- New research from Healthgrades and OutCare Health highlights the challenges LGBTQIA+ people face when seeking medical care.
- The study found that 47% of LGBTQIA+ people experience medical gaslighting.
- The research also found that 18% reported experiencing medical trauma and 10% said they have experienced some form of medical discrimination.
For members of the greater LGBTQIA+ community, the medical system can be difficult to navigate. Oftentimes, structural barriers, biases, and discrimination against queer people in the healthcare system can prevent them from not only getting the care they need but inflicting trauma as well.
Recently, Healthgrades, the leading online resource for comprehensive information about physicians and hospitals, and LGBTQIA+ health equity resource OutCare Health partnered on a joint study.
The research gives a snapshot of the challenges members of this community face when seeking medical care — from medical gaslighting to trauma.
Experts say spotlighting this kind of data can pave the way forward for making the healthcare experience safer and more equitable for LGBTQIA+ people.
For this study, the two companies surveyed 952 adults who identified as being LGBTQIA+ as well as 1,049 adults who identified as cisgender as well as heterosexual.
Generally, they found LGBTQIA+ respondents were less likely than their cis and straight peers to have gone in for a health screening over the past year and were more likely to skip care altogether.
The reason why?
LGBTQIA+ people ran into less supportive, far more traumatizing, and exclusionary treatment from providers.
Among the findings, 47% of LGBTQIA+ people surveyed reported experiencing medical gaslighting in the past two years.
That ranged from 45 to 54% across all subgroups within the larger LGBTQIA+ community, except for those who identified as gay — they had similar levels of reported gaslighting as their cis and heterosexual-identifying peers, at 26%
When asked to agree with the following statement, “My doctor listens to me when I express concerns about treatments and prescriptions,” 49% of LGBTQIA+ respondents agreed compared to 61% of straight and cis respondents.
The survey shows that 47% of LGBTQ+ participants agree with the statement that they “feel confident communicating with their doctor,” compared to 63% of cis and straight people.
For the statement, “My doctor takes my opinions seriously,” 44% of LGBTQIA+ respondents agreed compared to 57% of straight and cisgender participants.
In looking even closer to the patient-provider relationship, less than half of LGBTQ+ people said they were satisfied with their doctor while 37% said they “feel respected by them.”
This pervasive gaslighting and lack of respect and understanding can take a toll.
In the past year, the survey reveals that 1 in 4 LGBTQ+ adults did not have a health screening of any kind, compared to 1 in 5 cisgender, heterosexual people. Around half of queer respondents “intentionally delayed, avoided, or skipped an exam in the past 12 months” and were also found to be 26% more likely than straight and cis people to avoid these screenings.
Lack of perceived respect and support from providers isn’t the only reason.
High out-of-pocket medical costs were a big reason for both groups to skip appointments. Still, LGBTQIA+ people were almost three times more likely to skip an appointment due to poor mental health and twice as likely to avoid a health screening “due to a past negative experience,” compared to their cis and straight peers.
The survey shows that 29% of queer respondents felt dismissed and not taken seriously by their doctors, 15% were told their symptoms were “all in their head,” 18% reported experiencing medical trauma, and 10% said they have experienced “some form of medical discrimination.”
Mandi Pratt-Chapman, PhD, is the associate center director for community outreach, engagement, and equity at the George Washington University Cancer Center, and has been very familiar with these issues through her own research.
In 2019, Pratt-Chapman, who is unaffiliated with the new survey, published a study that looked at transgender and gender-diverse people’s experiences with the healthcare system.
Pratt-Chapman told Healthline that medical gaslighting “is a huge issue for the queer community,” explaining that “if people feel like they have to hide who they are or they will be misgendered or they will have negative encounters, many people choose to not engage with the healthcare system until they are in extreme need.”
Pratt-Chapman’s research found that transgender men and nonbinary people especially had these negative experiences.
Heather Zayde, LCSW, a Brooklyn-based clinical social worker and psychotherapist, stressed that medical gaslighting is “a very serious issue” that can be “harmful, destabilizing, and even deadly.”
“Medical gaslighting occurs when a medical provider, like a doctor, nurse, technician, or therapist, downplays, invalidates, or negates a patient’s concerns about a health-related issue,” said Zayde, who is unaffiliated with the Healthgrades and OutCare Health survey. “This is, unfortunately, more common when patients are women, people of color, are members of the LGBTQ community, and/or are geriatric patients.”
Zayde told Healthline that the effects of medical gaslighting can manifest themselves in different ways. If someone doesn’t feel like their doctor is actively listening or taking them seriously, the person will then be more likely to underreport their medical concerns.
“Feeling invalidated or dismissed by a medical professional can cause feelings of hopelessness, worthlessness, depression, and anxiety. If a person deals with these issues frequently, they may deliver up on advocating for their care which is severely detrimental to one’s health,” Zayde added.
Another expert, Rhonda Schwindt, D.N.P., RN, PMHNP-BC, PMHCNS-BC, a tenured associate professor at The George Washington University School of Nursing and is a nationally certified Psychiatric-Mental Health Nurse Practitioner with an active clinical practice specializing in LGBTQIA+ health, trauma, and treatment-resistant mood disorders, echoed these thoughts, saying this is a serious, pervasive problem.
