HMO teaching: LGBTIQ+ (Diversity, Inclusion and Being Respectful) - PowerPoint Presentation

1. HMO teaching:LGBTIQ+ (Diversity, Inclusion and Being Respectful)

2. Sarah Cox, Senior Obstetrics and Gynaecology Registrar, she/her, female, lesbian, mother

3. Learning ObjectivesThe key learning objectives for this presentation are:1 Terminology for LGBTIQ+ patients2 How to ask the hard questions3 What to do if you make a mistakeThe Australian Curriculum Framework objectives aligned with are:1 Communication - Respect2 Managing information - Handover3 Professionalism - Culture, society & healthcare The Safety and Quality National Standard aligned with are: 1 Partnering with Consumers2 Comprehensive Care

4. Diversity & Inclusion at Northern HealthNorthern Health promotes equity for all Everyone needs to feel safe and includedWe recognise some groups are more vulnerable than others

5. Equity vs EqualityThe fence, for LGBTIQ+ people, is stigma or prejudice

6. The basics of caring for LGBT patientsIt is important that LGBT patients feel comfortable interacting with, and providing relevant information to, staff - from history taking to clinical examination and treatment Many LGBT individuals may have encountered situations where they face discrimination in healthcare and/or lack of knowledge about LGBT health and wellbeing, which may influence avoidance of or lack of trust towards mainstream health services in the future Getting it right and apologizing if you make a mistake is an important issue for health equity and accessibility

7. Why is this important?Health inequalities amongst LGBTIQ+ peopleWhen compared with the general population, LGBTIQ+ people experience:Greater psychological distressTwice as likely to be diagnosed and treated for a mental health disorderMore likely to engage in self harmMore likely to attempt suicide: 16-27yo 5x more likely**People with intersex variation 6x more likely**Transgender people >18yrs 11x more likely**Likelihood increases with experience of abuse/harassment Higher levels of use with alcohol, tobacco, illicit drugsStatistics at a glance - National LGBTI Health Alliance https://lgbtihealth.org.au/statistics

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9. LGBTIQ+ An acronym for: Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and Others People Matters Survey (2018): Gender Identity:2% self described6% prefer not to saySexual Orientation:3% same sex attracted1% bisexual or pansexual16% prefer not to say

10. What is trans and transgender? Currently in Australia, babies are classified at birth as female, male or undetermined A female-classified person who identifies as a boy or man may describe himself as a trans man or simply as a man A male- classified person who identifies as a girl or woman may describe herself as a trans woman or simply as a woman Some trans people identify trans as their gender Cisgender - refers to people whose gender identity (not sexuality) is consistent with their sex assigned at birth Pronouns:LGBTIQ+ An acronym for: Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and Others Which points are you already aware of? Are there aspects you would like to learn more about?What are some issues that transgender people may come across in the health service?

11. LGBTIQ+ PronounsAn acronym for: Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and Others PronounsIt is important to listen to, understand, and mirror the terms that patients use to describe themselves.If the patient is comfortable, you should document their pronouns somewhere where other staff can see it so that do not have to explain them to multiple people – eg the front of the folder or in handover.Why is it so important to respect someone’s pronouns?You can’t always know what someone’s pronouns are by looking at them. Avoid using pronouns if you are not sure.Asking and correctly using pronouns is a basic way to show respect for their gender identity.When someone is referred to with the wrong pronoun, it can make them feel disrespected, invalidated, dismissed, alienated, or dysphoric (often all of the above).How do I ask someone what pronouns they use?Try asking: “What pronouns do you use?” or “Can you remind me what pronouns you use?” It can feel awkward at first, but it is not half as awkward as making a hurtful assumption.

12. LGBTIQ+ PronounsAn acronym for: Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and Others What if I make a mistake?Acknowledge, apologize, correctEveryone is human. The best thing to do if you use the wrong pronoun for someone is to say something right away, like “Sorry, I meant (insert pronoun)”If you realize your mistake after the fact, apologize in private and move on.If you make a mistake, it can be tempting to go on about how bad you feel or how hard it is to get it right. This is inappropriate and makes the person who was misgendered feel awkward and responsible for comforting you, which is not their job.You may hear a colleague using the wrong pronoun. In most cases, it is appropriate to gently correct them without further embarrassing the individual who has been misgendered. Eg “Alex uses the pronoun she,” and then moving on. If other people are consistently using the wrong pronouns, please try and bring it up with them. It may harm patient care and other staff members may mimic their practice.

