Members of the lesbian, gay, bisexual, transgender and queer community have long experienced prejudice in medical settings. This can range from microaggressions, such as comments that a patient doesn’t “look” queer or trans, to outright discrimination like denial of care. Combined with living in a society where LGBTQ+ people are routinely subjected to discrimination and bigotry, many patients choose not to disclose their sexual or gender identities to medical providers or not to seek care at all.
Even among medical providers who practice some form of cultural competency – an awareness of and respect for differences across cultures – and are accepting of LGBTQ+ patients, unconscious biases can shape how they understand and talk to and about LGBTQ+ patients and issues. No one leaves their cultural baggage at the clinic door.
I am a medical anthropologist who researches LGBTQ+ health and health disparities. I have paid special attention over the past decade to how a particular kind of bias called heteronormativity shapes how health care providers deliver care and practice medicine.
Heteronormativity refers to a cultural bias that presumes heterosexuality is the natural and normal default state of all people. Under this worldview, cisgender male and female bodies are treated as complementary opposites that are “meant” to fit together. Heteronormativity is pervasive in contemporary societies and is easily visible in social norms about gender relations, gender roles, sexual attraction and kinship and family.
An example of heteronormativity I have personally experienced in multiple settings is being asked if I have a wife. That question is heteronormative because it presumes the person is heterosexual and requires them to “come out” as not being straight to correct the bias.
Deviations from heterosexuality have historically been considered pathological. Homosexuality was removed from the list of diagnostic mental illness categories only in the 1970s. Despite that change, some contemporary conservative discourses continue to pathologize LGBTQ+ people as dangerous and abnormal and consider the heterosexual nuclear family as the ideal social arrangement. This perspective is known as heterosexism.
While heteronormativity is largely implicit and unconscious, heterosexism is explicit and considers heterosexuality to be morally superior. Heteronormativity might involve asking questions that assume a patient is heterosexual, but heterosexism would deny patients care altogether.
Homophobia – a disgust, hatred or prejudice toward queer people – often stems from heteronormativity or heterosexism. Sometimes homophobia is unintentional, and people don’t immediately recognize that something they said or did is homophobic. Other times, people deliberately intend to express bigotry.
Like other forms of prejudice such as racism and ableism, people are socialized into homophobia, heteronormativity and heterosexism. Even members of the groups that are being targeted and marginalized with these forms of prejudice can internalize them. When these cultural norms and values are internalized, they become biases like heteronormativity.
Cultural norms and values, of which heteronormativity is one, are deeply ingrained and form personal and societal worldviews. These attitudes shape individuals’ thought and behavior and social institutions such as health care. So it is unsurprising that heteronormative biases are just as pervasive in medical settings as they are in other areas of society.
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