OPPRESSION, DISCRIMINATION, AND CULTURAL BIAS IN HEALTHCARE

While a person may define themselves largely by their sexual orientation and/or gender identity, one’s experience is also influenced by the intersection of sex, race, ethnicity, socioeconomic status, ability, and other social determinants. All these factors have an impact on a patient’s access to healthcare, health risks, and health outcomes. Any past and present discrimination, oppression, or fear related to these factors can greatly influence an individual’s actions to actively seek care when needed or, conversely, to defer their healthcare needs until a crisis occurs (Medina-Martinez et al., 2021).

An Intersectionality Perspective

Providing whole-person, patient-centered care requires proactively considering how the intersection of each person’s diverse identities and broader cultural factors can affect their health risks, healthcare experiences, and health outcomes. Such an “intersectionality” perspective should not lead to assumptions about an individual based on the minority groups with which they identify but should inform the clinical experience in a positive manner in order to respect and address each person’s unique needs (Medina-Martinez et al., 2021).

Cultural Bias and the Provision of Care

When working with LGBTQ+ patients, it is especially important for clinicians and case managers to build a positive rapport as a way to counteract the exclusion, discrimination, and stigma their patients may have experienced previously in the healthcare environment. However, despite their best intentions, healthcare professionals may hold internalized cultural biases that affect their interaction with patients. For example, a clinician, case manager, or other staff member may say something or use body language that communicates a stereotype or negative message about LGBTQ+ people.

These biases can lead to unequal care and affect a patient’s decision to follow medical advice or return for follow-up care. Negative messages can also become internalized in the patient, adding to an LGBTQ+ person’s stress and contributing to negative mental and physical health outcomes (Medina-Martinez et al., 2021).

Studies have shown that no matter how individuals may feel about prejudiced behavior, everyone is susceptible to biases based on cultural values and stereotypes that were embedded in their belief systems from a young age. To increase one’s own awareness of internal bias, it is helpful to notice times when biased attitudes and beliefs may arise. Such internal awareness is the first step in making changes. Internal questions to ask may include:

• How do my current beliefs help me?
• What might I lose if I change my beliefs?
• How might my current beliefs harm others?
• How might it benefit me and others to change my beliefs?
  (NCCC, n.d.)

It is important for clinicians and case managers to focus on remaining open and compassionate by consciously intending to set aside assumptions and get to know a patient as an individual. For example, when first meeting a new patient who is a transgender man, the clinician can imagine what it might be like for this person to see a new provider for the first time. Instead of focusing on the patient’s gender identity and when or if he has transitioned, the clinician or case manager can focus on getting to know him as a person, such as understanding where he lives and works and more about his family support.