More Than a Pin: LGBTQ+ Healthcare Allyship Beyond the Symbol
Healthcare providers who display rainbow pins often miss the fundamental care that protects their patients
In healthcare, we love an in-your-face symbol. A laminated poster. A mission statement in 800-point bold font. A tasteful rainbow pin that says "We Care" right next to the hand sanitizer container.
As a provider, LGBTQ+ health advocate and self-identified Big Huge Queer, I appreciate the gesture. But I also need providers to not misgender me when they're performing intimate exams. Unfortunately, those two things don't always go together.
Every day in my job and every evening in text messages from friends, exes and strangers who found me online, I see a massive gap between providers who want to be allies (or at least say they do) and the actual, practical behaviors that make LGBTQ+ patients feel safe, believed and cared for. Right now, when anti-LGBTQ+ legislation is spreading across the country, that gap matters even more.
But here's the good news: Quality healthcare for LGBTQ+ people has a lot in common with quality healthcare for everyone. Clear communication, careful check-ins about consent, accurate documentation, respect for patient identity and understanding of a patient's support system are baseline competencies, not rare niche skills.
"LGBT people live in a world where harm and bias from healthcare providers is assumed to be the default," said Michael Ioerger, MD, a Northville-based physician and coach for healthcare providers. "As a result, it's up to providers to clearly set themselves apart and prove themselves to their LGBT patients."
The first five seconds
Before you've examined a single patient, you've already told them something about whether they're safe with you. Ioerger recommends a "universal approach to meeting patients that minimizes assumptions." That can be as simple as asking, "What name would you like me to use?" and "Who did you bring with you today?" It sounds basic. For patients who have been harmed before, it's everything.
"Previous negative experiences make LGBT patients hypervigilant, so even small things can help to build trust," Ioerger explains. Your patient is already scanning for danger. You can either lower the temperature or accidentally turn the stove on high.
When you mess up on pronouns (and you will)
You will probably make pronoun errors. Congratulations, you're human. The question is not whether you make an occasional misstep; it's what you do next.
The gold standard: Briefly correct yourself and move on. No TED Talk about how you're "still learning." No commentary on how complicated or surprising modern pronouns are. Just say a quick but clear, "Sorry, they," and continue the visit. Because here's what patients notice: Are you centering their care or your own discomfort?
Your chart is not decorative
When providers juggle packed schedules, no one expects every line of the chart to be treated like literature. But the chart isn't background noise. Often, it's where a patient has already tried to meet you halfway.
Sometimes the chart itself has limitations. Fields are restricted. Options are outdated. The system was clearly designed by someone who thinks there are exactly two genders and everyone is married to a person named Steve.
But Tay M., a genderqueer lesbian in Grand Rapids who asked that we use only their last initial, put it simply: "What is supportive is when a provider actually reads my chart and demographics and uses that to inform our conversation."
When that partial information is ignored, the message is clear and not neutral. It tells the patient they're starting from scratch again. For a lot of LGBTQ+ people, that "starting from scratch" feeling is exactly what makes care exhausting.
When providers do engage with available information, it shows up in subtle and important ways. "A good ally notes my identity and sexual orientation and that informs our conversation in some meaningful way, even in the things they don't say," Tay said.
Ask better questions, get better care
One of the most common ways providers accidentally derail trust is by asking incomplete or awkwardly constructed questions and then trying to build clinical decisions on that shaky foundation.
"When taking a history, provide an inclusive set of options and ask for exactly what you want to know," Ioerger said. "For example, when asking about relationship status, if someone says they are married, ask if their spouse is a man, woman or nonbinary person, and then ask if they have any additional romantic or sexual partners."
In other words, don't make your patient reverse-engineer your question. Say what you mean. Ask what you need. And critically, signal that you're comfortable with whatever the answer might be.
"Simply showing that you are comfortable discussing the full range of possibilities can go a long way to creating a situation that helps LGBT patients feel more comfortable being open and honest about themselves," Ioerger said.
What allyship actually requires
Allyship is not a declaration. It's a series of choices, repeated consistently, often under time pressure and institutional constraint. That can be difficult.
But avoiding care because you don't trust the system that's supposed to keep you alive? That's more difficult.
Keep the rainbow pin. But make sure what happens in the exam room lives up to it. "The best way to be an ally to LGBTQ+ patients is simply to listen to us," said Kaine St. Amour, a trans man in Grand Rapids.
Because at the end of the day, all the policies, trainings and laminated rainbow clip art in the world cannot replace the most basic and most powerful clinical skill we have: listening.
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