LGBTQ+ identity concealment and disclosure within the (heteronormative) health professions: “Do I? Do I not? And what are the potential consequences?”

Abstract

In the power-laden context of the health professions, disclosure of LGBTQ+ (or queer) identities carries particular risks, with disclosures to patients/clients seen as ‘unprofessional.’ Pervasive heterosexism and heteronormativity regulate professionals toward conformity, leaving them with ongoing strategic decision-making regarding identity concealment/disclosure. In this qualitative study with 13 health professionals (nurses, physicians, occupational therapists) from across Canada we used in-depth interviews to examine how they engaged with concealment/disclosure and impression management in heteronormative professional contexts. Most disclosed at least selectively with colleagues, but far more rarely with patient/clients, citing harm to therapeutic rapport and violation of professional boundaries. Navigating concealment/disclosure was exhausting and energy-consuming, with constant risk-benefit calculations on multiple levels. Culture change within the professions is critical to create work contexts in which LGBTQ ​+ ​people can be fully themselves, in turn providing safer spaces for queer patients/clients.