Address one’s own bias Explicit bias is conscious; the person is aware of their feelings, which may be expressed in words or actions. Implicit bias is unconscious and can reflexively interfere with assessments, decision-making, and provider-patient relationships. 82 Both explicit (conscious) and implicit (unconscious) bias should not be in healthcare. The former will take significant time and effort to overcome. Implicit bias must be uncovered and identified by the individual who must then desire to change their thoughts and behavior. 81 Several versions of the Implicit Association Test 82
can be accessed online (https://implicit.harvard.edu/ implicit /takeatest.html). Consider taking the Sexuality IAT, Transgender IAT, and Race IAT to assist with your self-evaluation. Use of screening tools and guidelines Guidelines and screening tools exist for general wellness in primary care practice and for specialty diagnosis in multiple settings. Additional research is needed to provide consistent care and optimize outcomes for our LGBTQ clients, including adequately developed guidelines that are evaluated and revised as information is updated.
Case study 2 A new patient has presented to your primary care practice. Sarah M. is a 55 YO female without any known past medical history. You notice on her intake form that she is in a long-term, monogamous relationship with her female partner, Melissa, for 23 years. Sarah admits she has not seen a physician “in probably 25 years.” She is not taking any medications or supplements. Sarah has a BMI of 34 and her vital signs are: HR= 78 RR= 16 BP 155/92 T=98.8 F Sarah reports she did have a miscarriage at age 24 but no additional pregnancies. She states her periods had been regular until she completed menopause more than 3 years ago. Questions 1. Based on this limited information, you recognize that: a. Sarah does not require any specific gynecologic care since she is not sexually active with men. b. Sarah has a lowered risk for breast cancer compared to a heterosexual woman. c. Sarah may have been hesitant to seek medical care over the past several years because of negative interactions with healthcare professionals. d. Sarah should attempt to lower her BMI with weight loss supplements. Rationale : Correct response: C. It is important that healthcare professionals recognize that a large number of individuals within the LGBTQ community have experienced negative interactions within the healthcare
system. These negative interactions may result from explicit or implicit bias. 2. Based on this limited information, you believe Sarah could be at risk for a. Breast cancer. b. Metabolic disease.
c. Cervical cancer. d. All of the above.
Rationale : Correct response: D. Sarah has not received any medical care in more than 20 years. Based on her age, lack of prior screening and elevated BMI, she is at risk for all of the above disease processes. In fact, she has an elevated blood pressure at this visit, which could represent an indication of metabolic dysfunction. Conclusion As summarized in this learning activity, LGBTQ
experienced providers can cause a delay in seeking care. Health care providers can take meaningful, positive steps to promote the health of their LGBTQ patients by examining their practices, offices, policies and staff training for ways to improve access to quality health care for LGBTQ people and by following the recommendations made in this activity. This course discussed methods to create a welcoming environment with a focus on primary care. Healthcare professionals can still identify ways to create a more inclusive environment and address instances of outright bias observed or encountered. Change is reliant on the identification of a situation in need of a different outcome.
patients, in addition to having the same basic health needs as the general population, experience health disparities and barriers related to sexual orientation and/or gender identity or expression. LGBTQ health disparities exist throughout all age groups. Youth have higher rates of homelessness, suicide, and mental health issues than their heterosexual peers. Many avoid or delay care or receive inappropriate or inferior care because of perceived or real homophobia, biphobia, transphobia, and discrimination by health care providers and institutions. Fear of and experiences with discrimination and stigma influence the decision whether to seek healthcare. Insurance coverage, cost, and lack of knowledgeable and Glossary Unless otherwise stated, definitions are from New Jersey Institute of Technology. 65
● Ally : A person who supports and respects sexual diversity and acts to challenge homophobic or heterosexist remarks.
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Book Code: CT24CME
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