LGBTQ+ in Orthopaedics: Creating an Open and Inclusive Environment

Abstract

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ1) individuals may encounter added challenges in the healthcare setting. Both providers and patients may face discrimination based on their sexual orientation or gender identity, which may lead to avoidance or delay in seeking care. LGBTQ1 physicians often choose not to disclose their sexual orientation because of concerns about harassment, isolation, and depression. Orthopaedic surgery remains the least diverse medical specialty and there is inconsistent training about the needs and cultural issues that affect sexual and gender minority individuals. Furthermore, orthopaedic research specific to LGBTQ1 patients and physicians is exceedingly limited. By encouraging mentorship and improving awareness of the challenges that this community faces, the field of orthopaedic surgery can work to foster an open and inclusive environment that is conducive to the experience of all patients, trainees, and healthcare personnel. LGBTQ is an abbreviation for lesbian, gay, bisexual, transgender, and queer or questioning. The added "1" in "LGBTQ1" is used to indicate the larger community which may include those with nonbinary gender identities and allies (Table 1). Another term that encompasses this population is sexual and gender minority (SGM), which has seen an increase in use since the formation of the Sexual & Gender Minority Research Office by the National Institutes of Health in 2015. 1 This community comprises as much as 2% to 6% of the US population. 2 Many disparities exist for LGBTQ1 individuals in the healthcare setting. SGMs are less likely to seek health care because of fear of being stigmatized by the dominant culture. The Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities found that 56% of LGBTQ1 individuals reported experiencing discrimination while seeking medical treatment. 3 Nineteen percent of transgender and gender nonconforming people have been refused care, and a quarter of these individuals report not seeking care for urgent problems. Up to 75% of lesbians have reported delaying or avoiding health care altogether. 4

How Much Bullying and Discrimination Are Reported by Sexual and Gender Minorities in Orthopaedics?

“…In the United States, LGBTQ+ individuals often encounter discrimination and stigmatization because of their sexual orientation and gender identity, impacting their workplace experiences and overall well-being [24,30,31,35]. Knowledge of LGBTQ+ practitioners' experiences in orthopaedics, particularly in terms of workplace openness about sexual and gender orientation and perceived experiences of bullying, discrimination, or differential treatment, remains limited despite acknowledged diversity gaps in our profession [6,15,20]. We aimed to gather demographic information and assess reported experiences of bullying, discrimination, and differential treatment toward LGBTQ+ individuals in orthopaedic surgery.…”

“…More recently, a 2014 national climate survey of general surgery residents reported that 57% of LGBTQ+ residents concealed their sexual orientation from fellow residents and physicians because of fear of rejection or poor evaluations [25]. These findings show that LGBTQ+ physicians often choose not to disclose their sexual orientation because of concerns about harassment, isolation, and depression [6]. Chu et al's [6] review of evidence about LGBTQ+ experiences in orthopaedic healthcare revealed notable challenges that affected patients and providers.…”

“…These findings show that LGBTQ+ physicians often choose not to disclose their sexual orientation because of concerns about harassment, isolation, and depression [6]. Chu et al’s [6] review of evidence about LGBTQ+ experiences in orthopaedic healthcare revealed notable challenges that affected patients and providers. That study underscored the need for mentorship and inclusivity initiatives, particularly for orthopaedic trainees and providers.…”

Letter to the Editor: Equity360: Gender, Race, and Ethnicity: Sex and Fairness in Sports

“…However, I remain hopeful that as more transgender and gender-diverse athletes demonstrate the bravery required to risk everything for a life of authenticity, we as physicians will have the courage to support them. Through the recent formation of organizations such as Pride Ortho and research within orthopaedic surgery that focuses on the care of transgender and gender-diverse patients [3,4,7,10,16], our field demonstrates capacity and eagerness to provide exceptional care for all patients. It is not a risk to provide the highest level of care for patients subjected to disproportionate rates of discrimination within healthcare.…”

Investigating and Practicing Orthopedics at the Intersection of Sex and Gender: Understanding the Physiological Basis, Pathology, and Treatment Response of Orthopedic Conditions by Adopting a Gender Lens: A Narrative Overview

“…Clinicians should be attentive to the needs of sexual minority individuals, including members of the LGBTQIA+ community and men having sex with men (MSM) [90,91]. These populations have been disproportionately impacted and are still impacted by the HIV pandemic.…”