For many LGBTQ2 folks, going to the doctor can be an uncomfortable experience. Despite increased risks for certain health issues, doctors don’t always understand our specific needs—and that can create barriers to the healthcare our communities can receive.
In Canada, it all starts at school: Doctors-in-training receive minimal education on LGBTQ2 health or queer and trans identities, and in turn, many physicians and other healthcare providers lack the necessary knowledge to support and affirm LGBTQ2 patients.
That’s why researchers in the Postgraduate Medical Education program at the University of Toronto have launched a brand new curriculum for medical trainees about LGBTQ2 health and inclusion—including a special focus on how the COVID-19 pandemic is affecting LGBTQ2 people.
The curriculum—one of the the first of its kind in Canada—seeks to equip medical trainees with a basic understanding of diverse LGBTQ2 identities, the fundamentals of how to be inclusive of patients and how to put these ideas into practice. The aim of the curriculum is to show future doctors just how important it is not only to consider the physiological or scientific health of patients, but to understand how social determinants of health and membership in different marginalized communities affects both patient health and patient experience accessing healthcare.
The curriculum uses case studies to help medical trainees better understand the concepts, and move from a theoretical to a practical approach. It also explores some of the technical aspects of LGBTQ2 health, with a focus on transition-related healthcare—such as diagnosis of gender dysphoria and the impact of hormone replacement therapy.
The team of researchers that developed this curriculum largely consists of LGBTQ2 people, many of whom were compelled to make the changes due to their own experiences in the healthcare system. They hope the curriculum will help other members of LGBTQ2 communities accessing healthcare to have more positive experiences than they did.
Miranda Schreiber, a researcher who helped develop the curriculum, says that education for medical trainees tends to focus on the scientific side of health without engaging sufficiently with social factors.
“Medical education tends to be very physiological in nature,” she says. “But when you look at the actual statistics on wellness and health, you’ll see all these disparities that can’t be explained by the physical body alone.”
While physiological and scientific education is crucial, “It isn’t sufficient to explain, for example, why queer women have higher rates of breast cancer than cisgender and heterosexual women,” Schreiber adds.
The curriculum particularly focuses on helping medical trainees understand the difficulties LGBTQ2 communities encounter when accessing healthcare. For example, 12 percent of trans and non-binary people in Canada have avoided going to the emergency room in the past year, and 45 percent report unmet healthcare needs. An American study published in 2015 found that one-third of trans people in the United States who had seen a healthcare provider in the past year had at least one negative experience while doing so. Similarly, studies have routinely found that cisgender LGBTQ2 individuals often face discrimination from health providers—ranging from experiences of verbal abuse and refusals to acknowledge same-gender partners, to unwanted physical contact.
“We wanted physicians to understand how scary it can be for patients, especially queer patients and queer patients of colour, when it comes to accessing care,” Schreiber says. Still, she admits that tackling LGBTQ2 inclusion in the healthcare system isn’t easy.
While Schreiber says there are understandable fears among doctors who have been taught to think from a purely scientific approach, and are therefore reluctant to incorporate new ideas or approaches, acknowledging the social determinants of health and the lived experiences of patients can lead to better research, better care and a better healthcare system overall.
The curriculum’s inclusion of COVID-19-related content is intended to highlight how the pandemic aggravates existing social inequities. “One thing they really wanted to emphasize as people who work in LGBTQ2 research was the ways in which queer people are particularly at a heightened risk of getting COVID-19 and then being harmed in their experiences access healthcare,” Schreiber explains.
This, she says, demonstrates the urgency to improve the training medical trainees receive on LGBTQ2 identities. LGBTQ2 people are at higher risk of various health issues, are less likely to access care and more likely to experience discrimination while doing so. The pandemic only exacerbates these existing inequities.
The new curriculum will be unveiled on May 27, when it is presented to the postgraduate medical trainees at the University of Toronto. Schreiber admits the curriculum is but one of many steps needed to improve how the healthcare system treats LGBTQ2 patients. But she hopes that it will ensure future doctors are better trained to be queer- and trans-inclusive.
Schreiber wants the curriculum to be shared with other medical schools across Canada. In the long term, she hopes that it can help Canada move toward the creation of national standards on LGBTQ2 health, which would ensure that all physicians in the country have the knowledge and tools needed to support their LGBTQ2 patients.
“We know we can’t solve the entire LGBTQ2 health gap,” Schreiber says.“But we know there’s a source of the disparity that comes from bad encounters between LGBTQ2 members and clinicians.” She hopes this curriculum can help bridge that gap.