Emily Kim

Dr. Bessett

SOC3090

7 April 2017

Inside the Doctors Office: Queer/Trans Identities and Fibromyalgia

Illness connects every human in a shared experience, as we have all been sick at some

point in our lives. All people with access to a physicians office in developed countries have also

probably experienced some sort of setback in their interactions with a physician: perhaps they

assumed a facet of your identity that was not true, or maybe they stared at a computer while you

explained the story of your pain. However, some people experience comparably more barriers to

care than others who find themselves in the same doctors office. Why is this? Many times, it is

because of a lack of cultural competency. Cultural competency can be defined as ability of

providers and organizations to effectively deliver health care services that meet the social,

cultural, and linguistic needs of patients (Cultural Competence). Thus, cultural competency can

encompass religious beliefs, language barriers, ethnic traditions, socio-economic status, level of

education, social identities, etc. Both patients and providers bring their own cultural backgrounds

and beliefs into the appointment, which many times doctors fail to realize, only thinking about

the patients biases, not their own. If mishandled or ignored, especially chronically, a lack of

cultural competency can lead to stigma and build barriers between the patient, the physician, and

the care the patients need. In The Remedy, queer and trans-identifying patients and professionals

detail their accounts of challenges they face in the medical institution because of their sexuality

or gender identity. Kristen Barker chronicles in her book, The Fibromyalgia Story, how people,

especially women, suffering from fibromyalgia syndrome experience barriers to care because of
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the nature of fibromyalgia, a contested disease. Lack of cultural competency surrounding just

transgender people is an atrocity in itself as there are 700,000 transgender people living in the

United States, which is equivalent to the entire population of Detroit. That is a whole large urban

center not receiving adequate care and being stigmatized when they are in a healthcare setting

the place where everyone should be comfortable being their most vulnerable.

Besides the sheer number of people failing to receive care because of their LGBTQ status

or because of their fibromyalgia diagnosis, there is another factor that details why cultural

competency is becoming increasingly important in the 2017 medical appointment. Of all three of

the traditional doctor-patient relationships widely accepted by health analysts and sociologists,

mutual participation is becoming by far the most important relationship because of the rise of

chronic illnesses. As chronic illnesses, including heart disease, diabetes, cancer, arthritis, and

Alzheimers disease, to name a few, become increasingly common and hold more of the disease

burden in the United States, the nature of a patients relationship with their physician has

changed. Chronic illnesses require more adaptive, attentive care from the provider and more

effort from the patient to create lifestyle changes. More time and greater effort is needed from

both the patient and the physician to reach the goal of providing excellent care for the patient.

With more time spent in the interaction of the doctor and patient, and with the patients lifestyle

and culture being taken into more account, there is a greater emphasis on cultural influences in

biomedicine.

However, this greater influence on culture has not necessarily led to a shift in the typical

doctor-patient model. Mutual participation is still not as common as the morbidity-mortality shift

in the United States has required. Because of their medical education, physicians follow a disease

model that privileges biology and objective signs rather than personal accounts. This model with
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an emphasis on biomedicine creates a poor setup for physicians with patients who suffer from

contested illnesses like fibromyalgia, complicated, chronic diseases, or patients with identities or

sexual preferences that may be considered deviant. Many of these complications for physicians

arise because of cultural norms and societal disparities rather than cut and dry physiological

causes. In The Remedy, the Patient Care Competency states that physicians must be able to

"gather essential and accurate information about patients and their conditions through history

taking, physical examination, and the use of laboratory data, imaging, and other tests." This

statement seems a bit impersonal and biomedically focused. The author, a psychiatrist who

advocates for LGBTQ+ health equity, argues that the statement should be edited to include

competencies for the discussion of gender identity and sexual orientation, which would

encompass a more holistic approach to the patient's life rather than just seeing a patient through

the lens of a test (Sharman 70). Likewise, in The Fibromyalgia Story, Kristen Barker concludes

that fibromyalgia's root cause is women's suffering due to disparities and discrimination in

society, which greatly affects the care that the sufferers of fibromyalgia, primarily women,

