“Fat broken arm syndrome”: Negotiating risk, stigma, and weight bias in LGBTQ healthcare

Paine, Emily Allen

doi:10.1016/j.socscimed.2020.113609

Cited by 41 publications

(44 citation statements)

References 35 publications

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“…We find standard data may promote visibility of “social factors” in certain clinical settings, yet can also constrain clinical utility among providers and staff with greater knowledge and experience with related domains ( Gaspar et al, 2020 ; Thompson, 2020 ). We further illustrate how data reporting may result in limited attenuation of health inequities, despite broad expectations of clinical change ( Institute of Medicine, 2014 : 17; Douglas et al, 2015 ; Zhang et al, 2017 ): evidence from our two sites illuminates how entrenched inequities actively inform organizational asymmetries in serving different communities ( Paine, 2021a , 2021b ; Martos et al, 2017 ; Ingraham and Rodriguez, 2021 ), discussing related topics with patients as a part of care ( Cruz, 2020 ; Carabez et al, 2015 ; Banerjee et al, 2018 ), and establishing provider and staff knowledge and experience in redressing social problems ( Donald et al, 2017 ; Mansh et al, 2015 ). Our fieldwork “on the inside” of clinical settings thus reveals a much more fundamental set of stakes at play with data standardization, beyond implementation and associated technical challenges ( Cruz, 2021 ).…”

Section: Discussionmentioning

confidence: 91%

“…Providers understood gender and sexuality to be diverse and fluid, and cited not making assumptions about patient sexual and gender identities as foundational to providing affirming care to LGBTQ people (e.g., by asking patients gender pronouns). Through their experiences of caring for SGM patients, providers developed ways to ask gender and sexuality-related questions to affirm care recipients as well as build rapport and trust ( Paine, 2021a ), but these oftentimes conflicted with the standard SOGI items. Ensuring that patient SOGI data fields were filled out within EHRs was largely seen as a box to be checked that intruded upon time to provide quality care, as one staff member put it:…”

Section: Resultsmentioning

confidence: 99%

“…Both projects drew from earlier analyses, represented as independent publications on SGM health inequities ( Paine, 2018 , 2021a , 2021b ; Cruz, 2020 ). The first author’s project on data analytics within safety-net care was not originally designed to explore questions of gender and sexuality: following the principles of constructivist grounded theory ( Charmaz, 2007 ), guided attention to SOGI data instead emerged in response to observed conflicts among providers and staff.…”

Section: Methodsmentioning

confidence: 99%

“…The implementation of evidence-based practices for certain sub-populations may be further undermined by limited institutional support, generating tensions between data-centered evidence and care capacity constraining even SGM-knowledgeable providers within patient care ( Gaspar et al, 2020 ; Thompson, 2020 ). SGM patients also report limited understanding among medical staff within LGBTQ organizations, especially for transgender and nonbinary patients and those with multiple marginalized identities ( Paine, 2018 , 2021a , 2021b ).…”

Section: Introductionmentioning

confidence: 99%

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Capturing patients, missing inequities: Data standardization on sexual orientation and gender identity across unequal clinical contexts

Cruz

Paine

2021

Social Science & Medicine

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In effort to address fundamental causes and reduce health disparities, public programs increasingly mandate sites of care to capture patient data on social and behavioral domains within Electronic Health Records (EHRs). Data reporting drawing from EHRs plays an essential role in public management of social problems, and data on social factors are commonly cited as foundational for eliminating health inequities. Yet one major shortcoming of these data-centered initiatives is their limited attention to social context, including the institutional conditions of biomedical stratification and variation of care provision across clinical settings. In this article, we leverage comparative fieldwork to examine provider and system responses to mandated data collection on patient sexual orientation and gender identity (SOGI), highlighting unequal clinical contexts as they appear across a large county safety-net institution and an LGBTQ-oriented health organization. Although point of care data collection is commonly justified for governance in the aggregate (e.g., disparity monitoring), we find standardized data on social domains presents a double-edged sword in clinical settings: formal categories promote visibility where certain issues remain hidden, yet constrain clinical utility in sites with greater knowledge and experience with related topics. We further illustrate how data standardization captures patient identities yet fundamentally misses these unequal contexts, resulting in limited attenuation of inequity despite broad expectations of clinical change. By revealing the often-invisible contexts of care that elude standard measurement, our findings underline the strengths of qualitative social science in accounting for the complex dynamics of enduring social problems. We call for deeper engagement with the unequal contexts of biomedical stratification, especially in light of increasing pressure to quantify the social amidst the rising tide of data-driven care.

