Diversity in private practice: Why Performance Medicine is loud and proud for the LGBTQIA+ community
Cliniko believes it’s essential to support the LGBTIQA+ community all year round. In this article, Andy Haycroft shares exactly why it's so important to make your healthcare practice a safe space for everyone who visits – patients and staff included.
Well hello there and welcome to my big queer article! *insert hair toss here*
My name is Andy, my pronouns are he/him, and I’m writing this article in hopes that I can help you and your health practice better understand the LGBTQIA+ community and why it matters, even if it’s not your clinic’s specialty.
If you aren’t acquainted with the incredible rainbow community yet, I can’t wait to introduce you. However, I first want to say that I’m writing this as a remedial massage therapist, diversity ambassador at Performance Medicine (Melbourne, Australia), and a ciswhite queer man. I can only share my experience and why diversity means so much to our team. If you have additional questions or want to keep learning, a resource I love is Rainbow Health Australia.
With that in mind, I’m thrilled to say it has been an overwhelmingly positive experience guiding Performance Medicine to become a more inclusive practice—from new patients arriving due to word of mouth about our diversity focus, to staff feeling safe to be themselves and bring their full knowledge and experience to the job.
On to the nitty gritty.
Why did Performance Medicine decide to be so overtly rainbow friendly?
We genuinely believe there is no other choice. Our main interest area is sports and the performing arts, which means we are very privileged to have direct contact with storytellers. Nearly every queer person has some terrible story to tell about discrimination in a health setting and we wanted to make sure we would never be part of that problem.
Performance Medicine is also a vocal physiotherapy centre, giving us the ability to work with speech pathologists to help trans and gender minority patients through their gender confirmation treatments.
As we heard these stories and helped our patients, we came to realise that creating a safe space isn’t enough: people also need to see and hear about it. We started a mission to build trust with the LGBTIQA+ community and this goal continues to be a huge part of the decisions we make.
Of course we also slip up plenty of times, but we focus on responding quickly and kindly to reassess what we need in our practice for the future and make changes. For example, did you know that in Cliniko you can change auto communications to use “preferred name” over “first name”? We had a non-binary patient inform us that our reminder texts and emails were dead-naming them (meaning we were using a name they did not identify with). It’s important that we have our patient’s current legal names for insurance reasons, but it was so simple to change any automatic communications to their actual name that it seemed silly we hadn’t thought about it. Plus, it was an incredibly lovely feeling that this particular patient felt safe to tell us knowing we’d just fix it.
What does it mean to have an inclusive practice?
An inclusive practice is a place where people from all walks of life feel safe to be who they are and have their healthcare needs respected.
That’s a simple enough statement, right? However, if it was that simple you probably wouldn’t be reading this article. Understanding and knowing what actions will foster inclusivity is a completely different challenge. So what do you need to consider when building an inclusive practice and where do you start?
You start small. As my passion is the LGBTQIA+ community, I am going to speak only to their part of this equation as my first small step.
1Trust is a hard thing to come by
As I mentioned before, most queer people have already had a traumatic healthcare experience. For many of us, it was bad enough to turn us off certain types of care all together or led us to only seek help from places recommended to us by other queer people who have already been made to feel safe by a specific practitioner or practice.
2You don’t just “come out” once.
Every time a sexually diverse or minority gender person meets someone new, they need to “come out” all over again. “Coming out” being the process of disclosing your gender or sexuality to someone if that sexuality or gender is at all different from being cisgendered (a person that identifies with the gender they were assigned at birth) and heterosexual (attracted to people of the opposite binary gender).
The thing is, we never know if someone is going to take our coming out well or not and we face a very real threat of abuse, both physical and psychological. For many of us that have had safe interactions time and time again, we feel more comfortable expressing ourselves freely in areas we can assume we will be accepted. However, if you misjudge a health professional you become stuck in the vulnerable position of needing help from someone that thinks your identity—who you are as a person– is wrong and then you have to PAY that person.
As a practitioner, proving ahead of time that you are a safe person or practice to come out to can save a lot of anxiety that could otherwise lead to a patient not getting care at all, or withholding information and not receiving good care as a result.
3An inclusive practice helps people's health!
No matter what kind of practice you are in, the mental health of your staff and patients affects all kinds of health outcomes — as you can’t assume or “tell” someone’s gender or sexuality, the environment needs to reflect safety. Without that clear reflection, self preservation will be the strongest instinct. Someone may feel unable to genuinely be themselves or feel forced to mask, assimilate or hide. Whether that’s directly due to a negative environment or more a reflection of an individual's past experiences, the result will likely be the same. Patients will be unlikely to communicate the whole story needed to improve their health, and good staff may leave to find an overtly safe place to work, or burn out due to the sheer effort it takes to hide parts of themselves. Whether or not this sounds dramatic or feels extreme to you, I can tell you from personal experience as both a patient and a practitioner that it needs to be taken into consideration.
What steps does it take to become an inclusive practice?
Do training with a queer training provider, even if you think you’re doing pretty well without it. Every state in Australia has a not-for-profit pride centre and advocacy group, but I know that Rainbow Health Victoria offers online training options if you can’t find one where you are. I cannot recommend this strongly enough.
