Case Study 1 - Part 1
Instructions: Please read through the case study below and consider the questions that follow, then do the same for Part 2.
Sam had been searching for a primary care provider for months. He wanted to find someone who would treat him like a person, not a freak. In the previous primary care clinic where he received care, he overheard a front desk person commenting it was a shame that such a pretty girl was going to be a male. Fortunately, that was a different place, and he was now away at graduate school in a liberal arts college with a Campus Pride Index of 4.5. Someone in the resource center recommended this office, and he had a few things he hoped to find once he arrived. Sam called to inquire and received a package of information electronically that already gave him some comfort. Instead of the questions Sam had normally seen, these forms had options for gender that included transgender and relationship questions that did not assume married or single but allowed for partnered.
1. From the information in the case study, how does Sam identify?
2. What type of barrier to care did Sam experience in his previous primary care practice?
Discussion for Question 1: Gender identity is a personal feeling or idea that one has of themselves. One may choose to express their gender identity through the way they dress, behave, and mannerisms they use. They may also select pronouns they feel express who they are. The most identified genders are male, female, intersex, non-binary, trans, and non-conforming. Gender identity may or may not conform to assigned sex at birth. At birth Sam was identified as female according to anatomy and now identifies as male and is referring to himself as “he.” Gender transition occurs when a person begins to live their gender identity. This transition is different for each individual and may include changing clothing, appearance, name, pronoun, identification, and for some, may include hormone therapy and/or surgery. Discussion for Question 2: Multiple barriers can affect a person’s access to healthcare. Relational or interpersonal interactions and system or institutional functions can present barriers impeding or serving as a discouragement for individuals needing or desiring healthcare. Sam purposefully left a previous healthcare provider because of insensitivity and bias from an employee who commented on his male identification. This is an example of a personal or relational barrier that created a stressful situation for Sam and resulted from the bias of another person. The experience of stigma is common among LGBTQ people and is a cause for stress and avoidance of healthcare. Insensitivity and/or discomfort of providers and office staff and occasionally refusal of care are also in this personal/relational category. System or institutional barriers are issues like transportation, distance, access to appropriate care, insurance restrictions, and assumed heteronormativity.
Case Study 1 - Part 2
Sam entered the office and scanned the waiting room/reception area. There were several areas for literature around the room, with one section dedicated to sexual minorities. The receptionist greeted Sam, and he handed her his previously filled out forms. The receptionist asked for a preferred first name and pronoun. Sam felt relieved that he could tell the office his preferred pronouns were he/him/his because the legal-name- change paperwork was not finalized. He grabbed a brochure and had a seat to wait for his appointment. In about 10 minutes, he heard someone call his name and he stood to walk in the back. After having his height and weight measured, he was led to an exam room. The nurse introduced herself, and Sam noticed a framed print on the wall titled “We Promise.” The nurse saw him looking at it and explained the people who worked here felt very strongly that each person deserved respect and privacy for who they were and what they believed, and that everyone signed it. She asked a few questions and then handed him a form, saying they have all adult patients complete it and that the nurse practitioner would go over it with him. He turned it over and saw it was a sexual history form.
3. What are some methods the office used to provide a welcoming environment for LGBTQ people?
Discussion for Question 3: This office provided a section in the waiting room for literature relating to local resources and information for LGBTQ individuals. The intake form included preferred gender and pronoun, which was reinforced by the receptionist. Instead of asking only for marital status, it included additional options. In the exam room there was a nondiscrimination policy statement signed by employees, which showed their support for all individuals. Finally, the use of a sexual history form to be reviewed with a provider serves as a starting point for a discussion related to sexual practices and assists with risk identification. There are additional methods including displaying sexual minority couples, displaying a rainbow flag or sticker, providing a gender-neutral toilet facility, and listing your office on the Gay and Lesbian Medical Association (GLMA) directory.
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