Intro

Hello and welcome to this episode of the Conference Conversations focus 2022 podcast series. In this episode Dr Jenny Setchell, they/them, NHRMC Research Fellow at the University of Queensland, and Dr Megan Ross, she/her, Chair of the APA’s LGBTQIA+ Advisory Panel, physiotherapist and Post-Doctoral Research Fellow at the University of Queensland, discuss the importance of inclusive and respectful communication with patients and colleagues who identify as part of the LGBTQIA+ community. Before we start this series of Conference Conversations podcasts has been brought to you by the Physiotherapy Research Foundation supporting the promotion and translation of research and supported by Pain Away, platinum and content sponsor of the PRF. Let’s get started.

Jenny

Hi, I’m Dr Jenny Setchell and today we’re going to talk about the LGBTQIA Advisory Panel of the APA. I would like to start with an acknowledgement of country. Megan Ross, Dr Megan Ross, our guest today and I, are sitting in Meanjin, Brisbane, on Turrbal and Jagera Country, wanted to acknowledge that this land has never been ceded and pay both of our respects to elders past and present, and also to ancestors and their descendants of this country. We’d also like to extend that acknowledgement to the country listeners are listening in from as well to acknowledge the many and diverse First Nations people around the country and their contributions to physiotherapy and the broader landscape.

First of all I think we should introduce ourselves, Megan. I’m, as I said, Dr Jenny Setchell, I’m a Senior Research Fellow at the University of Queensland, I’ve been a physiotherapist clinically for about 20 years and worked in lots of different elements of physiotherapy and most of the sub-disciplines in that time. My role is on the LGBTQIA panel, that we are going to talk about today, as a member of the panel. I’m really pleased to introduce Dr Megan Ross who is chairing the panel. Megan, would you mind introducing yourself, please?

Megan

Sure. My name is Megan Ross, I am a physiotherapist. I’ve been a physio for ten years this year. I worked clinically for a few years in the musculoskeletal area and then I went back to do my PHD which was in tendinopathy, and I am currently a Post-Doctoral Research Fellow at the University of Queensland as well. As Jenny mentioned I am the chair of the APA’s LGBTIQ Advisory Panel and I’ve been doing research in the LGBTIQ and physiotherapy space since about 2019. At the end of 2019 and into 2020 I received a Physiotherapy Research Foundation seeding grant to develop an educational resource for physiotherapists about how to work with LGBTIQ sensitively and safely.

Jenny

Awesome, thank you, and we will talk more about that work, I hope, as we move along through this discussion. It’s so exciting to be talking about the LGBTIQ community in the physiotherapy space, there’s lots of work going on and lots more to do as well. You’ll notice to start with that we probably use the acronym in different ways, there’s no perfect acronym may be one of the first things to say. There’s a lot of letters, we often put a plus on the end so that we can say there’s a lot of different identities. To start with, and perhaps this will help with that definition in some ways, Megan, can you just explain what the remit is of the LGBTQIA Advisory Panel for the Australian Physio Association?

Megan

Sure. I guess the main vision of the advisory panel is to increase the awareness, inclusivity and advocacy for LGBTIQ communities within the physiotherapy profession. So we as a committee provide a voice within the APA for both the APA’s members and also the patients of physiotherapists to ensure that members of our communities are included in decisions that affect them and we also provide expert advice to the APA and guidance around strategies and tools that could be developed to assist physios in Australia working sensitively with LGBTIQ communities.

Jenny

It’s really exciting that this has started up, this panel, two years ago now, I think, or a year.

Megan

No, just a year. We actually held – EOIs opened around September last year and then we were informed of the outcome, I think, in November 2021. We had our first meeting in February this year so not that long, almost a year, and we’ve done a lot in that time actually which is pretty exciting. In this first year we really did just focus on starting to deliver some education to the APA members about how their practices and communication are more inclusive for their communities.

Jenny

What does LGBTQIA or IQA, or whatever, stand for? I know our listeners will have a range of different levels of understanding so could you explain the acronym, the exciting acronym?

Megan

Of course. The acronym is an umbrella term and as you mentioned there are quite a few variations in the acronym and we acknowledge that there probably isn’t one correct one because there are so many identifies and experiences within the LGBTQIA+ community but the acronym that we do use stands for the lesbian, gay, bisexual, transgender, queer, intersex, a-sexual and other related identities and experiences within these communities. We do put the plus sign there to acknowledge that language is always evolving and that lots of people might be part of the community but not identify with any of those specific terms so we like to always use the plus to make sure that we’re being inclusive of everyone who feels like they are part of the community.

