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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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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We all have those areas of life where we just feel incredibly out of place and like we are standing like deer in the headlights. For me, this is going to the mechanic. I’m always nervous to bring my car in; what if there is something wrong with my car and I can’t afford it, what if the mechanic tries to pull a fast one on me, what if, what if, what if? I recently had to go to my mechanic, and he proceeded to list all the things wrong with my car. As I stood there nodding my understanding I was really thinking that I had no idea what he was talking about. He was using words I didn’t know, explaining about parts of the car I had never heard of, and the list of my ignorance goes on. Obviously I know nothing about vehicles, but I don’t want him to know that! When he finished and asked if I had any questions I responded confidently, “Nope, you did a great job of explaining that, thank you,” when really I had no idea what to ask because since I only understood maybe 10% of what I was told, forming any question was difficult.
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