Tag Archives: education

LGBT Health Is More Than HIV and STIs

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Adam Lake, MD

When it comes to LGBTQ+ health, the first topic that I often see is related to HIV and STIs.

While this is certainly one of many health disparities that emerge when comparing the LGBTQ+ population to the population as a whole, overdoing the focus on this topic can be divisive. The health disparities extend to mental health, cardiovascular risk, and use of preventative care.

As a family doctor and HIV care provider, I see this bias leading to an earlier diagnosis in a young gay man who had a sore throat that wouldn’t quit, but missed completely in the straight married woman with unexplained low cell counts despite extensive testing and multiple subspecialist referrals. This pattern is borne out in many, many, many studies.

True, sexual (and/or romantic) identity is what can be used to define the LGB population, though same-sex sexual activity is not always the defining factor for self-identification. As a juxtaposition, Trans*, queer, and gender non-conforming populations generally are defined by their non-cis gender identity and not sexual identity. The impact we have on Trans* patients seeking health care is especially striking with 28% putting off care due to discrimination and disrespect even when sick or injured.

The challenge here is deeper than where we may immediately recognize. The hard part is not seeing the nuance in the population prevalence: this is about being a safe space for all patients.

As teaching family doctors, we have a great opportunity to demonstrate empathy and to teach appropriate care for all. I encourage my learners to find a way to add sexual history inquiries into standard questions and to create a safe space to have candid dialog between provider and patient.

I will never forget a true conversation I had with a 60-year-old man in our more rural practice:

Me: Do you smoke cigarettes?

Patient: Nah, quit that years ago.

Me: Any alcohol?

Patient: Here and there, you know, nothing on a regular basis.

Me: Any other drugs?

Patient: Nope.

Me: Are you currently sexually active?

Patient: Yep.

Me: With men, women, or both?

Patient: Both, but I generally only have sex with guys when my wife and I are doing coke…

As you can imagine, more questions followed. While this patient identified as straight, I have found again and again that simply asking about sex will often lead to more accurate histories from patients in other domains of information. Questions about this have helped me break down my own preconceived notions of sexuality, especially when encountering unexpected answers in patients who challenge our assumptions.

To change the health care system as a whole is not within the power of a single one of us, but affecting that which is within our influence is possible. You may have the ability to affect curricular development or develop community educational activities. Or you may have the ability to personally open the eyes of your students, residents, or colleagues.  Whatever your power may be, go out and make the change.
We owe it to all our patients. For patients invisibly attracted to those on the same side of the gender spectrum who have never revealed that to a provider. For the transwoman who just wants to talk to you about her shoulder pain and not her genitals. For the straight woman with the sore throat that won’t go away. For the queer teen who just can’t take it anymore. I want our patients to know that we care.

Notes on the Ethics of Reflection

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Sharon A. Dobie MCP, MD

It is important that we reflect and write about the work we do with patients. As we reflect, we create a narrative that sometimes becomes a written piece. We cannot really tell our stories without including the patients because it is actually our perception of the patients and their stories. And yet, we also have a covenant of confidentiality with our patients. Beyond what HIPAA says, we live within ethical considerations that must protect our patients.

What then can we do when we write and then want to share that writing with a friend, in a blog, or for a journal submission?

When writing about patients, we must respect these ethical considerations. In an evolving set of guidelines, the best practice remains to show what we write to the person about whom we wrote. That is what I encourage writers to do whenever possible. It can be scary and it is always fruitful. You might learn more about the story, about the person, about yourself, and the bias inherent in your viewpoint. That information might lead you to add to or edit your reflection. Then what you have is a co-creation, and your patients will feel valued and respected. Alternatively, these conversations may also clarify reasons to not publish the piece.

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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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