Inhospitable Healthcare Spaces: Why Diversity Training on LGBTQIA Issues Is Not Enough


In an effort to address healthcare disparities in lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, many hospitals and clinics institute diversity training meant to increase providers’ awareness of and sensitivity to this patient population. Despite these efforts, many healthcare spaces remain inhospitable to LGBTQ patients and their loved ones. Even in the absence of overt forms of discrimination, LGBTQ patients report feeling anxious, unwelcome, ashamed, and distrustful in healthcare encounters. We argue that these negative experiences are produced by a variety of subtle, ostensibly insignificant features of healthcare spaces and interpersonal interactions called microaggressions. Healthcare spaces and providers often convey heteronormative microaggressions, which communicate to LGBTQ—and, we suggest, intersex and asexual (IA)—people that their identities, experiences, and relationships are abnormal, pathological, unexpected, unwelcome, or shameful. We identify heteronormative microaggressions common to healthcare settings and specify how they negatively impact LGBTQIA patients. We argue that standard diversity training cannot sufficiently address heteronormative microaggressions. Despite these challenges, healthcare institutions and providers must take responsibility for heteronormative microaggressions and take steps to reduce their frequency and mitigate their effects on LGBTQIA care. We conclude by offering strategies for problem-solving at the level of medical education, institutional culture and policy, and individual awareness.

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    These examples might also fit into the category “use of heterosexist and transphobic terminology.” However, in That’s So Gay, Nadal reserves this category for slurs. In an earlier article (Nadal et al. 2010), the terminology category is broader and would include the above examples. In any case, it is clear that the use of these terms and phrases are microaggressions according to Nadal’s taxonomy.

  2. 2.

    This is despite prolonged activist efforts and work by the Hastings Center to argue that these “normalizing” surgeries should not be performed without the individual’s consent, unless there are other medically relevant considerations. Greenberg reports: “Most doctors, however, oppose a moratorium on infant genital cosmetic surgeries and believe that surgical alteration is in the best interests of a child born with an intersex condition … According to one comprehensive study published in 2007, most parents still choose to consent to genitoplasty on behalf of their infants” (2012, 866).

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    This trend of “feminizing” intersex patients has been critiqued heavily, and these cases are not as common as they used to be (Greenberg 2012, 860).

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    It should be noted that individuals who do not explicitly share their LGBTQIA status with a provider may not be withholding anything; they may simply feel that the information is irrelevant to their care at that time.

  5. 5.

    This point holds for providers who belong to the LGBTQIA population as well as those who are cisgender and heterosexual.


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The authors would like to thank Nabina Liebow, participants at the 2014 meeting of the American Society for Bioethics and Humanities and the 2015 meeting of Canadian Bioethical Society, and two anonymous reviewers for their helpful comments on this paper. Megan Dean would like to thank the Social Sciences and Humanities Research Council of Canada for its support.

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Correspondence to Megan A. Dean.

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Dean, M.A., Victor, E. & Guidry-Grimes, L. Inhospitable Healthcare Spaces: Why Diversity Training on LGBTQIA Issues Is Not Enough. Bioethical Inquiry 13, 557–570 (2016).

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  • Microaggressions
  • Heteronormativity
  • LGBTQIA health
  • Diversity training
  • Queer bioethics