Inhospitable Healthcare Spaces: Why Diversity Training on LGBTQIA Issues Is Not Enough
Inhospitable Healthcare Spaces: Why Diversity Training on LGBTQIA Issues Is Not Enough
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DOI：
10.1007/s11673-016-9738-9
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发表时间：
2016-12-01
影响因子：
2.4
通讯作者：
Guidry-Grimes, Laura
中科院分区：
文献类型：
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作者：
Dean, Megan A.;Victor, Elizabeth;Guidry-Grimes, Laura
为了解决女同性恋者、男同性恋者、双性恋者、变性人和同性恋者(LGBTQ)人群中的医疗保健差距，许多医院和诊所设立了多元化培训，旨在提高提供者对这些患者群体的认识和敏感性。尽管做出了这些努力，但许多医疗空间仍然不适合LGBTQ患者及其亲人。即使在没有公开形式的歧视的情况下，LGBTQ患者也会报告在医疗保健方面感到焦虑、不受欢迎、羞愧和不信任。我们认为，这些负面体验是由医疗保健空间和称为微侵略性的人际互动的各种微妙、表面上微不足道的特征产生的。医疗保健空间和提供者经常传达异性恋的微攻击性，这向LGBTQ-我们建议是双性恋和无性恋(IA)-的人传达他们的身份、经历和关系是不正常的、病态的、意想不到的、不受欢迎的或可耻的。我们确定了医疗保健环境中常见的异形微侵袭，并具体说明了它们如何对LGBTQIA患者产生负面影响。我们认为，标准的多样性训练不能充分解决异形微攻击。尽管有这些挑战，医疗机构和提供者必须对异性性微侵袭负责，并采取措施减少它们的频率，减轻它们对LGBTQIA护理的影响。最后，我们提出了在医学教育、机构文化和政策以及个人意识层面上解决问题的策略。
In an effort to address healthcare disparities in lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, many hospitals and clinics institute diversity training meant to increase providers' awareness of and sensitivity to this patient population. Despite these efforts, many healthcare spaces remain inhospitable to LGBTQ patients and their loved ones. Even in the absence of overt forms of discrimination, LGBTQ patients report feeling anxious, unwelcome, ashamed, and distrustful in healthcare encounters. We argue that these negative experiences are produced by a variety of subtle, ostensibly insignificant features of healthcare spaces and interpersonal interactions called microaggressions. Healthcare spaces and providers often convey heteronormative microaggressions, which communicate to LGBTQ-and, we suggest, intersex and asexual (IA)-people that their identities, experiences, and relationships are abnormal, pathological, unexpected, unwelcome, or shameful. We identify heteronormative microaggressions common to healthcare settings and specify how they negatively impact LGBTQIA patients. We argue that standard diversity training cannot sufficiently address heteronormative microaggressions. Despite these challenges, healthcare institutions and providers must take responsibility for heteronormative microaggressions and take steps to reduce their frequency and mitigate their effects on LGBTQIA care. We conclude by offering strategies for problem-solving at the level of medical education, institutional culture and policy, and individual awareness.