By Nicole Flemmer, ARNP, FNP-C
“I don’t have any lesbians in my practice.” – A physician attending a recent gynecological conference in a major American city, when asked why he wasn’t planning to attend the presentation from a world-class researcher on sexually transmitted infections between women who have sex with women.
But you and I know that’s not true. Women of sexual minority are everywhere, in every city, town, and rural community in every part of the world. The problem is that so many of us remain invisible to our communities, even, frighteningly, to our own doctors.
It’s 2015, but LGBT invisibility is still a problem in the health care setting. I know of what I speak. I’m a family nurse practitioner who is a lesbian. Many lesbian and bisexual women, myself included, have been disregarded, mistreated, marginalized, unseen, and misunderstood by our health care providers and the health care system. In the eyes of health care, we either don’t exist or if we do, the message we are given is that we are unacceptable or unwelcome.
From the intake forms that do not use inclusive language, to the awkward moment when your doctor asks why you not on birth control if you are sexually active but aren’t trying to get pregnant, to the uncertainty that floods you every single time you see a new provider because you don’t know if you are safe to be you – it is no wonder we, as lesbian and bisexual women, access health care less than the general population.
As both a lesbian and a health care provider, I am standing up. It’s time to shed my invisibility cloak and stand with you as you shed yours.
As a patient, you have every right to a health care interaction that makes you feel seen, taken care of and heard. You have the right to be in partnership with your provider to create your own goals for your optimal health.
That being said, I know firsthand as a patient how hard it is to stand up to a system that has demanded that you sit down and do exactly as you are told. It takes much courage to stand in the face of that oppression.
I created a practice framework for doctors and other helping professionals called Empathetic Partnership that is based on the concept that doctors have an opportunity to create partnerships with you, the patient, instead of hierarchies. This approach holds that you and your doctor have an opportunity to work together on your health goals, and that each of you deserves to be treated with respect for exactly who you are.
Here are some things to look for in your doctor or health care provider if you are interested in creating a partnership and claiming your right to a safe health care experience – one that recognizes and validates you for who you are.
1) What’s the environment of the health care office or setting? Is there an anti-discrimination policy posted? What kind of reading material is available? Is it inclusive of varying lifestyles? What kind of photography is posted? Is there a human rights campaign sticker, a rainbow sticker or a pink triangle displayed anywhere?
2) What kind of language is used on the intake forms and in the office by providers and staff? Is the language inclusive of non-heteronormative identities? Or do you have to write in “lesbian,” “bisexual,” or “partnered” when you don’t fit into the checkboxes provided? Does your provider take cues from your language or does he/she seem oblivious to your personhood?
3) Does your provider have knowledge about specific health care risks or concerns that you may have as a woman of sexual minority? Do they know the difference between stereotypes and verifiable research? Are they also willing to look at you as an individual, not just a member of a population? Although there is not very much research available (yet), what research is available says there may be higher risks of certain mental health and substance abuse issues, higher rates of cancers as well as lower access to health care among the women of sexual minority populations. Does your provider have a clue?
4) Does your provider show any interest in your personal ideas around health, what goals you might have, or how you feel about your overall health? Does he/she ask you questions that make you feel that you are in partnership with them around working toward your desired health goals? A health care provider who is interested in partnering with you in this way is first of all aware of the inherent power dynamic that has been passed down through the years of doctor being powerful and patient being powerless. They acknowledge this dynamic and work to create a more equal partnership with you. They bring their expertise and knowledge about science to the table, you bring your expertise and knowledge of yourself to the table, and together you figure out a plan. You feel safe with them, they value your opinion, and they actually care about you. They are your cheerleader as you work toward your own goals around health.
It is your right to have all of this if you want it. You have the power to request and create the kind of relationship you want with your provider and that you do not have to put up with being berated, lectured to, or put down. You are the expert in your own life. While you trust your doctor to have insight and knowledge about the science of your body that you may not have, that does not give them free reign over you.
You deserve to feel heard and seen and valued by your health care provider. You deserve to stand up for yourself if you need to. You deserve to be healthy in ways that are meaningful to you and to be supported in your efforts by a doctor who wants to see you succeed.
I am ready to stand up, to shed my invisibility. To make myself seen and heard. Will you stand with me?
Nicole Flemmer, ARNP, FNP-C is a nurse practitioner in Seattle, Washington, and the founder of The We Belong Project, an online resource for women of sexual minority and health care providers who care for them.