How to provide inclusive care to Two-Spirit & LGBTQ+ people

By committing to examining your attitudes, beliefs, and emotions on an ongoing basis, you can increase your self-awareness and adjust your daily practice as needed. As you interact with patients, try to reflect on any bias or prejudice that you may have. For example, what are your thoughts and feelings about 2SLGBTQ+ people and issues relating to them, such as pregnancy, adoption, surrogacy, parenting, and gender reassignment?

“So often when people talk about transness, they talk about gender dysphoria. They very rarely talk about gender euphoria, when you get a body that fits with who you know you are.”

Examine any assumptions you may make about a person's name, pronouns, or appearance. These assumptions can lead you to make inaccurate conclusions, which can harm your relationship with a patient or family. Some examples of these include:

• Mistaking someone’s gender identity
• Assuming a person’s sexual orientation
• Assuming that someone with cirrhosis is drinking a lot of alcohol
• Assuming that someone’s dying partner is the opposite sex

“In LGBTQ communities, people often have a ‘chosen family’. These are the people they want to support them and make decisions for them.”

Your attitudes and beliefs have a strong influence on your emotions. By paying attention to the feelings that come up for you, you may recognize when your emotional responses are giving them messages or cues. By reviewing your interactions, you may identify your strengths and weaknesses and develop strategies to improve your practice.

“The healthcare team’s refusal to let me be part of the conversation about my partner’s health has really had a bad impact on my grief.  It’s been a year, and I’m still crying about it; and that’s not me. I felt so helpless against the health system. It was de-humanizing: the lack of dignity, the lack of respect.”

An important part of your work is to learn about your patient and their healthcare needs. Much of this learning comes from the answers your patient provides to questions that you ask, which may be face-to-face and often collected through forms they will complete.

“I didn’t pick up any signals that it was safe to talk to my GP about my sexual activity. He knew I was gay, but he never brought it up or asked questions about my sexual activity. So, he didn’t set up appropriate tests and follow up. He could have asked in a curious, accepting way. It was information that he should have, but we both held back and avoided that conversation.”

Taking a look at the language used in these questions is an important step toward providing inclusive care. Sometimes questions that may seem fine to you may be triggering or upsetting to others.

“I like intake forms that have places for both given name and preferred names – for example, ‘Katelyn’ and ‘Kattie’. It can also be beneficial for those who don’t use their gendered name. I don’t mind a category for biological sex but I don’t like ‘preferred’ pronouns. For me it’s just my pronoun; it’s not a preference.” 

Here are some examples:

Like you, your patients bring their attitudes, beliefs, and emotions with them. Keep in mind that many 2SLGBTQ+ people have had negative experiences with healthcare providers in the past. The way you approach these interactions can help you build a better and more trusting relationship with each patient.

“I went to a new GP to talk about transitioning. He told me that I was his first transgender patient, so it was a new experience for him. He wanted to learn and be helpful, and I was surprised at how fast things moved forward in terms of getting the documentation and referrals I needed. I think our relationship has helped us both.”

As a healthcare provider, your practice will benefit if you find ways to make inclusivity an integral part of your life. Some ways that you can do this include:

• Asking for and correctly using someone’s pronouns
• Educating yourself and others about the various sources of 2SLGBTQ+ oppression by reading, listening, and watching reliable sources of information
• Speaking up when you hear or witness discriminatory statements or actions
• Reflecting on your discomfort and reducing or removing it
• Inviting and accepting feedback
• Helping to create other non-discriminatory practices in your work setting

Inclusive care is good for the patient, good for the provider, and good for the healthcare system.

“We’ve always had these intake forms. I never realized that they were so outdated. By changing some of the language, I’ve found that we’re getting more thorough information from our patients, (which helps me prepare) and also that it’s made the first meeting more pleasant and relaxed.”

Read more

• Why inclusivity matters
• How to be an ally

Resources

• Gender and sexual diversity glossary - Government of Canada
• CCGSD queer vocabulary - The Canadian Centre for Gender+Sexual Diversity