of people will tend to “melt together”. The trouble with this theory is that in “melting together”, we all lose our unique identity.  

Instead I prefer the “salad bowl” theory.  The salad bowl is a metaphor for the way in which each individual can integrate and co-exist within society whilst maintaining their separate identities. We each are “salad” but are also different. Each part of a salad has a different taste, texture, colour and each part adds something unique, each ingredient has the chance to shine and each is as important as the next. 

I identify as a pansexual woman. I have a daughter and I'm married to a woman. I also don't “look” gay (I still struggle with that remark) but this can lead to curiosity about my sexuality which I don't mind talking about as long as it's coming from the right place and being asked in a respectful way. 

Many times during these conversations I have been told “I don't care what someone's sexuality is, it doesn't matter to me if they are gay, straight, trans or bi, everyone is the same to me and I treat everyone the same” and I always reply “but we're not all the same”. 

People need to be recognised, respected and treated as a whole person, which encompasses their unique identity. For me, this includes the fact that I have a stoma, I'm a woman, I'm a mother, I’m a grandmother, I'm a wife, I have a wife and I don't tolerate morphine very well. 

An example would be, when I'm asked by a healthcare professional if I could be pregnant, I appreciate that there is a clear clinical need for this question (I'm a cisgender* woman, I'm of child bearing age). But when I reply with, “nope, that would be a miracle as I’m married to a woman” I expect that to be the end of the conversation, I don't expect to have to continue to answer questions regarding birth control or explain myself any further. 

In the same way that If I were a cisgender man, I would not expect to be asked if I could be pregnant, (that would also be a miracle). The bottom line is that I want to be seen and treated appropriately but as an individual.

If healthcare organisations are not seeing the whole person, are we able to deliver equitable healthcare? ‘Given the example of pregnancy, do we have the understanding, and organisational culture in which we recognise and feel comfortable that there may be a clinical need to ask a transgender man if he could be pregnant?  

Another example that I would like to share is one that has happened to me very recently during a stay in hospital. During my admission, the nurse asked me who I live with at home. I knew exactly how the conversation would go as i've been here many times before:

Nurse: “Who do you live with at home Jenny?”

Me: “My wife Tasha.”

Nurse: “OK, so, upon discharge will your partner be able to pick you up and take you home?”

Me: “Tash is my wife and yes she will.”

Nurse:“Oh, oh yes OK.” (uncomfortable silence for a moment) “Will your partner be able to bring some of your medication into you until we can get some from the pharmacy?”

Me: “Yes, she's my wife and she will be able to do that”. 

The nurse carries on with the paperwork, and asks me to confirm my next of kin details (making sure to avoid the need to call Tasha my wife). They then leave the room. 

Such a seemingly small thing as referring to Tasha as “my partner” makes me feel like the nurse doesn't recognise our relationship as a marriage and it’s clear that referring to Tasha as my wife makes them feel uncomfortable.  I'm left feeling belittled, unseen, frustrated and embarrassed.

Were my healthcare needs met? I'm not sure; we were both distracted by the whole wife/partner thing and I can't remember what she said. Do I trust that they will care for me and Tasha appropriately at my most vulnerable time? Not really - I'm unsure if they will respect our relationship in the same way as any other married couple in an emergency situation for example.  

Equality, Diversity & Inclusion in healthcare starts within - in order to deliver equitable healthcare we need to see the value of a workforce that reflects the people it serves. It’s more than having rainbow flags in the staff room, it’s uncomfortable to reflect on and it’s not an easy thing to do. It takes time, understanding and resources in an already stretched healthcare system.  

I invite us all to challenge our thoughts and the healthcare that we deliver; ask yourself if it is equitable. Be curious, be respectful, and don't be afraid to ask questions. I don’t expect you to understand but I do expect to be respected, seen and valued as a human being whether as your colleague, employee or patient. I'm sure you will agree, that's a basic human need. 

*Cisgender - A person whose gender identity corresponds with the sex registered for them at birth; not trangender.