The LGBTQ community, health outcomes & the importance of relationships in healthcare

In this moment, in this world, being a queer and/or trans person can feel really hard and scary. It can be hard to prioritize your health and well-being in a world that seems hell-bent on making your life terrible. I’ve written before about the utility that Chinese medicine has in treating anxiety, depression and chronic pain, which disproportionately effect the LGBTQ community, and today I want to talk about something a little more subtle: early detection of possible health issues.

Statistically-speaking, queer and trans people are less likely to have a serious illness or condition diagnosed early-on. (1) This results in poor treatment outcomes, especially for potentially life-threatening conditions like diabetes and cancer. The reasons for this trend are multifaceted; many queer and trans people are low-income and cannot afford preventative care, many LGBTQ people fear (often correctly) that they will be subject to harassment or cruelty in medical contexts, and healthcare providers are not always trained in how to appropriately do screening tests for bodies like ours.

There is also just the human level of things, where a provider who feels discomfort with a patient because of their perceived sex/gender/orientation will be more likely to forget questions, or will feel shy or awkward about having the conversations that need to be had. (2)

To give an easy example, let’s think about a conversation about breast/chest discomfort.

A patient who has pain in this area may feel hesitant to share this information with a provider who they do not trust, especially if they think it will result in an examination that will make them feel vulnerable or ashamed. A provider who is not comfortable with LGBTQ patients may hear the patient say “I’ve been having pain in my left breast/chest” and note it down without asking any follow-up questions, because they don’t know how to navigate the patient’s discomfort – or their own.

The solutions to this problem are easy to imagine; physicians should develop solid rapport with patients, be educated about their experiences, work through any emotional baggage that they as providers might have about certain types of patients, and pay careful attention to the patient’s comfort in the interaction. All take time, though. Often the most well-meaning and educated western medicine providers are expected to see each patient for 15-20 minutes. This can create serious problems with detailed conversation and questioning.

Luckily in the world of natural medicine, we are able to spend 40 minutes to an hour with each patient.

This means that we can get to know patients and develop trusting relationships with them over time, such that the above conversation would be more likely to happen and go smoothly. We also have specific diagnostic tools in Chinese medicine that help us to detect issues before a patient mentions them. With the patient in the above example, a practitioner might feel the patient’s pulse and notice a choppy or tense quality in the left distal pulse position (associated with the upper torso) and inquire whether the patient was having any discomfort there.

This could create an opportunity for the patient to say “oh yes, I forgot about that, but in fact I have been”. Many early warning signs of illness are subtle enough that patients genuinely forget to mention them, so having several diagnostic systems that go beyond asking questions is quite helpful. A practitioner might also look at that patient’s tongue and find discoloration or a change in texture in the part of the tongue associated with the left side of the chest, and this would have a similar diagnostic meaning, and lead to similar sorts of questions.

All of these factors, combined with a provider who has genuine competency with queer and trans people and their healthcare needs, can create a patient experience where the vital details of a patient’s symptoms are not overlooked. Working in concert with other kinds of providers, Chinese medicine practitioners can help to provide the trusting relationships that make good healthcare possible for everyone.

Resources cited

(1) http://www.familyequality.org/_asset/bg19d2/Top-Health-Issues-for-LGBT-Populations-Information–Resource-Kit.pdf

(2) http://www.sciencedirect.com/science/article/pii/S0277953613001019

Written by Rowan Everard


I discovered Chinese medicine shortly after moving to Portland to complete my undergraduate studies. I began my journey as a patient, but after several years of being an increasingly curious patient I found myself drawn into the formal study of this medicine. In Chinese medicine, I found tools that helped me to transform myself, and which I have seen lead to dramatic positive shifts in patients.