Jenny

Great. I remember one time in New York going to a show by a non-binary person and they were exploring the whole alphabet of identity, so they started at A and ended in Z and they had one word for each of the letters, or at least one word for each of the letters which fits within that LGBTQIA+ umbrella. Yes, it’s absolutely limitless. On that note about language, really, why is it essential to understand the LGBTQIA+ community for physiotherapists and use appropriate language where possible?

Megan

I guess one of the biggest things and the most important is that it’s showing acceptance and respect and that you value someone’s authentic identity so the effect of not using inclusive language is really significant. Considering someone’s mental health and someone’s then willingness to continue to access healthcare, the negative effects can be really harmful. It is important for us to be able to use inclusive language and to be sensitive about people’s different experiences when we’re seeing them in clinic or in hospital, and it’s a matter of as well as being sensitive and inclusive it really just comes down to not being discriminatory as well.

The importance of it is huge and on the opposite side of that it can make someone feel really good, using gender affirming language can be a really positive experience and can be the difference between someone continuing on with their healthcare journey and someone not. I guess that is really important for us as health professionals, is that we’re providing environments where people feel safe and where people feel understood or heard and valued so that they can safely keep coming to see us to get better, and things like that.

Jenny

Yeah, and that sort of touches on access, really. It’s not like people don’t have access in the kind of broader sense of everyone being able to turn up but you may feel less like turning up or you may not want to return back if you’re feeling discriminated against.

Megan

Yeah.

Jenny

I guess that sort of borders on discussing stigma and harm you’ve already mentioned on some of this topic but if we take, for example, gender specific language, for example pronouns or I guess gendered terms for people like “girlfriend” versus “partner”, what’s going on there where stigma and harm happen?

Megan

What we have found in our research is that this stems from heteronormative and cis-normative assumptions, so the assumption that people are in heterosexual relationships and this is the norm, and also the assumption that people are cisgender which means that their gender identity aligns with the sex that they were assigned at birth. If you assume that everyone fits into those binary categories then the chance of misgendering someone or using the wrong pronouns for them or using the wrong gendered language for their partner or their parents or their children are a lot higher. If you can challenge those assumptions and be more open about the fact that not everyone is heterosexual and not everyone is cisgendered then you are less likely to make those mistakes.

We found that with people who are attending physio the biggest thing that they talk about is that their physio has made assumptions about their gender identity or their sexual orientation and for some people this was just frustrating. My personal experience is that for me it’s just frustrating but for other people, particularly people whose gender identity is the mistake that their physiotherapist made, so they have misgendered them, that can be really harmful and it can make someone question what was it that I did or is it something about the way I am presenting today that has led to the physio making this assumption that I am not a man or not a woman, or non-binary. It can be harmful and as well as questioning what it was they did or didn’t do. It can also impact mental health in terms of feeling anxiety or depression, and really significant mental health concerns.

Jenny

Yeah, and as you mentioned before on the other side if people get it right it can be a really positive experience and certainly some of your research we have both been involved in certainly we’ve seen some really positive effects where people have had really fantastic experiences too and it’s really welcomed them into the physiotherapy space too. I just want to return to a couple of great terms that you used there that might not be entirely familiar to people, “cisgendered” and “misgendered”.

Megan

As I mentioned before cisgendered is when your gender identity does align with the sex that was assigned at birth, so people who for them that is true are cis or cisgendered. People whose experience is not that, so people whose gender identity may not align with their sex that they were assigned with at birth, then we use the word trans or some people use non-binary as well. Misgendering is when you assume based on someone’s appearance or based on their characteristics that they are a gender that does not align with the way that they feel.

Jenny

How might physiotherapists avoid that, I guess, in their clinic? And I think it’s really important to point out now that we’re not just talking about patients but also with colleagues as well.

Megan

Yeah. There are quite a few different strategies and some people suggest that using gender neutral terms all the time is safer but as we mentioned for some people it is really affirming and it is a really positive thing when you do use gendered language for them, so gendered pronouns. I think that perhaps until you know otherwise or if you are not sure using gender neutral terms is probably okay but one of the best things that you could do is to where your pronouns on a name badge or have them in your e-mail signature, or when you first introduce yourself to someone introduce yourself using your pronouns so that then you’re giving that person the opportunity to tell you theirs and then you know, then there’s no ambiguity and you can appropriately address them with the right language.

