Coming Out in General Practice: The Experience of Older LGBT Patients

Problem

Previous studies suggest that lesbian, gay, bisexual and trans (LGBT) older adults may experience worse health outcomes than their heterosexual counterparts. Despite improvements in legal protection and social tolerance toward LGBT people within the UK, prejudiced attitudes persist among a minority of healthcare workers, and some older LGBT people report concerns about discussing their identity with healthcare providers. The provision of good quality general practice care may be inhibited if patients feel unable to have open conversations with medical staff about their identity and their key relationships. This paper explores older LGBT people’s perceptions of having conversations about sexuality or gender identity within general practice.

Approach

Exploratory interviews were undertaken with self-identified LGBT adults aged 60+, recruited via LGBT community networks and publications throughout the UK. Participants were asked about their experiences of general practice services, and about other support and information networks (for example, online health information). Interviews were recorded and transcribed verbatim. Thematic analysis was undertaken using NVivo-10.

Findings

Interviews were undertaken with 36 LGBT people aged 60-82, within England, Wales and Scotland. Participants reported being relatively unlikely to simply “come out” within general practice. Conversations about sexuality or gender identity were usually initiated either in regard to a specific medical need, or in relation to discussing a long-term partner. Discussing sexuality or gender identity in other circumstances appeared to be seen as more problematic. Few participants reported experiencing recent discrimination within general practice, but concerns were expressed about the quality of professional knowledge and training on LGBT issues. Participants who had long-standing, positive relationships with general practice staff were more likely to report feeling comfortable discussing personal circumstances with professionals.For a minority of participants, fears of discrimination prevented them from telling their GP that they were LGBT, even where this limited discussion regarding their medical needs, or resulted in concealing significant relationships.

Consequences

Discussions about sexuality and gender identity within general practice are affected by the context of the consultation. Some older patients may not identify themselves as LGBT within general practice, either because they fear discrimination, or because discussing identity does not seemed relevant. Taking steps to signal that a primary care setting is open to discussions about sexuality and gender identity may be more effective than assuming older LGBT patients will simply “come out”. Continuity of care may be particularly significant for some older LGBT patients.