LGBTQ representation matters: images, patient material and safe spaces


I love this image of a smiling person with their dog (SPWD) used by Macmillian in the UK as part of their support for LGBTQ people affected by cancer. I don’t know how SPWD identifies sexually or what pronouns she (?) uses that fit with her (?) gender identity but as well as looking happy SPWD does look distinctly….non heterosexual, dare I say queer? I think she/he/they would firmly fit under that wide umbrella definition. Why is this important and why do I care? I’ve been pondering representation (visual and otherwise) lately as I dive into my dissertation and a recent discussion at work has got me thinking.

I’m part of a group looking at LGBTQ patient experiences, and how we can make them better. Actually, there is a lot of solid evidence out there so the HOW isn’t really the question – it’s the WHEN and the WHY DON’T WE that preoccupy me.  Very broadly we know that improving intake forms (asking about sexual orientation and gender identity); making the space welcoming (signalling safety) and educating staff are three key areas. Where I work, I am really happy to say, we’re starting to change all of these things. We’ve amended our intake form and we have some grant money to develop staff cultural competence training. Training is really important – if we’re asking about sexual orientation we need staff to understand why, and how the information is relevant to that patient’s care. It’s also important to teach people why LGBTQ people might feel uncomfortable in a hospital or clinic, why they might be reluctant to come out and why just seeing a “safe space” sticker (or a rainbow pin on a staff member’s lab coat) might help a tiny bit.  Cultural competence training is important because that pin or sticker means nothing if we then misgender that patient, or fail to recognize their “friend” is actually their partner of twelve years.

What does this have to do with SPWD? My meeting was to look at the results of a review of some patient education material routinely given to patients. The booklets and pamphlets were examined to see if they were inclusive for sexuality (LGB) and gender (T). The best example was a pamphlet for screening for cervix cancer which listed groups of people who should be screened that included:

  • Women in a same-sex relationship and
  • “Transgender individuals” with a cervix

Great! The worst examples were the very, very pink flyers for mammography that didn’t list men (including trans men) as possible candidates and were full of infographics that used (pink) skirted female icons and photographs of very feminine women of various ethnicities.  None of this was very surprising.  What was surprising was the general consensus in the room that the organisation had done their best, there were only so many “populations” one pamphlet could cover (replacing one of the several femme women with someone like SPWD wouldn’t be hard) and….adding same sex couples and/or people who visibly flagged as queer might signal to heterosexuals that this material isn’t aimed at them. That was my favourite. As if I wouldn’t pick up the booklet that was asking me to donate money because it had a bride and groom on it, or the booklet on sexuality and cancer that had no obviously queer couples (that’s a bad example, most of our material has little or no useful information on queer sex).

These examples might seem trivial, but they are part of the landscape in our cancer centres and hospitals. They matter. They signal that we have thought about being inclusive, being welcoming and are willing to move from our positions of “it’s good enough” to “we could do better”.  Yes, there is only so much we can do but next time we redesign a booklet, or edit an instruction sheet we can also make sure it isn’t just one more barrier for our LGBTQ patients to climb over.

Image: Macmillan Cancer Support, UK