Research Spotlight: Health Care Discrimination and Care Avoidance Due to Patient-Clinician Identity Discordance Among Sexual and Gender Minority Adults

Alex Keuroghlian, MD, MPH, a physician investigator in the Department of Psychiatry at Massachusetts General Hospital and an associate professor of psychiatry at Harvard Medical School, is the senior author of a new original investigation published in Annals of Family Medicine, Health Care Discrimination and Care Avoidance Due to Patient-Clinician Identity Discordance Among Sexual and Gender Minority Adults. 

The corresponding and first author on the study is Michael Liu, MPhil, a student at Harvard Medical School.  

 

What was the question you set out to answer with this study? 

Identity discordance between patients and clinicians is associated with worse self-rated patient experience and less receipt of necessary care. Most prior studies have focused on racial discordance. However, it is not currently known whether these phenomena extend to sexual and gender minority (SGM) adults, who experience worse health outcomes than their non-SGM counterparts.  

What Methods or Approach Did You Use? 

We performed a cross-sectional analysis of national data from the National Institutes of Health’s All of Us Research Program. Specifically, this study evaluated the prevalence of care avoidance due to patient-clinician identity discordance and its potential association with healthcare discrimination among SGM adults. 

What Did You Find? 

We found that SGM adults across the United States are significantly more likely to avoid care because of perceived patient-clinician identity differences.  

One in five sexual minority adults and more than one-third of gender minority adults shared this experience. These rates were 58% and 100% higher than those of their non-SGM counterparts, respectively.  

Notably, exposure to discrimination in health care settings was more prevalent among SGM adults and was dose-dependently associated with higher rates of identity-based care avoidance. 

What are the potential clinical implications of your work? 

Our study is among the first to quantitatively demonstrate that SGM patients prefer clinicians who share similar sexual orientations and/or gender identities, likely due to more affirming care, desire for expertise specific to SGM health, and perceptions of safety, comfort, and solidarity. These findings highlight the importance of diversifying the healthcare workforce, expanding SGM-related clinical training, and preventing healthcare discrimination against SGM patients. 

Paper cited: 

Liu, M., Vishal, R. P., Sandhu, S., Reisner, S., Keuroghlian, A. (2024) Health Care Discrimination and Care Avoidance Due to Patient-Clinician Identity Discordance Among Sexual and Gender Minority Adults. Annals of Family Medicine, 10.1370/afm.3130. Advance online publication. https://doi.org/10.1370/afm.3130