Clinical Teaching for LGBT Health at the Point of Care

StumbarPortrait

Sarah E. Stumbar, MD, MPH

“Do you live with your husband, too?” the second-year medical student asked, innocently enough. It was our first visit with this patient, a healthy middle-aged African American woman. We were just chatting, trying to get to know her, and I had picked up on little clues in our conversation that had already led me to conclude that there was no husband in the picture. The medical student, though, didn’t seem to have picked up on this and, I thought, was trying to get at her sexual history by asking, instead, about her husband.

A few seconds of an awkward, heavy silence followed his question, until the patient forcefully said, “I’m an independent woman.” There was no room left open in her tone for further discussion, and our conversation quickly moved onto other topics.

Later, after the visit, I challenged the medical student to go back to that question and think of all of its assumptions: a heterosexual relationship, the need for a husband to have a child, the assumption that asking about a husband equated to asking a sexual history. I could see the student processing all of this, as he squinted his eyes and stated, “I come from a very conservative family.”

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Transgender Is Not a Verb: Three Ways to Provide Compassionate Care to Trans Patients

By Stephanie Aldrin, Medical Student

According to the Institute of Medicine, transgender and gender nonconforming patients access health care less often than their cisgender counterparts. And when transgender patients do seek medical attention, it is often with more serious ailments.1 While many factors contribute to these disparities, health care providers can play a crucial role in reducing the stigma associated with seeing the doctor and in promoting safer health care environments for the trans members of our communities.

In fall 2015, the clinic I work at, Smiley’s Family Medicine Clinic, asked its patients who identify as transgender or gender nonconforming to speak candidly about their experiences accessing primary care. I remember scrambling to take notes as I listened to the patients’ stories and feeling grateful for the opportunity to have this small window into the challenges of seeking health care as a trans person.

Three major themes emerged from the patients’ experiences. First, small changes in language can positively impact the way a patient feels during and after an encounter with health care providers. Second, trans patients see their doctors for a number of reasons, and, like their cisgender counterparts, want to be seen as any other patient and not have their gender identity be the focus of the visit. Finally, positive partnerships occur when physicians come into the exam room as their authentic selves, who genuinely care about the patient in front of them.

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What If Prince Had a Waivered Family Physician?

By Matthew Martin, PhD and the members of the STFM Group on Addictions

A Prince in Crisis

On April 21, at 9:43 am, the Carver County Sheriff’s Office received a 911 call requesting that paramedics be sent to Paisley Park. The caller initially told the dispatcher that an unidentified person at the home was unconscious, then moments later said he was dead, and finally identified the person as Prince. The caller was Andrew Kornfeld, the son of Howard Kornfeld, MD, an addiction medicine specialist from Mill Valley, CA. Andrew, a pre-med student, had flown to Minneapolis with buprenorphine that morning to devise a treatment plan for opioid addiction. Emergency responders tried to revive the musician but later pronounced him dead at 10:07 am.

On April 20, the day before, Prince’s representatives contacted Dr Kornfeld, who agreed to see Prince later that week. Dr Michael Schulenberg, a family physician in Minneapolis, saw Prince on April 7 and April 20 apparently for opioid withdrawal. However, Dr Schulenberg is not a waivered physician and thus could not prescribe buprenorphine. If he had, perhaps Prince would now be recovering in a comfortable treatment center in California receiving state-of-the-art medical care. He would likely be receiving buprenorphine treatment to prevent opioid withdrawals. Recent autopsy results show that Prince died from an accidental overdose of Fentanyl.

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