Authored by Austin Grattan, Health Care Policy ‘26
Art by Michelle Zhang, Biological Sciences and Information Science '25
A nurse handed Rachel a pee cup at her doctor’s appointment.
“What is this cup for?” asked Rachel.
“To see if you are pregnant,” the nurse replied.
“I’m gay, I’m dating a woman,” responded Rachel.
Rachel Susann is a lesbian woman who showed up on my For You Page on TikTok (@rachelsusann_) [1]. After recounting this story of her doctor’s appointment she brought up a painfully accurate point; medical practices and questioning often assumes that their patients are straight.
Like nearly every other institution in America, healthcare was designed for cisgender heterosexual individuals. The foundation of the American healthcare system was built at a time where gay marriage was illegal nationally, and discrimination against LGBTQ+ individuals was permitted. The design and structure of our healthcare system has utterly failed LGBTQ+ people countless times through inadequate and inappropriate care. My community is tired of accepting this recurring injustice.
As a white, cisgender, bisexual man I have not run into many barriers to quality and inclusive healthcare. But, if TikTok is good for something, it’s displaying queer creators who share their unfortunate healthcare stories to spread awareness about the ubiquitous issue. As I saw more videos like Rachel’s, I became more curious about how prevalent the issue of queer individuals being failed by their healthcare was.
Until 1973, homosexuality was a registered mental disorder in the Statistical Manual of Mental Disorders [2]. In recent history, medicine was used to help “treat” being gay. This has created significant disparities in health and medical treatment of LGBTQ+ individuals [3]. Members of the LGBTQ+ community are more likely to suffer from many mental and physical health conditions than heterosexual/cisgender individuals. LGBTQ+ individuals are more likely to have suicidal thoughts and severe anxiety as well as suffer from substance abuse. Additionally, gay and bisexual men are more likely to contract HIV/AIDS while lesbian and bisexual women are more likely to be diagnosed with breast cancer [4].
There are a few ways health disparities might manifest themselves. Compared to heterosexual/cisgender patients, medical doctors have been shown to be less confident in treating LGBTQ+ patients [3]. One study indicates that, on average, doctors ranked themselves a 3 on a scale of 1-5 on taking an unassuming position on a patient’s gender and sexuality [3]. The unfortunate possible explanation for these results lies in the current state of queer healthcare curriculum in medical school programs.
In one of the first studies of its kind, a 2011 American Medical Association study found that on average, medical students received 5 hours of education on LGBTQ+ health issues. Out of the 176 allopathic medical schools surveyed, 9 reported having zero hours of LGBTQ+ care education in the preclinical years, and 44 reported having 0 hours in the clinical years [5]. These embarrassing statistics were the first main push for the American Association of Medical Colleges (AAMC) to release new guidance, which was done in 2014 [6].
The effects on this new guidance have been underwhelming. The AAMC released 30 new healthcare competencies for medical doctors to be integrated in the medical school curriculum almost a decade ago [6]. A 2021 study showed that 67% of doctors rated their medical school education on LGBTQ+ care as fair or worse and over 70% of doctors said that they were not comfortable discussing gender affirming care or transitioning with transgender patients [7].
When doctors are not properly educated on queer healthcare, they are not able to deliver quality and equitable care to their LGBTQ+ patients. This leads to non-inclusive questioning, limited dissemination of queer health services, and amplification of the large health disparities observed within the LGBTQ+ community.
This failure by our health system has created a sincere queer fear; members of the LGBTQ+ community do not feel comfortable going to the doctor’s office. In the face of significant LGBTQ+ health disparities, it is essential that queer inclusivity is prioritized in healthcare reform and medical education. Starting small, like teaching doctors to not assume that all women who are sexually active have male sexual partners, like Rachel, can make a big difference. It’s time to eliminate this sincere queer fear once and for all.
Works Cited
@rachelsusann_. (2022, May 7). healthcare: start advocating for your LGBTQ+ patients [Video]. TikTok. https://www.tiktok.com/@rachelsusann_/video/7095038448620539182.
Beck, J. (2014, November 15). What Doctors Don’t Know About LGBT Health. The Atlantic. https://www.theatlantic.com/health/archive/2014/11/what-doctors-dont-know-about-lgbt-health/382792/.
Walia, H., Banoub, R., Cambier, G. S., Rice, J., Tumin, D., Tobias, J. D., Raman, V. T. (2019). Perioperative Provider and Staff Competency in Providing Culturally Competent LGBTQ Healthcare in Pediatric Setting. Advances in Medical Education and Practice, 10, pg. 1097-1102. https://doi.org/10.2147/AMEP.S220578.
LGBTQ+ Health Disparities. (2023). Cigna Healthcare. https://www.cigna.com/knowledge-center/lgbt-disparities.
Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., Wells, M., Fetterman, D. M., Garcia, G., Lunn, M. R. (2011). Lesbian, Gay, Bisexual, and Transgender–Related Content in Undergraduate Medical Education. JAMA, 306(9), pg. 971-977. https://doi.org/10.1001/jama.2011.1255.
Krisberg, K. (2016, September 29). New Curricula Help Students Understand Health Needs of LGBT Patients. American Association of Medical Colleges. https://www.aamc.org/news-insights/new-curricula-help-students-understand-health-needs-lgbt-patients.
O’Leary, K. B., Kunkel, G. H. (2021). Restructuring LGBTQ Curriculum in Medical Schools. Academic Psychiatry, 45, pg. 487-490. https://doi.org/10.1007/s40596-021-01414-1.