Queering the clinic : LGBTQ in the doctor's office



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Lesbian, bisexual, transgender, non-binary, and queer (LGBTQ) people in the U.S. are in worse health than their straight and cisgender peers. Models of minority stress and structural stigma explain how stigma related to minority sexual and gender identity “gets under the skin” to diminish LGBTQ health across the life course. Underutilization of healthcare is one mechanism through which the LGBTQ health disadvantage is produced. Little is known, however, about what happens within everyday healthcare interactions to compel LGBTQ people to continue or avoid seeking care. In this dissertation, I examine the healthcare experiences of LGBTQ people least researched, yet also least likely to seek care: cis women; trans men; and non-binary people assigned female. I also address an urgent gap in knowledge about how healthcare settings in general and LGBTQ health settings in particular are shaping patients’ experiences, interpretations of, and decisions about care. To do so, I observe organizational processes and strategies for delivering affirming care at a LGBTQ health center over the course of one year. In addition to interviewing 50 patients, I interviewed 12 staff and 11 providers at this site (N = 73). In three articles that make up this dissertation, I triangulate analyses of data to reveal how stigma related to nonconformity, sexual and gender identity, and fatness is constructed—or alternately, avoided—through relational processes within health settings. Analyses also reveal how new sexual and gender schemas constructed and deployed within a LGBTQ healthcare organization affirm patients; yet these practices center some LGBTQ groups over others. In these articles, in addition to using theories of minority stress and stigma, I draw from and contribute to theories of gender and sexuality in medicine and organizations. All together, findings indicate barriers and facilitators to care for multiply marginalized minority groups, which hold implications for LGBTQ healthcare. Findings also suggest that future research into sexual and gender inequality should attend to embodiment, visible nonconformity, structural schemas at play within situated interactions, and how material-discursive factors trouble the implementation of discursive ideals within queer organizations.



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