receive (Barker 198). Physicians struggle with trying to treat a syndrome that has a basis rooted

in oppression and culture, not fundamentally biomedicine. With little to no concrete

physiological knowledge of fibromyalgia, any type of biomedical treatment that physicians

attempted had little to no success. Margaret explains that each new rheumatologist would give

her the "wonder drug of the month," and each one worked just as poorly as the last. Mary details

how her physician tried to treat her with cortisone shots, physical therapy, and even hot wax, but

none of them worked. (Barker 94). Because of the construction of medical education, physicians

can only adequately treat bodily issues through biomedical, interventional techniques, so when

physicians encounter cultural and societal influences in patients that present as physiological
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symptoms, doctors are inadequately trained as to how to handle that. Biomedicine has become a

way to temporarily placate people's suffering, but it also lessens the energy people have to fight

against the ubiquitous, systemic oppression in culture. (Barker 198).

With queer and transgender patients as well as patients with fibromyalgia, mutual

participation is very limited because doctors are not invested in or are inhibited from giving

adequate care to patients with chronic symptoms or nonconforming identities, and patients

become impatient with providers who do not immediately show dedication, competence, and

empathy towards their condition. Not surprisingly, most patients in The Remedy as well as The

Fibromyalgia Story initially attempt to create mutual participation with their physicians, but this

type of relationship quickly fails. Several personal accounts describe how patients used providers

other than physicians who better handled their care, perhaps because these providers are not

necessarily tied to an established institution. There may be fewer pressures on them to take a

biomedical or legal approach to care from their colleagues, or their education may have provided

them with more tools to care for a broader range of patients. In Baby Escape Plan Two in The

Remedy, the transgender author explains how midwives handled his pregnancy with

understanding, care, and with trans competency whereas the physicians never seemed to show

compassion or competency towards a pregnant trans man (Sharman 198). Likewise, in The

Fibromyalgia Story, Joyce gathers from her personal experience that nurse practitioners will

spend more time with their patients and work with them to overcome fibromyalgia as compared

to physicians (Barker 123). Although physicians may feel they have more power during the

appointment, patients are ultimately in charge of the relationship, including its existence. It

seems that many people who have chronic diseases or nonconforming identities have turned to

providers other than physicians to seek care.

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The next question we as sufferers, patients, advocates, and allies ask is this: how do we

enact change? Access to excellent healthcare is a human right, so it is absolutely necessary to

fight for that right for all people. From reading The Remedy and The Fibromyalgia Story, it has

become clear that narratives can be used to disrupt the biomedical model. Narratives are very

impactful empathetic tools to create change and advocate for disadvantaged patients. In The

Remedy, the cartoon Queer in Common Country tells a deep story, but with visuals, especially

faces, to allow for meaningful interaction with the reader. Personally, this story was very

impactful for me because the drawings painted a picture in my head of what the author felt and

experienced (Sharman 89). I felt much more connected to this story because the faces, details,

and how the words interacted with the pictures created emotion that spoke more to my heart than

to my head. Narratives like these can be applied to medical school education as well as for

advocating for cultural competency to lawmakers or those with power in the medical institution.

This may lead to changes in recertification board requirements, which as of now only place

emphasis on biomedical and technical competency to allow physicians to continue practicing. At

conferences and other gatherings of professionals, a greater emphasis needs to be placed on

cultural competency and queer/trans education. However, it is important to keep in mind that as

both a physician and a patient, one needs to treat all people on an individual level and be

sensitive of each persons preferences and beliefs.

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Works Cited

Barker, Kristin K. The Fibromyalgia Story: Medical Authority and Women's Worlds of Pain.

Philadelphia: Temple UP, 2005. Print.

Bessett, Danielle. The Patient Perspective. Sociology of Health and Illness, 30 March 2017,

University of Cincinnati, Cincinnati, OH. Lecture.

Cultural Competence in Health Care: Is It Important For People With Chronic Conditions?.

Georgetown University Health Policy Institute, 5 February 2004. Webpage.

Sharman, Zena, ed. The Remedy: Queer and Trans Voices on Health and Health Care.

Vancouver: Arsenal Pulp, 2016. Print.