In terms of a physio clinic that works well if you are doing written communication via e-mail or if you are in person with someone already and you’re wearing a badge or something like that, that can help. In terms of a patient intake or if you haven’t met them yet but they have filled out documentation then ensuring that you have a section on your form somewhere where someone is able to enter their pronouns and ensuring that you look at that before you meet them and before you introduce yourself is also a good way so that you can make sure that you’re aware of it before you interact with them and then otherwise just introduce yourself with your pronouns and then that gives them the opportunity to say theirs as well.

Jenny

In terms of learning more about different LGBTIQ peoples’ life experiences, I guess, that might be relevant for physios where might the clinicians go, what’s available to clinicians to learn more?

Megan

A couple of exciting things. As I mentioned before our panel has worked quite hard this year to get some preliminary educational resources and things out to APA members, so we have had four different articles in In Motion and we’ve had two different online lectures which are accessible to all APA members, so that’s one stop. Educating yourself there are lots of different online tools and online websites designed for healthcare broadly where you don’t even need to log in, you can access and learn more about it.

The other super exciting thing is that, as I mentioned as well with the PRF grant, the educational resource. It’s an introductory module, so a shorter version of what we eventually would like to have, but that introductory module is not too far away from being finished and so compiled it and then the intention obviously is for that to be available to all APA members so that’s super exciting but in the meantime there are some non-physiotherapy specific resources online or some physio-specific resources through In Motion and online lectures that we’ve organised for this year.

Jenny

Are there any other strategies that physiotherapists can introduce in their clinic space or whatever to promote a more culturally safe environment for the LGBTIQ community?

Megan

As well as inclusive language and interpersonal communication that allows people to, like I said, tell you their pronouns or it allows people to feel safe and comfortable there are of course other things that you can do even before they get into your clinic. I guess you can consider inclusive digital spaces or online spaces and also physical spaces, so the actual clinic. Before they come on your website having your pronouns listed, and if physios who work there are comfortable with identifying that they are part of the community as well can help to make potential patients feel like it would be a safer and inclusive space or there will be someone there who may have some understanding of what being part of the community is like.

I have seen quite a few websites as well that have either the progress flag on their website too just to highlight that they are a safe and inclusive space, in the same way you can do that in the physical space too so you could have a flag or a welcome here type identification on the front of the clinic having inclusive terminology within your intake forms and having images of diverse people throughout your clinic. There are lots of different physio clinics that have images up on their wall and if these are diverse and people can see someone who is like themselves in the clinic that can help with feeling comfortable too.

The biggest thing is that any of these visible displays or visible signs of inclusion really do need to be followed up with actually inclusive practice so people who do use inclusive language and people who are sensitive because one of the most harmful, potentially harmful things, is someone choosing that clinic or that space and thinking that it would be safe and then feeling unsafe, that is quite harmful. One of the other things you can do is celebrate days of significance as well, there are quite a few throughout the year and if you’re celebrating them or recognising them then that shows that these days are important to you as a physio or as a clinic or an individual so that can also help as well.

Jenny

Great. What are some of those days?

Megan

There are lots. Wear It Purple Day is a great one, so that’s in August and that’s more for youth but lots of people celebrate Wear It Purple Day. There is IDAHOBIT as well which is International Day Against Homophobia, Biphobia, Intersexism and Transphobia. Then there is Trans Week of Remembrance and there are days throughout the year for different gender identities and sexual orientations as well. There are lots, actually.

Jenny

And Pride, and each state has its Pride Days as well. They’re called different things in different places, there’s also international versions as well.

Megan

Yeah.

Jenny

You mentioned, as well, the progress flag. Can you talk about what that is? I think some people would be familiar with the rainbow flag being a sign of the LGBTQIA+ community but what’s the progress flag then?

Megan

There are a couple of different versions of it. The one that I was referring to does not only have the rainbow, it also has representation for the trans community and also for people of colour, and also the intersex symbol as well, so being I guess more representative of the LGBTQIA and people of colour as well rather than just the rainbow community.

Jenny

People might spot that, it’s usually got the rainbow going across horizontally and then there’s a little diagonal bit going in, triangle bit going in, with the trans flag as well as black and brown stripes representing intersectionality with people of colour.

Megan

The intersex circle as well.

Jenny

And the intersex circle. Okay, great. Your research has both been on clinical physiotherapy settings, interactions between patients and therapists as well as what it’s like for people who identify as LGBTIQ who also happen to be physiotherapists to be in the physiotherapy community. With that second part in mind what is it like for the LGBTIQ community to be physiotherapists and what can we do to support our colleagues to feel safe in their workplaces.

