Visual by Akruthi Akula
This article will focus on what is entailed by Queer Representation (Q.R.) in medicine for the patients, as well as the healthcare providers, the current status of Queer Representation in medicine, how it impacts the field, and its impact on the progress in medicine. Thus, it becomes crucial to make note of one’s connotation of Representation. In this particular context, Queer representation is referring to the mention of LGBTQ+ people, their visibility as well as their inclusion in medicine.
Before we proceed, here’s a thought experiment for you.
Imagine that you’re living in a small town of 50 people that are cut off from the rest of the world. Nobody knows that there’s a world outside. It’s quite similar to any other town except for the fact that there are no birds in the town, only four-legged animals. Do you think that you’d be able to know that birds exist?
If David Hume was your neighbour, their response would be a big no. As an empiricist,
David Hume’s theory of ideas went along the lines that everything we believe in is ultimately traceable to experience. And that an idea cannot come to our mind unless we have perceived it through our senses. As for the things that don’t exist- such as a unicorn. One is able to create an image in their head as it is based on their previous knowledge of what a horse and a horn look like.
Do you think if there’s no mention of queer people in the medical textbooks, the healthcare providers would be able to treat queer patients the way they treat other patients?
That’s why representation matters. The current status of Q.R. is in a dismal state. A diverse panel of doctors isn’t limited to the diverse areas of their specialisation but the full spectrum of human differences. It may include visible traits like age, disability, and ethnic background, but also invisible traits like sexual orientation and gender. Diversity doesn’t entail inclusion. Dana Brownlee makes the distinction quite well. Diversity speaks to who is on the table but Inclusion focuses on who is really in the game.
An increasing number of queer doctors wouldn’t necessarily change the culture of the organization nor will it ensure that the queer community would feel fully included and valued.
Diversity without inclusion would be tokenism, and it has done more harm than good for the queer community. But it must be noted that inclusion is much more than being present in a space. It is a feeling of cultural and environmental belonging. Cellular knowledge of the human body neither encompasses, nor guarantees an innate understanding of invisible differences.
Dr. Blair Peters is a queer surgeon who sheds light on the medical culture and their own experience as a medical student and now a doctor. They say that the narrative of the gender binary is dominant throughout medical culture and training. It creates constant pressure on queer students to assimilate into the mainstream to succeed, especially when they don’t have power; resulting in less visibility. It is not the case that there aren’t queer people in medicine. The structure has been framed in a way where the idea of freely expressing yourself is suppressed right off the bat. Resulting in a culture where assimilation (when a minority group or culture comes to resemble a society's majority group) is preferred to enculturation and acculturation (the process of learning our own culture is called enculturation, while the process of learning another culture is called acculturation).
Assimilation has affected the practice of medicine in ways where it becomes difficult for queer patients (especially trans people), to seek healthcare.
In a study published in ScienceDirect journal, 408 trans individuals participated in the survey, Reported Emergency Department (ED) Avoidance, Use, and Experiences of Transgender Persons in Ontario, Canada
An estimated 21% (95% CI 14% to 25%) reported ever avoiding ED care because of a perception that their trans status would negatively affect such an encounter. Trans-specific negative ED experiences were reported by 52% (95% CI 34% to 72%) of users presenting in their felt gender. This study suggested that emergency care providers can benefit from training in the care of transgender persons.
While another study that specifically looked at the experiences of transgender and gender non-binary medical students and physicians suggested that 78% felt the need to censor themselves, while 69% had heard their colleagues disparage transgender and nonbinary patients.
There are several more studies that act as evidence of the discrimination queer individuals deal with, both as doctors and patients.
A non-inclusive medical practice misses out on a strong and progressive system that can benefit both queer and non-queer individuals involved in the system. When there’s an element of psychological safety in an organisation, an individual is able to exercise their autonomy of thought without fearing the repercussions of speaking up. An organisation that facilitates psychological safety would allow people to express the ideas that arise from their thoughts, without any filters in between. Without systemic inclusion, medical practice misses out on innovation within the field that can not only enrich the entire system but also help in actualizing the idea of treating all patients, a not-so-distant dream.