13. Key issues for staff when working with Trans and gender diverse patientsEnsure that documentation relating to gender and title is correct. If they are comfortable, ensure this is handed over between staff to avoid repetition of names and pronouns.Health and wellbeing needs are not always associated with gender identity. Only ask questions about a person’s gender identity or physical transition if it is clinically relevant.Confidentiality about a TGD person’s trans status is very important. Do not assume their next of kin or visitors will know about the patient’s gender identity.Where there is an option, it is important for TGD patients to be accommodated according to their choice and affirmed gender.If applicable, do not cease hormone therapy for TGD people while in hospital without a very good clinical reason and definitely do not cease it without consulting with the patient.

14. Key issues for staff when working with Trans and gender diverse patientsSome TGD people have specific medical issues associated with gender affirmation treatments (treatments sought to make them feel more comfortable in their bodies, for example surgeries, electrolysis, hormone therapy among others). Ask questions about medical or surgical affirmation IF and ONLY IF it is relevant to the clinical problem.When undertaking a physical examination of someone who is TGD, particularly an invasive one, please be particularly sensitive.Try and develop a good rapport first.Explain why the examination is important for their health clearly.You may ask if they want you to talk about what you are doing, or to be quiet.You may ask if there are particular words they might want you to use about particular body parts to increase their comfort, if those parts make them feel dysphoric (uncomfortable and removed from their gender identity).

15. LGBTIQ+ An acronym for: Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and Others What is Intersex?Intersex is a description of biological diversity and may or may not be the identity used by an intersex person. Intersex and Trans are not the sameIntersex people have reproductive organs, chromosomes or other physical sex characteristics that are neither completely female nor completely male 2% of the population are intersexThere are as many people who are intersex as there are as red heads There are over 40 different variations

16. Sexual orientationLesbian: This refers to a woman who is romantically and sexually attracted to other women. Gay: This refers to someone who is romantically and sexually attracted to people of the same gender identity as themselves. It is usually used to refer to men who are attracted to other men but may also be used by women. Bisexual: This refers to a person who is romantically and sexually attracted to individuals of their own gender and the opposite gender (specifically referring to being attracted to people who fit a gender-norm). Asexual: This refers to someone who does not experience sexual attraction. They may still experience feelings of affection towards another person. Pansexual: This refers to people who are romantically and sexually attracted to people of all genders. Queer: Queer is an umbrella term used by some people to describe non-conforming gender identities and sexual orientations. A little like the term “black”, it is not generally ok to label someone as “queer” unless they self-identify in that way

17. How gender and sexual orientation interactGender identity is an internal sense of being male, female, both, neither or another gender. Non-binary is any gender that is not male or female.Sexual orientation may not necessarily correspond with behaviour – someone may consider themselves gay for example, but has/is having sex with women – this may be relevant for taking a sexual health history.How you define your gender identity has nothing to do with sexual orientation – eg a transgender person can be gay, straight, bisexual etc.Both gender identity and sexual orientation can change over time.

18. Still not sure what some of these terms mean? Visit the NH Intranet Diversity web page for information, videos and links to community organisations:Departments – Diversity: LGBTQIhttps://intranet.nh.org.au/departments-and-services/diversity/lgbtiq/ 

19. Sarah Cox, Senior Obstetrics and Gynaecology Registrar, she/her, female, lesbian, motherWhy does it matter?Patient experience is affected by the things that healthcare providers say or doWhere’s the father?It will be nice for you to have your own childOnly fathers can visit after hoursDo you think she will love him as much as her daughter?