Megan

There were some similarities between the experiences of people who identify as being part of LGBTIQ communities who are physios in the profession to patients in the physio context and so those were their assumptions around gender and sexual orientation, so the heteronormativity and the cisnormativity exists within the profession as well so that looked like gendered stereotypes around what sort of area of physio people would be working in or some assumptions around someone’s gender identity or sexual orientation because of the area of physio that they work in. Then there was experiences of additional stress and labour, and this was talked about in terms of that additional stress that comes with having to constantly come out in the workplace or questioning whether it was safe to come out or not as well as if you decided that it was not safe then the extra stress and load of hiding as well.

Then there was additional load that people described that was related to the feeling of having to educate people all the time, so educating colleagues and sometimes even educating patients as well which can be quite stressful or tiring. We called that “doing the work” and there was the importance of allies, actually, really came up there, so people who are either outside of the LGBTIQ community who support and advocate for people within the community as well as people within the community with different identifies so as an example, lesbian women who are allies for the trans community as well. The importance of those allies came up there where it felt nice to have other people doing the work so it wasn’t always coming down to people of the communities.

Then the final discourse that came up from those interviews was discussion around professionalism and feeling like your gender identity or your sexual orientation wasn’t professional or that you had to hide so that you were considered to be professional. We talked about people not being able to bring their whole selves to work and we also talked about how great it is when you do feel safe and comfortable to bring your whole self to work and how much of a positive impact that has on all aspects of your work life and your personal and mental and emotional wellbeing as well.

Jenny

Certainly as an LGBTIQ person myself I certainly can agree with that. It is really wonderful to have allies, a great term that you brought up there. I think that really is a nice way of framing how we might be allies for our patients as well as allies for our colleagues. Can you go into just a little bit more for people who aren’t familiar with that term, what an ally is?

Megan

Yeah. An ally is someone who we like to consider active allies, so someone who actively promotes inclusion and actively promotes education around – so you can be an ally about anything but particularly in the LGBTIQ context, so you actively advocate for people who are part of the LGBTIQ community and support education and take on some of the load around visible signs of inclusion and if you’re an ally you likely will wear some form of identification that shows that you’re a safe person for people of the LGBTIQ community to be themselves with.

Jenny

Maybe in some ways that’s the ideal that we are looking for, what about people who are just some of the steps along the way, what are some of the first things they might want to do in their clinic to better support their patients and colleagues who are part of the community?

Megan

I think some of those steps that we did already talk about before like adding your pronouns to your e-mail signature or wearing your pronouns on a name badge if you have name badges and then little visible signs of inclusion. The other thing is participating in education so learning yourself, taking it upon yourself to learn about the community and to learn about historical and current experiences of people within the community, particularly around healthcare and access to healthcare and discrimination, educating yourself is one of the best things that you could do.

Jenny

Thank you so much. I think just to finish up what we might do is talk about sort of what’s happened so far. In the panel you mentioned that there’s a lot of things that’s already being done even just since February or so when the panel was established, what is there in the future for physios to look out for?

Megan

Yeah. Some of the things that people might already have noticed that are happening are within the APA mentoring program we have added categories for mentors and mentees to select that they would like to be mentored or a mentee in the space of being an LGBTIQ physio in the profession or help with working with LGBTIQ patients in physiotherapy, so we’ve done that. We’ve added a space for pronouns and we’ve had more expansive gender identification markers in the online membership portal and we have also added a section where you can identify if you are part of the LGBTIQ community, you don’t have to but we’ve put that there if people would like to respond to it.

We have added some PD tags, so for any content that’s delivered that is around LGBTIQ experiences we have added a tag so you can quickly and easily search for that. Then the other things that I have already mentioned are around those four In Motion articles this year and the two online lectures and we have a series of articles and online lectures planned for next year as well moving forward just to cover off on a few different aspects that we haven’t touched on just yet.

Jenny

Awesome. I think there’s a lot there for members to follow up on if they want some more information. Thank you so much, Dr Megan Ross, for joining us today, I really appreciate your time.

Megan

Thank you, Jenny, it was really exciting to be able to share what we’ve been working on both in research and on the panel, so thank you very much for having me.

Outro

That was Dr Jenny Setchell, NHRMC Research Fellow at the University of Queensland, and Dr Megan Ross, Chair of the APA’s LGBTQIA+ Advisory Panel, physiotherapist and Post-Doctoral Research Fellow at the University of Queensland. You’ve been listening to another episode of Conference Conversations brought to you by the Physiotherapy Research Foundation and Pain Away, platinum and content sponsor of the PRF. Thanks for listening and make sure you catch the next episode in the Conference Conversations podcast series.