You have to remember that you are the health provider. The burden to educate everyone you meet and explain why your existence and identity matters can be heavy for the queer community. Our job as health practitioners is to improve health and wellbeing, which isn’t possible if you’re creating stress for queer patients and staff (even if you aren’t aware of it). One option is to get queer speakers in to help talk you through the process.
Put up a rainbow flag, celebrate pride, post on social media about queer specific issues that come up in your health setting and/or add your pronouns to your emails and publications. These are all just gestures, but they show that you’ve considered the importance of someone's identity and how you will work to respect them. It’s also one way to make the “coming out” process easier.
Need some rainbow stickers for your window, laptop or reception desk? You can order free stickers from Cliniko here.
Your intentions matter, especially to vulnerable communities. Many practices will start incorporating inclusivity to make more money by introducing a new demographic to their client list, which is a valid starting point. But just remember the reason that any of this is necessary is because LGBTQIA+ people need to feel safe in your practice.
If you are doing the superficial work to advertise yourself as a safe space, then making your queer patients feel unsafe because you didn’t do the training or the organisational work, you are not only potentially causing harm to those people, but you are also likely blacklisting yourself to that community. You’re also potentially multiplying the number of negative experiences from healthcare providers that this community already has suffered.
Can being openly supportive of the LGBTQIA+ community be detrimental to the business?
I have to admit, this question makes me want to throw up a little. I thought to myself, how can people feeling safe to be who they are be at all detrimental to a health business? However, I do understand that if you aren’t queer yourself and you’re a business owner, these questions can genuinely come up and you should be asking every question you can to make the right choices.
Homophobia and transphobia are real and you are not in control of your clients’ beliefs, but you are in control of your own. A myotherapy business once told me “we don’t want to put up rainbow flags in case the male practitioners get hit on.” At the time this comment baffled me and, honestly, hurt me a little. However, the more I work in this field, the more I learn that all of these questions and concerns are just that—questions and concerns. If they are misguided, answering the question and educating compassionately can ease concerns, or at least encourage the questioner to consider the view of the community you are talking about. So to respond to this concern: adding a flag to your business does not increase the risk of male practitioners getting hit on, because you are a professional practice that already sets those boundaries. However, it might make your female or gender minority staff feel safer if the clientele coming in are more diverse.
So coming back to the question of whether visible support of LGBTQIA+ people is detrimental to the business—let's break it down. A 2021 survey from Ipsos estimated that nearly 20% of Generation Z identify as LGBTQIA+ in one way or another. I remember in the 2000s thinking it was around 10-12%, and there was once upon a time when I’d heard from my dad it was more like 3%. These numbers are really hard to substantiate, as here in Australia, we have still not added gender minorities into our census and sexuality is only counted if you are co-habitating with a same sex partner. However, if those numbers are even close to accurate the change (perceived or fact) isn’t actually because more people are LGBTQIA+, it’s just that more people feel safe saying it out loud and there is still the potential for many older generations to come out later in life as well.
Reflect on your patient base. What percentage of them do you believe would stop coming to see you if you started to engage with LGBTQIA+ health issues? Are they people that don’t know any queer people and could be educated? If they are openly homophobic, are they the people you want to base your business around? If they are a huge part of your base, what processes do you have to protect other patients they may encounter in the waiting rooms and your LGBTQIA+ staff? If you don’t think you have any queer staff at the moment, is it possible that an existing staff member doesn’t feel safe to come out? Would you be a safe business to come out to if these clientele are a big part of your patient base and, if a staff member did come out to you, would you be willing to lose that practitioner if they didn’t feel protected?
Performance Medicine has only seen amazing results from diversifying our practice and we continue to grow and expand with “celebrate diversity” as one of our core values. In our experience, there have been no downsides to being loud and proud.
I can’t say that I have experienced any of the concerns people gave for not putting up rainbow flags. For you, though, it might help to think about why you opened up your health practice or became a practitioner.
Who did you originally want to help? This might include sports, arts, various age brackets, or community groups.
Are there sexually or gender diverse individuals within these communities?
If you can’t think of any, is that because they don’t exist or have they simply not come into your practice?
If they haven’t come into your practice, why might that be?
Is there something you could do to change that?
I know this can be overwhelming! How do you eat an elephant? One bite at a time. It takes time, but in the end it comes down to keeping an open mind and caring about people. If you make a mistake on someone’s pronouns, gently correct yourself and move on. If something comes up you haven’t thought of, thank the person who made you aware and make changes. These sorts of things usually aren’t that big a deal to people if you show you’re trying and putting the effort on yourself, rather than on the person you’re there to help.
Remember that you will always learn the most from people who aren’t you, so having staff and patients who are diverse gives you the opportunity to learn from as many perspectives as possible. You’ll be giving you and your business many more ways to grow and adding to the positive experience of healthcare. So to all the fems, thems, womens, mens, mascs, eithers and neithers. You are loved, you are welcome here, and most importantly you are safe to be you.
Cliniko believes strongly in the value of diversity and inclusivity.
Dr Megan Sharp wrote a guest article for us last year that offers some further strategies for making your practice more LGBTIQ+ inclusive. Check it out here.
We all want to create respectful and safe environments in our work. But how active are we in this process, and do we assume others think of us as an inclusive person without us actually doing anything to show it?
As of today, we’ve introduced two new fields: Sex and Gender Identity. Gender identity is a person’s sense of their gender. It is not necessarily related to sex, physical characteristics, appearance, behavior, or sexual orientation.