We the People of Physical Therapy (Part 1)
/This article is for you. Well, not if you are a veterinarian, I suppose; but, even then I’m sure some similar argument could be made in regard to your client satisfaction. But, I digress. This article is for you. The healthcare provider. Specifically, the physical therapist who gives care to patients—to people, to humans—of all different backgrounds.
Why did you choose a career in healthcare? What made you want to be a physical therapist? The common trend among responses, and the hackneyed answer that employers hear too often, is that you want to help people. You simply want to help humans feel better.
So, what does it take to make a human feel better? All the science-y things we go through school to learn—duh! However, we cannot forget that quality healthcare requires us to consider the biopsychosocial influences on the health of our patients. Included in the biopsychosocial model of healthcare is the concept of cultural competence, which requires “acceptance and respect for difference” with “continuing self-assessment regarding culture, vigilance towards the dynamics of differences, ongoing expansion of cultural knowledge and resources, and adaptations to services” (Hayward, 2015 & Burch, 2008). In fewer words, cultural competence requires we treat all people like humans, each deserving equal respect and quality in healthcare regardless of personal or societal biases.
Unfortunately, cultural competence and humility is often lost when it comes to providing care for the lesbian, gay, bisexual, transgender, queer (LGBTQ+) population. Despite growing efforts to create inclusive physical therapy (PT) school curriculums and clinical settings, the marginalization of this group is largely apparent. Additionally, uninformed attempts at inclusivity of this population sometimes serve to further stigmatize patients who are LGBTQ+ as atypical.
It is well documented in literature and research that people who identify as LGBTQ+ have been historically marginalized, and suffer increased health risks in conjunction with the added stressors affecting healthcare services (Copti, 2016). Those who identify as LGBTQ are at increased risk for substance and tobacco use, sexually transmitted diseases, depression and anxiety, disordered eating, suicidal ideation or attempt, sexual abuse, chronic pelvic pain, low back pain, obesity (Copti, 2016, Mayer, 2008, & Eisenberg, 2017). Those undergoing hormonal therapies are also at further greater risk for various cancers, diabetes, cardiovascular issues, and osteoporosis (Copti, 2016). Additionally, a greater proportion of people who are LGBTQ+ face known negative determinants of health, such as homelessness, social isolation, and poverty (Colpittis, 2016).
These risk factors are derived from and influenced by the disproportional victimization and discrimination by healthcare workers toward people who are LGBTQ+, as well as the “ignorance of LGBT health care needs” that “contributes to the misallocation and wasting” of health resources (Taylor, 2018, Nadal, 2016, & Goldhammer, 2018). Lack of cultural humility and sensitivity from healthcare workers and institutions creates physical and emotional barriers to receiving quality care, limits access to preventative care measures, and negatively influences health outcomes. The conscious and unconscious biases apparent in clinician-patient interactions cause people who are LGBTQ+ to endure lower quality of care, lose out on proper continuity of care, and avoid seeking necessary and timely medical treatment (Glasper, 2016).
This invites conversation about how we can make changes in the clinical setting to help all humans feel better, without further stigmatizing or ignoring LGBTQ+ health issues. Cahill (2017) states that “one thing lacking in much of the analysis of this increased focus on LGBT health is the human element” (Cahill, 2017). Note the emphasis on human. So, the simple answer to this multifaceted issue? Just treat all patients like humans!
Too simple? No. But, as with many things in life and healthcare, we make it complicated. Combatting the complexities and intricacies of societal discrimination, socioeconomic obstacles, political challenges faced by people within the LGBTQ+ community is beyond the scope of this blogpost, but we can discuss small changes we can take in the PT setting to make all patients feel human while in our care.
In Part 2 of this blogpost, we will review some techniques and modifications cited in literature that we can use to help create a clinical environment that is competent in providing quality care to all humans who walk through our doors.
Jordan is completing her final clinical rotation at Entropy Physiotherapy and Wellness before graduating from Old Dominion University this May as a Doctor of Physical Therapy. She will be starting her career as an outpatient pelvic physical therapist, following her passion to provide quality care for all people with pelvic health needs.
Update: Jordan has completed her rotation at Entropy and has passed her board exam!! Congrats!!
Resources
Abramovich, A & Cleverley, K. A call to action: The urgent need for trans inclusive measures in mental health research. The Canadian Journal of Psychiatry. 2018;63(8): 532-537.
American Physical Therapy Association (APTA). Blueprint for teaching cultural competence in physical therapy education. Retrieved from http://www.apta.org/Educators/Curriculum/APTA/CulturalCompetence/. August 2014. Accessed April 3, 2019.
Burch, A. Health care providers’ knowledge, attitudes, and self-efficacy for working with patients with spinal cord injury who have diverse sexual orientations. Physical Therapy. 2008;88: 191-198.
Cahill, S. LGBT experiences with health care. Health Affairs; Chevy Chase. 2017;36(4): 773-774.
Colpittis, E, & Gahagan, J. The utility of resilience as a conceptual framework for understanding and measuring LGBTQ health. International Journal for Equity and Health. 2016;15(16): 1-8.
Copti, N, Shahriari, R, Wanek, L, & Fitzsimmons, A. Lesbian gay, bisexual, and transgender inclusion in physical therapy: Advocating for cultural competency in physical therapist education across the United States. Journal of Physical Therapy Education. 2016;30(4): 11-16.
Deutsch, MB & Buchholz, D. Electronic health records and transgender patients—Practical recommendations for the collection of gender identity data. Journal of General Internal Medicine. 2014;30(6): 843-847.
Eisenberg, ME, et al. Risk and protective factors in the lives of transgender/gender noncomforming adolescents. Journal of Adolescent Health. 2017;61: 521-526.
Glasper, A. Ensuring optimal health care for LGBT patients. British Journal of Nursing. 2016; 25(13): 768-769.
Goldhammer, H, Malina, S, & Keurogblian, AS. Communicating with patients who have nonbinary gender identities. Annals of Family Medicine. 2018;16(6): 559-562.
Hayward, LM & Li, L. Promoting and assessing cultural competence, professional identity, and advocacy in Doctor of Physical Therapy (DPT) degree students within a community of practice. Journal of Physical Therapy Education. 2014;28(1): 23-36.
Jann, JT, Edminston, EK, & Ehrenfeld, JM. Important considerations for addressing LGBT health care competency. American Journal of Public Health. 2015;105(11): e8.
Mayer, KH, et al. Sexual and gender minority health: What we know and what needs to be done. American Journal of Public Health. 2008;98(6): 989-995.
Nadal, KL, et al. Microaggressions toward lesbian, gay, bisexual, transgender, queer, and genderqueer people: A review of the literature. The Journal of Sex Research. 2016;53(4-5): 488-508.
Reisner, SL, et al. Comprehensive transgender healthcare: The gender affirming clinical and public health model of Fenway Health. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2015;92(3): 584-592.
Taylor, AK, Condry, H, & Cahill, D. Implementation of teaching on LGBT health care. The Clinical Teacher. 2018;15: 141-144.
Wahlert, L & Fiester, A. Repaving the road of good intentions: LGBT health care and the queer bioethical lens. The Hastings Center Report. 2014;44(5): S56-S64.