4. Patient Centeredness & Diversity

Chapter Summary

SGM people represent very diverse populations, with a broad spectrum of sexualities and gender identities, each of which is associated with distinct health concerns.

Some people experience their gender identity (or internal sense of gender) and sexual orientation (or emotional and sexual attraction towards others) as unchanging. In contrast, these experiences are much more fluid for others, meaning that they shift over time.

SGM patients reflect different races and ethnicities, abilities, religions and cultures, geographical backgrounds, socioeconomic situations, legal statuses, and ages. Using an intersectionality approach, we can begin to understand how such social categorizations, and the privileges and oppressions associated with each, can impact health and access to health care.

Minority stress, the chronic stress caused by experiences of violence, discrimination, stigma, and neglect, can be intensified for all patients with multiple marginalized social identities, including those who are SGM. Therefore, providers and staff need to be aware of how these social identities may “intersect” and how they are affected by structural vulnerabilities that may require attention in primary care.

Paying attention to structural vulnerabilities means reframing the focus of primary care to include concern for financial security among patients (including the ability to pay for basic living expenses); the safety and stability of their residences; their daily exposure to harassment, discrimination, violence, injury or illness; their food access; their connection to supportive family, friends, and healthcare providers; their legal status and eligibility for public services (e.g., health insurance); and their education needs. 

Included in this Chapter: Overviews of key terms used to discuss fluidity in gender and sexuality, the relationship between social identities and minority stress, critical influences on health and health care based on social identities, and how to support diverse SGM patients.