ColumnsSmart Health

Working with Imperfect Systems

Interacting with institutions that have historically caused harm.

Despite the efforts in the fields of medicine and law enforcement to repair past harms against LGBTQ communities, it can still be hard—particularly for queer and trans BIPOC folks—to trust these systems.

Quite frankly, the mistrust is justified. 

The Trust Factor

There are countless examples of queer patients seeking medical or mental-health care, only to have their experiences judged or their health needs misunderstood or disregarded.

From the moment a queer person arrives at a clinic, the risk for harm is present. It can begin with having only “M” or “F” gender options to check on intake paperwork. A lack of gender-inclusive restrooms or clear signage regarding provisions for LGBTQ-affirming care can also suggest an environment that may not be welcoming. Misgendering trans and nonbinary patients, or using deadnames or improper pronouns, can be tremendously invalidating and create anxiety and feelings of dread. 

During the history-taking part of the physical examination, queer patients are sometimes subject to questions that feel gratuitous or voyeuristic. Assumptions about sexual orientation or the gender of one’s partner(s) can force queer patients to “come out” to their providers.

 Alternatively, aspects of health that are specific to queer people may be completely ignored. For example, it has been widely found that lesbian and bisexual women have a greater risk for developing breast cancer, and may also be less likely to receive mammograms. These types of health disparities in queer communities are not solely based on lifestyle choices. They are the result of a system that was built around cisgender and heterosexist identities.

Altogether, these types of interactions with healthcare systems can cause people to feel dismissed or invalidated. The presence of implicit bias (or outright prejudice) can impact health encounters, leading to delayed diagnoses and improper care. 

Policing the Police?

While the queer community’s relationship with the medical field is certainly fraught, the of trust law enforcement is exponentially worse by comparison. In fact, we are not that far removed from the time when queer identity was criminalized and could result in arrest or public shaming.

Harassment and judgment by some police officers has done significant damage to the queer community. Derogatory language, as well as the expression of homo- and trans-phobic attitudes, has further widened the divide between LGBTQ people and law enforcement.

 In some areas, queer spaces have been disproportionately policed in regard to drug- and sex-related crimes. LGBTQ people have higher rates of incarceration and victimization while in custody, compared to cisgender and heterosexual people. And there is a fear that when LGBTQ people become crime victims, law enforcement may not take those cases seriously.

A Path Forward

So what do we do with all of this? Well, we can begin by acknowledging these systems’ faults. It is reasonable to retain a healthy skepticism of systems that have historically disregarded or done harm to your community. However, it doesn’t serve you or your community when you react by refusing to interact with those systems. 

For your next medical appointment, consider taking a partner or trusted friend with you. Sometimes just having a supportive friend in the waiting room can make all the difference. If you’re comfortable, that person can accompany you to the exam room and help to make sure all of your questions and concerns are addressed. Remember, there is strength in numbers. And as a general rule, it’s not a bad idea for at least one person to know a bit of your health information in case of an emergency.

And as for your interactions with law enforcement, remember that it’s critical to inform the police when something has happened in the community. Failing to report crimes, including those based on hate, means that crime victims may never receive justice. It is also important to collect crime statistics within queer communities so that appropriate police training and resources can be allocated to those communities. Additionally, incidents where police officers do not behave appropriately should be reported through the proper channels in order to address bias and prejudice within the system. 

Maybe what we need is to become even more involved with law-enforcement systems so that we are in a position to challenge and change them from within. We could certainly use more queer police officers to work directly with our community. Consider how you could become an advocate within the justice system and help to improve relations and promote reform. Is there some way to channel anger and mistrust into action?

Perhaps the bottom line is that we must make peace with imperfection. This is a practice that we should employ with ourselves, and then extend it to our friends and family. In the same way that we can extend grace to ourselves and others by saying “nobody’s perfect,” we can agree to accept imperfect systems and continue working to improve them.

This article appears in the September 2021 edition of OutSmart magazine.


Daryl Shorter, MD

Daryl Shorter, MD, is a Diplomate of the American Board of Psychiatry and Neurology and is board certified in both general and addiction psychiatry. His clinical practice focuses on veteran care, and he lectures widely on LGBTQ mental health. Dr. Shorter can be reached at [email protected]
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