One of the oft cited benefits of higher education is the shift in perception that comes with taking a wider view. I remember it from my Master’s degree – it was harder to take things at face value, issues were approached with a more critical lens and research projects were developed left right and centre! We all agree… there is just something that happens when you take comfortable, preconceived ways of doing things and give them a good shake with a whole load of new stuff. Change happens.
Change – it is generally understood in health care (and in life) – to be inevitable. It is also seen as difficult, sometimes resisted, and often hard to implement. In the last blog I talked about how reflexivity can lead to a literally changed mind. What I have been feeling, these last few weeks, is the result of that changed mind in an environment that hasn’t changed.
The paper I’ve been co-authoring on discrimination in LGBTQ health care (and how to make things better) has made it to the peer review stage. As an associate editor, I know the value and the limitations of the process. I’ve wrangled some terrible reviews – some that are so short they are of no practical use, some that are (to be honest) really, really rude and some that list 56 typos and grammatical errors but tell me nothing about the actual publishability of the paper. Of course this is #notallreviewers! Most are hardworking, experts in their fields who generously give up their limited spare time to help advance their profession. The trouble is, we’re not an especially academic profession (yet) and most of us (me included) are making this up/learning as we go. Anyway, you can see where this is going! One review was respectful, polite, well considered and had some great suggestions for change that were very helpful. Reviewer 2 (it’s always Reviewer 2!) questioned the need for the paper because there are anti-discrimination policies in workplaces – so surely I am exaggerating? Gay people don’t experience this – at least not to the degree that we are claiming! Despite using references from many studies and position papers, the paper was really more of a “political manifesto” than anything else. Woah!
Reading reviews is always an emotional experience! The first response is often “they just don’t get it”. I tend to skim the comments, leave it for a few days, read again, leave a day or so and then start to work on the changes. That takes some of the emotion out of it, allowing you to see where the reviewers have valid points, and (sometimes) where you still feel the original should stand. I did this last week – and still have a hard time with Reviewer 2. It comes down to (I think) the fact that I am standing in the same spot, dealing with the same issues at work but with a different set of eyes. I can see that – yes, there are policies, but oppression is institutionalised. I think, what this boils down to, is a general blindness about types of oppression and how they work. To a (I am taking a wild guess here) straight person, the fact that some people do have problems and are treated differently because of their sexual orientation or gender identity is antithetical to how the system is supposed to work. Yes, of course HCPs are usually kind, compassionate people but they work within a system that professes patient centred care but does a poor job of treating patients as individuals.
And – I get it! It took a concentrated 8 months at UBC for me to even begin to see outside my ordered, comfortable, health care-centric box. As a white woman, I am highly privileged – and had the privilege to be able to ignore the not-so-privileged experiences of other groups. As a queer woman, I thought not being able to marry who I wanted, having multiple barriers in place for parenthood and doing the exhausting dance of being both in and out of the closet was just my thing to deal with. Turns out it really wasn’t. So Reviewer 2, I understand you! But just because you haven’t seen it, doesn’t mean it doesn’t exist.