“Healthcare providers, individually and collectively, have a long history of pathologizing diverse sexual orientations and gender identities based largely on religious, medical, social, and legal stigmas. While we’ve made progress, the pathology narrative continues to influence many providers’ decision-making and approaches to care,” Schwindt told Healthline.
“Dismissing a patient’s concerns (i.e., medical gaslighting) denial of services, and exposure to discriminatory practices while seeking care, are all significant contributors to poor health outcomes for LGQTQIA+ people compared to their cisgender, heterosexual peers,” Schwindt added.
The LGBTQIA+ community isn’t a monolith.
It is an incredibly diverse population of people with intersecting identities and vastly different experiences between one another.
In a way not unlike the different experiences a straight person may have compared to a gay person, a cis queer person could interact with the healthcare system very differently than a trans or nonbinary person. A white gay person, for instance, might face different experiences in a hospital than a queer person of color.
“An individual’s cultural and social identities — including race and ethnicity, social class, socioeconomic status, gender identity, sexual orientation — can collide or intersect to create social injustices, health care inequities, and marginalization,” Schwindt explained. “The additive effect of more than one minority identity is a well-known contributor to an increase in the likelihood that the person will experience daily discrimination, bias, and prejudice.”
Pratt-Chapman added more context, giving the example that bisexual people often are discriminated against and disbelieved in both straight and queer communities.
She said this may account for why tobacco and alcohol use rates are highest among bisexual people, citing another study she worked on from 2022.
“Transgender and nonbinary people frequently experience misgendering that can cause people to avoid or leave care entirely. People who experience multiple forms of discrimination, such as queer racial or ethnic minoritized persons, have exponential obstacles to quality care,” Pratt-Chapman explained.
“The discordance of providers in terms of lived experiences, lack of knowledge about queer health needs, and increasing cultural polarization have been extremely harmful to queer people of diverse backgrounds.”
The new survey shows the medical trauma that LGBTQIA+ people can face. What kind of impact can that have on one’s overall health, and on their life in general?
Schwindt said that there is a robust body of research out there that examines the effect exposure to minority group-specific stressors can have on a person. Those traumas experienced in medical settings “can disrupt an individual’s ability to cope and achieve optimal health,” she added.
“The cumulative effect of these experiences over time can have a devastating impact, such as an increased risk for PTSD, suicide ideation and attempts, and other mental and physical illnesses,” Schwindt added.
The survey reveals that 13% of LGBTQ+ people reported emotional medical trauma, 6% reported physical trauma, and 3% reported sexual trauma.
For cisgender and heterosexual people? Those numbers stand at 5%, 4%, and 1%, respectively.
With all of this outlined and brought to the forefront, there is no surprise that LGBTQIA+ people have low levels of trust in healthcare.
While 54% of LGBTQ+ people reported trusting their primary care providers in the survey — compared to 70% of heterosexual, participants — the numbers go down precipitously when you look at other areas of one’s healthcare experience, including:
- 50% of LGBTQ+ people trust specialists
- 17% trust the U.S. healthcare system as a whole
- 16% trust pharmaceutical companies
- 15% trust insurance companies
All of the numbers were considerably higher among the straight and cisgender participants.
When asked if anything can be done from a policy standpoint to Strengthen conditions within the healthcare system for LGBTQIA+ people, Schwindt explained that the greater lack of access to culturally informed, affirming healthcare for queer people coupled with anti-LGBTQIA+ rhetoric and legislation that has flooded national politics in the United States, has created “significant health disparities.”
“Health care providers must be willing to examine their own implicit and explicit biases, push for enhanced emphasis on LGBTQIA+ health during medical education, and join the LGBTQIA+ community in the fight to eliminate social injustices and health inequities,” Schwindt added.
When facing these obstacles, what can LGBTQIA+ people do when seeking care that will be safe, inclusive, and accessible?
Pratt-Chapman suggested trying to find another provider if you feel you aren’t being supported or getting the care you need.
“If youcan find an affirming provider, do so. If you have limited options in terms of specialty care, bring a person you trust with you, ask about patient advocacy and complaint services — tell a patient advocacy rep about your experience so it can be addressed at a system level,” Pratt-Chapman explained. “I realize doing this is more complicated than telling someone to do it. There are a lot of safety considerations when reporting, so people should trust their instincts when it comes to safety disclosure.”
She pointed to one tool — I Want You to Know — that might help you navigate discussion with your provider about your identity and health care needs. Pratt-Chapman also recommended a tool to share with providers, Practice Patient-Centered Care Posters for them to find education and resources for better communicating with their patients in an inclusive, empathetic, culturally sensitive way.
Zayde said you have to be clear about your concerns with your provider.
“Ask them to notate your requests and concerns in your chart. If your doctor is making you feel like your issues are being downplayed, point that out to them. Keep a log of your symptoms and the tests you’ve been offered. A doctor-patient relationship should feel like a partnership and should not be totally one-sided,” Zayde added.
“If you feel as though your doctor is not honoring your requests, seek out another doctor or a specialty clinic that works with the LGBTQ community. You might choose to bring a friend to your appointment if that helps you feel more comfortable in speaking up for yourself.”
For LGBTQIA+ people, oftentimes, you have to be your own best advocate. Research like this can shed light on some of the challenges present in the healthcare system for queer people and can offer a roadmap for solutions to make things better.
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