Coming out to Healthcare Providers: Lived Experiences of Lesbian, Gay, Bisexual, and Queer Patients

Background and Purpose:

Lesbian, gay, bisexual, and queer (LGBQ) patients experience healthcare disparities. In response, notable national efforts emphasize sexual orientation and gender identity (SOGI) data collection to increase healthcare’s capacity to identify disparities and measure progress towards eliminating them. Our research aims to further inform these efforts by prioritizing LGBQ patients' voices. In this qualitative component of a mixed methods phenomenological research we ask: What is the experience of coming out as LGBQ to healthcare providers?

Methods:

We collected data (n=10) as part of a QUAN–PHEN study. LGBQ online survey participants of any gender, 18 or older, who indicated interest, were eligible for a follow up in-depth interview.  Quantitative online survey findings (N=398) informed the interview. The final sample included one African American man, one Asian American man, three Latina/Hispanic women, one Latino/Hispanic man, two non-Hispanic White women, and two non-Hispanic White men. Out of 10 participants, three identified as bisexual, four as gay, two as queer, and one as lesbian. All of the participants were college-educated (n=8) or in college (n=2). They were 22-48 years old and lived in five U.S. states. Ahmed’s queer phenomenology and Merleau-Ponty's philosophy of embodiment framed the study. We analyzed the data following the tradition of interpretive phenomenology.

Results:

The process of coming out in healthcare contributes to various levels of ongoing distress, often embodied, revealing how unjust institutions “get under the skin” of LGBQ patients. Ahmed’s concept of straightening, a dynamic process shaped by the repetition of learning and action over time, occurs in response to queerness becoming visible in a space in which straightness (heterosexuality) is normative. The findings reveal that straightening is firmly embedded in patient-provider encounters. In such contexts, healthcare providers, almost universally, read queerness as a deviation. As a result, they experience disorientation, demonstrating surprise and discomfort. In response, patients experience distress, including shame and fear. The relational disconnect contributes to distrust, ultimately creating memories which negatively influence LGBQ patients’ future decisions to come out or honestly discuss health behaviors.  Given this reality, LGBQ patients navigate a number of competing priorities related to obtaining quality healthcare (e.g., protecting dignity by remaining invisible vs. protecting health by becoming visible in order to honestly discuss all factors affecting health) and engage in an ongoing, often laborious, cost/benefit analysis related to coming out. Severity of illness, stage of coming out, and patients’/providers’ race/ethnicity, gender, and age influence the cost/benefit analysis and associated distress.

Conclusions and Implications:

Healthcare data collection best practices recommend universally assessing and documenting patients’ SOGI as a strategy towards eliminating healthcare disparities. Our findings, however, highlight the ongoing distress that LGBQ patients experience coming out in healthcare settings. Given the documented association between stress and LGBQ health disparities, our findings complicate the underlying assumption that SOGI data collection always contributes to health equity goals. Although data collection is crucial, a simultaneous focus on developing healthcare providers’ critical consciousness, enhancing LGBQ communities’ health inequity knowledge, and forming LGBQ communities-healthcare policy advocacy partnerships is essential for health equity efforts.