International Lesbian, Gay, Bisexual and Transgender Human Rights
Conference, Montreal, Canada. 26-29 July 2006
http://www.montreal2006.org/en_conference.html
Author and presenter:
Dr Ruth McNair
Paper title:
Effective patient-doctor relationships: a right or a privilege
Abstract:
Conference theme:
Participation in Society – access to health care
Findings from an Australian interview-based PhD study of same sex
attracted women and their general practitioners will be presented.
Study background:
The Australian primary care context is centred around contact with
a regular general practitioner (GP). The GP provides care to individuals
and families, coordination of care in the community and referral
to specialist medical care. Therefore, the effectiveness of the
patient-GP relationship is crucial to the quality of health care
delivered and received. Australian lesbian and bisexual women, when
compared with heterosexual women, are shown to have experienced
higher levels of abuse, are more likely to use illicit drugs and
to suffer with depression and anxiety. Much of this difference relates
to homophobic societal pressures. So, these women have pressing
needs for a GP that they trust and can be open with about their
sexual orientation. While Northern American and UK studies reveal
that lesbians and bisexual women are less likely to attend primary
care and have lower levels of satisfaction, this has not been studied
to date in Australia.
Method:
In-depth semi-structured interviews were conducted with a wide range
of same sex attracted women in rural and urban locations. With the
participants’ permission, their usual GPs were subsequently
interviewed. Interviews were conducted by a researcher who is both
a GP and a lesbian.
Findings:
This presentation will focus on experiences of the quality of patient-GP
relationships from the women’s perspective. Many women were
highly satisfied with their regular GP, having developed a trusting
relationship. The various reasons for this satisfaction will be
explored as will the influence of the need to disclose sexual orientation
to the GP. The need to disclose or not emerged as a complex and
variable issue. Many women felt that they found the right GP purely
by chance, and others were unsure of how to find a GP who is sensitive
to their particular needs.
Conclusion:
While an effective and honest relationship with a GP is a right
in a country with universal health care such as Australia, many
of the participants regarded this as a privilege for them. Finding
an appropriate GP was neither easy nor possible for some women.
Strategies to improve the effectiveness of general practice care
to lesbian and bisexual women that are relevant to their needs and
achievable will be discussed.
Royal Australian College of General Practitioner’s Annual
Scientific Convention, Brisbane, Australia. 5-8 October 2006
www.racgp.org.au
Author and presenter:
Dr Ruth McNair
Title of paper:
Giving voice to the silence: researching the professional relationships
between GPs and same sex attracted women
Award:
Ruth won the Alan Chancellor Award for best first time presenter
of a research paper for this paper.
Abstract:
Objective
To provide some of the emerging findings about the relationship
between same sex attracted women and their GPs from both perspectives
and why sexual orientation does or does not enter into the consultation.
Method:
This PhD study has used qualitative methodology. In-depth individual
interviews have been conducted with 33 same sex attracted women
and 27 GPs, using semi-structured interview schedules. Most women
were recruited from a large general practice based survey and most
GPs were the regular GP of the participating women. The theoretical
framework was chosen to understand the experiences of the patient-doctor
relationship for each participant in the context of their knowledge
and expectations (hermeneutic phenomenology), and the impact of
gender and power on these experiences (feminism). Critical theory
was also used to incorporate the socio-political context of same
sex attraction and identity and enable a change agenda for the research.
Analysis for this paper has focused on a comparison of perceptions
of the need for disclosure of sexual orientation within the patient-doctor
relationship as experienced by women and their regular GP.
Findings:
Sampling stigmatised populations is notoriously difficult and often
results in samples that are homogenous. Recruitment through a general
practice based survey has resulted in a much more diverse group
of same sex attracted women than is usually obtained, most of which
had a regular GP. All but two of their GPs were also willing to
be involved. Disclosure of sexual orientation was influenced particularly
by the nature of the woman’s sexual identity and understandings
of its perceived relevance to health care. It was clear that some
women preferred the GP to ask, whereas most GPs preferred the woman
to tell about her same sex attraction or sexual orientation. This
commonly led to an awkward silence on this issue and prevented some
women from presenting relevant health issues.
Implications for practice:
There is a clear need for increased exposure to knowledge and skills
development for GPs to enhance their work with same sex attracted
women.
Australian GLBTI Multicultural Conference, Melbourne, Australia.
13-15 October 2006
http://www.agmc.org.au/
Author and presenter:
Dr Ruth McNair
Title of the Paper:
For better or worse. Various impacts of culturally diverse backgrounds
of same sex attracted women and general practitioners on the health
care encounter.
Abstract:
Cultural and linguistic diversity (CALD) of lesbian and bisexual
women has been the subject of some research, with evidence that
their marginalisation within health care is compounded. There has
been little attention paid to the effects of CALD background of
the health care provider on the lesbian or bisexual client. This
is important in the current climate in which increasing numbers
of overseas trained doctors are entering Australian general practice.
Ruth will present findings from her PhD study for which she conducted
in-depth individual interviews with 33 same sex attracted women
and 27 general practitioners (GPs). A number of the women discussed
experiences of seeing GPs from CALD backgrounds and some of the
women were of CALD background themselves. Some GPs discussed the
influence of their cultural background on their role in caring for
SSA women. The experiences suggest a wide range of impacts on the
patient-doctor relationship, from complete misunderstanding to enhancement.
Overall, this part of the study highlights the need to consider
issues of diversity from both consumer and health care provider
perspectives.
International Women’s Health Conference, Sydney, Australia.
15-19 November 2006.
http://www.icowhi2006.com/
Author and presenter:
Dr Ruth McNair
Title of Paper:
The Socio-Political Climate, Identity And Disclosure In Health Care
For Same Sex Attracted Women.
Abstract:
All general practitioners (GPs) see same sex attracted women in
their practices, although many of these women have not disclosed
their sexual orientation to the GP. Disclosure is thought to enhance
the patient-doctor relationship and improve the quality of health
care. However the issue has been found to be much more complex in
the PhD study that will be presented here. In-depth, semi-structured
individual interviews were conducted with 33 same sex attracted
women and 27 GPs. Most women were recruited from a large general
practice based survey and most GPs were the regular GP of the participating
women. The interviews explored the experiences of the patient-doctor
relationship for each participant in the context of their knowledge
and expectations (using hermeneutic phenomenology), the impact of
gender and power (using feminism), and the socio-political environment
(using critical theory) with regard to sexual orientation.
The social and political understandings of each participant about
lesbian and bisexual female sexual orientation had a bearing on
perceptions of sexual identity. Is it a lifestyle choice or an innate
characteristic, is it defining and central or merely a sexual behaviour,
should it be openly displayed or concealed? These understandings
in turn heavily influenced decisions regarding the place of disclosure
of sexual orientation in the consultation. Further influences on
disclosure were considerations of relevance, trust and risk.
The paper will present these various influences on disclosure and
their impact on the patient-doctor relationship. The implications
for GP education will be presented including the need for GPs to
understand the impact of the socio-political climate on their same
sex attracted patients’ identity. This will more fully equip
GPs to provide patient-centred care that is tailored to the individual
woman’s needs.
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