The LBGTQ community has not always been openly acknowledged or treated with regard and respect. Thankfully, modern thinking is seeking to change this for the better and many studies have already been done highlighting the major health issues of the community worldwide. Most of the research and literature review so far seem to focus on social challenges and health topics. But the increasing inclusiveness also has major implications for language and communication skills of healt
hcare providers, including second language learners coming into English-speaking healthcare settings. This becomes even more challenging because firstly, currently most professional academic education is still far behind (R.Carabez, M.Pellegrini et al.) and secondly, what is considered acceptable language is evolving on a daily basis.
Language in a patient interview can promote or destroy the health provider-patient communication bond and whether the patient seeks healthcare further or on an ongoing basis. Clearly then, language communication needs
to be a focus in addressing LBGTQ healthcare—if not already for the OET candidate in their Speaking test, then most certainly beyond when successful candidates move into working in their profession in English-speaking settings.
The actual healthcare issues prevalent among LGTBQ patients give a first glimpse of where communication skills need to focus: this community has
The challenge for health providers comes in the issues they have to address, including from talking
directly to patients, talking with parents to colleague discussions about treating LGBTQ patients or interacting with LBGTQ peers. The latter two topics will be saved for another blog, while this one will focus on the HCP-patient interaction. Health providers frequently lack adequate preparation and this can contribute often judgmental language and so suboptimal care outcomes. One professional noted: “In medical school, we do not learn how to either be comfortable with sexuality or how to talk about sex. We’re taught a script or we’re taught risk factors or very scientific things, but we’re not taught to talk to kids about how people make them feel, or being excited by somebody. Because of that, people really avoid talking about it” (Public Health Insider).
Awareness in Language
An error can occur at the very start of the care provider-patient interview with assuming the patient is genetically and gender male/female as well as heterosexual. Hence the opening greeting, “Hello, I’m X. How may I address you?” takes on a broader significance since, in the first instance, many LGBTQ patients mention feeling unsafe when accessing care. They often feel judged or not taken seriously, blamed for their own health problems or, especially for youth, not given a voice in their own health. As one youth said, “… this is my body, this is my mental health, this is me; I feel like I’m not in control over any of it” (Public Health Insider). So clearly even the initial greeting of a patient accessing service and the first open-ended questions become an important first demonstration that the health facility is there to help. This starts with language that does not assume the patient is cisgender-heterosexual (Victorian Government).
“Hello, I’m X. How may we help you?
“How may I address you?”
“What pronouns do you use?”
“Do you have a partner?”
“What pronouns does your partner use?”
“Would you like your partner to be here for our conversation?”
When dealing with LGBTQ youth, there is often a lack of family support and reports of being bullied at school (R.Carabez, M.Pellegrini et al.). Hence the healthcare provider’s language should show clear support and signal that the patient can feel safe:
“Please tell me how I can help.”
“Is there anyone you would like here with you?”
“Do you wish to have a member of your family involved or do you wish to chat with me only?”
“Besides the issue you just told me about, is there anything else going on that you have strong feelings about or which is causing you concern?”
The latter can serve as a good opening to even more sensitive topics like depression or thoughts of self-harm.
“Would / Do you feel comfortable talking about this?”
“Do you think you need to speak to someone who specialises in a particular area?”
When speaking with a parent, providing correct information and demonstrating that further resources are available to help becomes an important tool to help navigate a difficult time:
“I know this seems challenging but rest assured that there are resources that can help. And we are also here for you. Just let us know what you need.”
And of course, there is a whole new vocabulary to be learnt: cis-gender, transitioning, gender re-assignment, puberty blockers, and more. Knowing this vocabulary and using it easily puts the patient at ease, letting them know they are already a natural part of the healthcare conversation and promotes understanding in both directions. However, if an error is made when using new terminology or pronouns, the healthcare provider should feel comfortable acknowledging that they, too, are on a learning curve, simply apologise and move on (Victorian Government):
“I apologise in advance if I make an error while we chat. Just let me know when I do make an error so I can be correct going forward.”
Ultimately, language skills when interacting with the LGBTQ community should be an issue of continuing professional development for healthcare providers. In the collection of essays, “The Remedy: Queer and Trans Voices on Health and Health Care”, Kyle Taylor-Shaughnessy notes, “While the constantly evolving language […] can be overwhelming at times, if we don’t keep up we lose the ability to connect and therefore to do effective work…”.” (Victorian Government). And as one patient simply puts it: “[That’s] what it’s all about – being open to changing the way you do things, even if it’s unfamiliar. It will improve health outcomes for LGBTQ+ people” (E.Hunt).
Reading Exercise: Read the statements in the table, compare their meaning within the text above; then decide whether they are true or false.
Skills: Paraphrasing and gauging meaning based on context.
|1. Paragraph 1: The majority of current investigations concern themselves with shifts in society’s attitude toward the provision of LGBTQ healthcare.||True||False|
|2. Paragraph 2: The way doctors and nurses communicate, and whether they are careful about the use of specific vocabulary with particular patients, can influence the medical specialist-patient interaction and its future continuation.||True||False|
|3. Paragraph 3: The rates of psychological and lifestyle illnesses is higher in the LGBTQ community than among the wider population.||True||False|
|4. Paragraph 4: Meeting the healthcare professional initially is not an issue for most LGBTQ patients. However, problems invariably come up in the ongoing care of their mental health or other physical issues.||True||False|
|5. Paragraph 5: “The latter” refers to all questions the interviewer asks which help the patient to feel safe.||True||False|
|6. Paragraph 7: It is okay for an interviewer to not be correct in language when speaking to an LGBTQ patient. They should, however, know what to do when this happens.||True||False|
|7. Last paragraph: The word “Ultimately” can be replaced by the words “Above all else” and the meaning of the sentence remains the same.||True||False|
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