Case Study 2 Instructions: Please read through the case study below and consider the questions that follow. (ANSWER KEY AND RATIONALE IS DISPLAYED AT THE BOTTOM OF THIS EXERCISE)
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. 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. 1. Based on this limited information, you recognize that a.
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
1. Answer: C - Rationale: 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. Answer: D - Rationale: 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.
The Gay and Lesbian Medical Association: Health Professionals Advancing LGBTQ Equality (http://www.glma.org/index.cfm?fuseaction=Page. viewPage&pageId=534), founded in 1988 for physicians and medical students, is now open to members of other health specialties including nurses. Their mission is to ensure health equality for all sexual minority individuals. On their resource page, there are links for both patients and providers. They also have free webinars and continuing education related to quality healthcare for LGBTQ people and assorted publications. Familia es familia (https://www.familiaesfamilia. org/) provides information and links to topics such as family issues, immigration, school, community, discrimination, transgender, same-sex relationships, and student resources for LGBTQ individuals. Many of these are in Spanish and English. The Safe Zone Project (https://thesafezoneproject.com/resources/) provides training resources in creating LGBTQ/Ally training and many other links to a variety of topics related to sexual minorities. Campus Pride Index (https://www.campusprideindex.org/contactus/ index) launched in 2007 and provides an assessment of colleges on eight LGBTQ-friendly aspects including safety, housing support, academic and student life, counseling and health, institutional support and commitment, and recruitment.
The (https://www. thetrevorproject.org/about/), founded in 1988, provides crisis intervention and suicide prevention 24/7 to LGBTQQ people under the age of 25. In addition to online and telephone service, individuals can chat confidentially via instant messenger or text a counselor any day any time. Text START to 678- 678. Trevor Project HealthSherpa (https://blog.healthsherpa.com/ lgbtq-healthcare-resources/) helps individuals find quality, affordable health coverage under the Affordable Care Act. There are also links for people to become involved in political activism. U.S. Office of Special Counsel (https://osc. gov/Pages/SearchResults.aspx?k=sexual%20 discrimination) provides guidelines and factsheets related to complaints of employment-related discrimination in the federal workforce based on sexual orientation or gender. The National Center for Transgender Equality (https://transequality.org/) was founded by transgender activists who desired to see policy changes. The site has multiple resources along with an FAQ section, issues relevant to transgender people and their advocates, legal rights information, and self-help guides.
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. Cisgender: A person whose biological sex matches their gender identity. Gender expression: The way a person presents and behaves. Gender identity: How one perceives oneself (man, woman, or otherwise); this gender identity is internal and cannot be seen by others. Healthcare disparity: Inequitable differences in healthcare resulting from differences in insurance coverage, access and availability of care, and quality of care received, leading to disparities (differences) in health and/or outcomes. Healthcare provider: A person who is licensed, certified, registered, or otherwise authorized by the law of a state to provide healthcare in the ordinary course of business or practice of a profession. 83 Heteronormativity: The assumption that all individuals are heterosexual or that heterosexuality is superior.
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