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Section: Discussionmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Capturing patients, missing inequities: Data standardization on sexual orientation and gender identity across unequal clinical contexts

Cruz

Paine

2021

Social Science & Medicine

Self Cite

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“…Indeed, we could not identify any published study on discrimination and health care among transgender and gender diverse individuals explicitly focusing on classism, ableism, or xenophobia. Further, to our knowledge, only one published study has specifically investigated the negative effects of weight-based discrimination on the health care experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in general [ 27 ]. Thus, we designed a qualitative research study to contribute to the literature on intersectionality, discrimination, and access to and use of health care among multiply marginalized transgender and gender diverse individuals—focusing on how transmasculine people of color, a particularly understudied and underserved subgroup, experience and resist cissexism, racism, and other forms of discrimination in health care settings.…”

Section: Introductionmentioning

confidence: 99%

Experiences of and resistance to multiple discrimination in health care settings among transmasculine people of color

Agénor

Geffen

Zubizarreta

et al. 2022

BMC Health Serv Res

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Background Research shows that transmasculine people experience discrimination based on their gender identity and/or expression (i.e., cissexism) while obtaining health care. However, studies examining the experience of other forms of discrimination in health care settings among diverse subgroups of transmasculine individuals, including those from minoritized racial/ethnic backgrounds, are very limited. Methods Guided by intersectionality, we designed a qualitative research study to explore how transmasculine people of color experience—and resist—multiple, intersecting forms of discrimination in health care settings. Guided by a purposive sampling strategy, we selected 19 transmasculine young adults of color aged 18–25 years to participate in 5 mini-focus groups conducted between February and May 2019 in Boston, MA. Focus group transcripts were analyzed using a template style approach to thematic analysis that involved both deductive and inductive coding using a codebook. Coded text fragments pertaining to participants’ experiences of health care discrimination were clustered into themes and sub-themes. Results Transmasculine people of color described experiencing notable challenges accessing physical and mental health care as a result of structural barriers to identifying health care providers with expertise in transgender health, finding providers who share one or more of their social positions and lived experiences, and accessing financial resources to cover high health care costs. Further, participants discussed anticipating and experiencing multiple forms of interpersonal discrimination—both independently and simultaneously—in health care settings, including cissexism, racism, weight-based discrimination, and ableism. Moreover, participants described the negative impact of anticipating and experiencing multiple interpersonal health care discrimination on their health care utilization, quality of care, and mental and physical health. Lastly, participants discussed using various strategies to resist the multiple, intersecting forms of discrimination they encounter in health care settings, including setting boundaries with health care providers, seeking care from competent providers with shared social positions, engaging in self-advocacy, drawing on peer support during health care visits, and obtaining health information through their social networks. Discussion Efforts are needed to address cissexism, racism, weight-based discrimination, ableism, and other intersecting forms of discrimination in clinical encounters, health care institutions and systems, and society in general to advance the health of transmasculine people of color and other multiply marginalized groups.

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Discrimination Against Asians: The Role of Belonging

Moodie,

Kong,

Ruffman

et al. 2024

Leadership and Politics

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“Fat broken arm syndrome”: Negotiating risk, stigma, and weight bias in LGBTQ healthcare

Cited by 41 publications

References 35 publications

Capturing patients, missing inequities: Data standardization on sexual orientation and gender identity across unequal clinical contexts

Capturing patients, missing inequities: Data standardization on sexual orientation and gender identity across unequal clinical contexts

Experiences of and resistance to multiple discrimination in health care settings among transmasculine people of color

Discrimination Against Asians: The Role of Belonging

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