20. What can you do?Communication and language used is importantUse gender-neutral words such as “partner”, pronouns such as “they / them” and other inclusive termsBe willing to involve domestic partners in decision-makingWhere clinically relevant, asking patients open-ended questions about their sexual orientation, gender identity or intersex status, rather than waiting to be told by the patientAvoid “Dead Naming”: Using a birth name that is no longer used by the person. Use their preferred name only.Avoid “Misgendering”: Using a pronoun that is no longer used by the person. Use their preferred pronouns or they / their if you are unsure. DO NOT use “s/he” ,“him/her” or “shim”. DO NOT use “it”. Avoid asking about surgical transitions unless clinically relevant. It doesn’t matter what your genitals look like if you simply have a cold…

21. Big Don’ts Don’t laugh or gossip about a patient’s appearance or behaviorDon’t use stereotypes or ask questions that are not necessary for care. Don’t try to build rapport by asking questions that may be offensive. “Have you had ‘the surgery’?”/other questions about their transition (where not absolutely clinically relevant)“You’re so pretty! I can’t believe you are a lesbian.” “I see you checked ‘gay’ on your registration form. How’s the club scene these days?”“You look just like a real woman.” Don’t be afraid to correct your colleagues if they make a mistake or insensitive comments“Those kinds of comments are hurtful to others and do not create a respectful work environment.”“My understanding is that this patient prefers to be called ‘Jane’, not ‘John’.”

22. Create an open space for disclosureSignal to patients that they are welcome to discuss their sexual orientation, gender identity and relationship status, and that heterosexuality is not presumed. You should facilitate disclosure while acknowledging that disclosure is not an essential part of good quality care, particularly to those who may not choose to disclose.Use open and inclusive questions that are gender neutral and demonstrate acceptance (for example, ‘Do you have partner? Are you in a relationship? What is your partner’s name?’). Consider using additional prompts when knowing a client’s sexual orientation or gender identity impacts on their quality of care (for example, ‘In our service we see a lot of straight and gay people…’). Respond to subtle cues by probing such as when ‘they’ is used to refer to their partner. You can ask ‘is your partner male or female?’Normalise your response when LGBT clients are open about their sexual orientation or gender identity (for example, do not be surprised or concerned). Be aware that some clients may be unsure of their sexual orientation and gender identity while others may be in the initial stages of ‘coming out’. If you ask, you should introduce questions regarding sexual orientation or gender identity by explaining why you are asking these questions (why they are clinically relevant). ‘How do you describe your sexual orientation?’ might be one way to ask.

23. Create an open space for disclosureOutside of making patients feel generally comfortable, do not make discussion all about their sexuality and gender identity if not necessary.Clarify the preferred next of kin, and don’t assume this is a sexual partner or person from the family of origin.Under Victorian law, same sex partners are legally domestic partners for the purposes of medical care, and evidence through documentation is not required.Address LGBT clients using terms that are respectful and consistent with their self-understanding. If unsure, ask clients how they would like to be addressed. Understand that sexual orientation and gender identity may be fluid or fixed, and that different LGBT people will prefer LGBT-specific or mainstream community connections. Provide extra support and sensitivity to LGBT people who have disclosed experiences of homophobic violence.

24. Create an open space for disclosureDocumentation Both staff and patients may be concerned about what is recorded in the file. The most useful approach may be to discuss this between staff and patient, with the staff member taking responsibility to: Seek consent when recording information about their sexual orientation, gender identity or intersex condition Inform clients why the information is needed, how it will be used and stored, and to whom it will be made available (such as referrals) Other demographic/sexual history questions that may be helpful(General) Do you have a partner? (rather than, are you married?), what is your partner’s/their name? If someone else is in the room – ‘friend or family?’ or ‘who is with you today?’ rather than ‘is this your husband/wife?’ (Familial history taking for someone with two parents of the same gender) Who is the biological parent/mother? (rather than, Who is the real/natural parent/mother?)(Sexual history) Do you have a current sexual partner or partners? (Sexual history) Do you have sex with men, women or both?

25. How can you be involved?Ideas Lab across sites, third week of October2 Ideas Labs at each site 1-2pm & 2.30-3.30pm on the same dayHow to best engage community, support staff, care for pts and their familiesLGBTIQ+ Working GroupIf you are interested in joining, speak to your presenterLMS – Diversity and Inclusion ModuleComing soonOur goal is to make Northern Health safe and inclusive for LGBTIQ+ people

26. Rather than what you said…People are more likely to remember how you made them feel.

27. Sarah Cox, Senior Obstetrics and Gynaecology Registrar, she/her, female, lesbian, mother