To care for people is to care for the stories that shape them. Clinicians can enhance patients’ confidence in the healthcare system by skillfully engaging with their stories of gender and sexual orientation.
Have you ever come out to your clinician about your gender identity or sexual orientation? If so, have you had to come out to the same clinician on multiple occasions? I have. And I’m not alone.
Imagine gearing up for years to come out—to yourself, to those you care about, and to your physician—only to have them “forget” this critical element of your identity between appointments. As disheartening as this has been for me, it’s unfortunately commonplace for queer people to experience disenfranchisement ranging from intentional misgendering to outright refusal of care. Poor healthcare experiences are especially common for those with additional intersectional identities—such as is the case for many who identify as LGBTQ2S+. You may not be the clinician who forgets or is unwilling to care for queer bodies. But your queer patients have likely had these experiences, and they affect the relationship they have with you.
The process of finding safe and accessible healthcare can be so intimidating that many queer-identified people still avoid or delay seeking medical intervention. Fear of negative healthcare experiences thus contributes to healthcare disparities.
What would help queer patients feel confident about seeking care?
To care for a body is to care for the stories that shape it.
The way to enhance clinical trust is by applying narrative skills in clinical settings. Using narrative skills in medicine is an aim of the field of Narrative Medicine, which founder Dr. Rita Charon defined as “clinical practice fortified by knowledge of what to do with stories.”
So, how do you care for a queer story? What skills are needed?
As a queer person, and as a scholar of gender and religion and who also studies and teaches Narrative Medicine and works in a medical residency, here are a few suggestions:
1. Trace your own story.
A good first step is to think through your own story of gender and sexual orientation. This is valuable no matter how you identify. What were the earliest experiences and beliefs that shaped your sexual orientation and sense of gender? How do these stories relate to your health over time? What parts of these stories are easy to take for granted?
2. Build your narrative skill bank with accessible tools.
Pay attention to the ways the patient’s story unfolds. Standard literary tools offer accessible ways to enter a story as you listen. Who are the characters? What’s the role of place or setting? What metaphors stand out? Character, voice, time, space, mood, genre, setting, word choice—considering these aspects of a story can enrich your listening in a mindful way.
3. Be curious about how the patient’s story works. Make space for story.
Gender is foundational in how we relate to each other and yet it’s not always easy to discuss. The CDC suggests asking all patients about their gender and sexual orientation. Studies show that when a patient is allowed to talk at the beginning of an appointment, they take less than two minutes. Invite stories and remember when they are shared. Look for ways to include self-identification in EHRs and encourage it in your healthcare system’s data collection.
4. Know that common words have many meanings.
The ways we define, understand, and live our genders can vary according to place, cultural context, and individual experience. Even for cisgender or straight patients, the way people express the labels of male or female or heterosexual varies broadly. All embodiments of gender inflect health.
The rainbows of Pride Month are key symbols that say, “Your body is welcome.” But we also need the skills to engage with the stories that shape the bodies. Inviting stories means having the interest and capacity to consider the role of gender and sexuality in health. Working mindfully with queer stories can teach us how to imagine the role of gender and sexual orientation in health more broadly for all patients. By unraveling what we take for granted about how gender and sexuality shape a life, we also develop narrative skills that are transferrable, scalable, and practical for thinking through other intersectional identities in healthcare.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.