The Importance of Gender and LGBTQIA+ Competence in Audiology Practice

Abstract

At the time of this article’s conception, dozens of states are considering legislation (in some cases, several proposed bills in the same state) based on outdated and misinformed views that would create devastating social, emotional, and health risks to lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual (LGBTQIA+) people and those who care for them personally and professionally.1,2 A commonly heard argument to quell concern for this issue is that society has advanced toward greater acceptance of LGBTQIA+ identity in general (see Table for definitions). However, this backsliding in the political landscape cannot be viewed in isolation and must be assumed to represent a growing (or at least strengthening) social conservatism that greatly endangers the lives and wellbeing of LGBTQIA+ people. Though audiology is not one of the many health care professions directly targeted by these proposed laws, we cannot assume that our work is divorced from this fight, one that our colleagues and patients who identify as LGBTQIA+ experience daily.www.shutterstock.com. Diversity, equity, inclusion, gender, health.Table: Common Definitions in the LGBTQ Community.Most of us are aware of news in this area. While we may experience anguish, outrage, fear, or confusion, we may also feel helpless to enact meaningful change. Whether or not our personal resources allow us to partake in direct action against these laws, our professional and workplace practices and interactions are a daily part of this battle. From a health care delivery perspective, it is paramount that audiologists ensure that they are fully informed on issues that impact the care they provide to all of their patients, and further to take concrete steps to provide inclusive and affirming care.3 Indeed, audiology’s code of ethics mandates this,4 and the delivery of person-centered care is dependent upon it.5 THE FACTS Surveys suggest that greater than 4.5% of adults in America openly identify as LGBTQIA+ and that this percentage rises with each emerging generational cohort6,7,8 with as many as 10% identification among those born between 1999 and 2004.6 While the increase in members of the LGBTQIA+ community who are “out” can be an indicator of younger cohorts having come of age during increasingly accepting times, the political landscape described above demonstrates that this acceptance does not hold true to people of all identities, in all places, at all times. In fact, nearly one sixth of LGBTQ adults have experienced health care discrimination, with nearly that many avoiding care for fear of discrimination.9 Furthermore, it is not only our patients who experience discrimination. Our colleagues who are members of the LGBTQIA+ community often confront both subtle and overt discriminatory statements and actions from fellow professionals.10 OUR OWN BIASES While some of us may have explicit biases based upon personal, political, or religious views, even those who believe they have no bias toward others are almost always mistaken. We all hold varying degrees of unconscious preconceptions, or implicit biases, toward those we perceive as different from ourselves based on race or other aspects of physical appearance, ability, socio-economic status, gender, sexual orientation, and the countless other factors that encompass identity. Ethical practice delivery dictates that we must rise above both explicit and implicit biases to provide equitable health care to all.4 While most of us have an increased awareness of ethnic and cultural backgrounds that differ from our own, we frequently fail to recognize biases that can interfere with our ability to foster affirming interactions with both patients and colleagues from the LGBTQIA+ communities. It is imperative that all clinicians engage in a critical introspection of internalized societal stereotypes. A good start is through the Harvard Implicit Association Test (http://implicit.harvard.edu/implicit/india/takeatest/html). Only when we do this can we divorce our opinions and personal beliefs from the respect we impart to our patients. A CALL TO ACTION Beyond increasing our awareness of and aiming to counter our own implicit biases, there are many steps we can take to meet our ethical mandate of creating an equitable health care experience for our patients within the LGBTQIA+ community. One critical step, especially given today’s political landscape, is to stay informed on policies and proposed legislation and the ways these would impact the LGBTQIA+ people in our lives—including patients and colleagues. Additionally, we can be active in our professional networks as a means to learn more about LGBTQIA+ affirming care; and we can challenge covert and overt prejudice when we encounter it from peers in the field as a way to keep ourselves and others accountable in this work. Finally, we can make concrete changes in our practices to create more safe, welcoming, and affirming environments.3