Bias In Healthcare
My experience with primary care has been that healthcare providers are not very good at divorcing how they feel about something from the way they treat their patients. When doctors aren't able to imagine the sexual identity or behaviors of their patients being different than their own or what they are used to, they make assumptions that make them miss things or make them biased. The thing is, you don't have to extensively know everything about your patient's identity or sex life, you just need to not make assumptions and take things off of your differential, or not take things into account, just because you've assumed something about them. It doesn't just apply to LGBTQ+ patients. For instance, assuming an older patient is not sexually active anymore or assuming all polyamorous patients are promiscuous. There are lots of situations where you might find yourself making an assumption, and you need to start catching yourself doing that. That's all I ask. You don't need to know every single possible sexual identity or activity. You just need to be able to talk about it without casting judgment on people and to cultivate a vocabulary where you're not using judgmental language to talk to patients about their sexual identities or behaviors. You need to be able to talk about risk management by telling your patients, "There are some of these risks that are attached to that behavior and would you like to talk about minimizing those risks?" or "Would you like to talk about doing some testing so that you know what's going on" without casting a moral judgment because it makes it really hard for someone with a marginalized identity to see a doctor, and, on top of that, having providers hyper fixate on aspects of their identity by tying every problem you have to that particular identity.
Gender-affirming Care
I think you should try to help your patients be comfortable with you. As student doctors, we're often told things about rapport and developing rapport, and the fact that rapport is important, but we don't talk very much about how to actively build it with a patient. I think that gender affirmation is a really good way to do this, on a practical level. Being willing to affirm the gender of your patient is a great way to build rapport, and, as a result, you are more able to do your job, and your patient is likely more willing to be in your office. At the end of the day, they have to be in your office for you to help them and for them to be safe. That's the thing of it.
L-R: Student Doctor Hampton presenting research at the 2021 Student Research & Scholarship Forum; with Benoit Dubé at the LGBTQI+ On Doctoring Session; speaking at the Transgender Day of Remembrance Vigil in Portland, ME.