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“It’s probably an STI because you’re gay”: a qualitative study of diagnostic error experiences in sexual and gender minority individuals
  1. Aaron A Wiegand1,2,
  2. Taharat Sheikh3,
  3. Fateha Zannath3,
  4. Noah M Trudeau3,
  5. Vadim Dukhanin4,
  6. Kathryn M McDonald1,4,5
  1. 1 Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
  2. 2 Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3 Johns Hopkins University, Baltimore, Maryland, USA
  4. 4 Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  5. 5 General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Aaron A Wiegand, Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA; aaron.alex.wiegand{at}


Background There is a critical need to identify specific causes of and tailored solutions to diagnostic error in sexual and gender minority (SGM) populations.

Purpose To identify challenges to diagnosis in SGM adults, understand the impacts of patient-reported diagnostic errors on patients’ lives and elicit solutions.

Methods Qualitative study using in-depth semistructured interviews. Participants were recruited using convenience and snowball sampling. Recruitment efforts targeted 22 SGM-focused organisations, academic centres and clinics across the USA. Participants were encouraged to share study details with personal contacts. Interviews were analysed using codebook thematic analysis.

Results Interviewees (n=20) ranged from 20 to 60 years of age with diverse mental and physical health symptoms. All participants identified as sexual minorities, gender minorities or both. Thematic analysis revealed challenges to diagnosis. Provider-level challenges included pathologisation of SGM identity; dismissal of symptoms due to anti-SGM bias; communication failures due to providers being distracted by SGM identity and enforcement of cis-heteronormative assumptions. Patient-level challenges included internalised shame and stigma. Intersectional challenges included biases around factors like race and age. Patient-reported diagnostic error led to worsening relationships with providers, worsened mental and physical health and increased self-advocacy and community-activism. Solutions to reduce diagnostic disparities included SGM-specific medical education and provider training, using inclusive language, asking questions, avoiding assumptions, encouraging diagnostic coproduction, upholding high care standards and ethics, involving SGM individuals in healthcare improvement and increasing research on SGM health.

Conclusions Anti-SGM bias, queerphobia, lack of provider training and heteronormative attitudes hinder diagnostic decision-making and communication. As a result, SGM patients report significant harms. Solutions to mitigate diagnostic disparities require an intersectional approach that considers patients’ gender identity, sexual orientation, race, age, economic status and system-level changes.

  • Diagnostic errors
  • Cognitive biases
  • Human error
  • Patient safety
  • Qualitative research

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • X @KathyMcDonald

  • Contributors AAW conceptualised the study, designed data collection tools, designed and implemented recruitment approaches, conducted and monitored data collection, analysed the data, drafted and edited the manuscript, managed references, and is the guarantor for this work. TS implemented recruitment approaches, conducted data collection, analysed the data and drafted and edited the manuscript. FZ acquired funding, implemented recruitment approaches, conducted data collection, analysed the data and edited the manuscript. NMT analysed the data and drafted and edited the manuscript. VD conceptualised the study, designed the study protocol, designed data collection tools and edited the manuscript. KM conceptualised and supervised the study, acquired funding, oversaw project development and edited the manuscript.

  • Funding Fateha Zannath received funding through a grant from the Stavros Niarchos Foundation.

  • Disclaimer The funding organisations played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report or in the decision to submit the report for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.