Discussion 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 birth sex. 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 is different for each individual and may include changing clothing, appearance, name, pronoun, identification, and for some, may include hormone therapy and/or surgery. 2. There are multiple barriers that can affect a person’s access to healthcare. Relational or interpersonal Case study – 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 obtaining height and weight, 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 and explained the office 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 the nurse practitioner would go over it with him. He turned it over and saw it was a sexual history form.
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 LGBTQQ 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. Question What are some methods the office used to provide a welcoming environment for LGBTQ people? Discussion This office provided a section in the waiting room for literature relating to local resources and information for LGBTQQ individuals. The intake form included preferred gender and pronoun, which was reinforced by the receptionist, and instead of asking only for marital status, included additional options. In the exam room there was a statement signed by employees that showed their support for all individuals (nondiscrimination policy). 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.
HEALTH RISKS FOR LGBTQ PATIENTS
LGBTQ patients have the same risk factors as any patient, but they also have risk factors and healthcare disparities that require special consideration. Healthy People 2020 targeted health disparities for elimination among LGBTQ people (ODPHP, 2020b). Research showed that negative health outcomes of LGBTQ individuals are often related to stigma, discrimination, and denial of human rights (ODPHP, 2020b). Elimination of disparities and improving LGBTQ health are important in contributing to increased longevity, decreased expenditure for healthcare, reduced disease transmission, and increased physical and mental wellness (ODPHP, 2020b). Equality in healthcare has not yet been achieved, but what has been accomplished is an increase in sexual orientation and gender identification data collection (Gonzales & Henning- Smith, 2017). This information will assist in identifying disparity, increasing recognition of the need to obtain unbiased social and sexual histories, and increasing provider education related to sexual minorities and social determinants of health to increase the potential for culturally competent care (ODPHP, 2020b). Social stressors contribute to increased rates of mental health issues, suicide, substance abuse, obesity, and victimization in this population. Chronic stress resulting from stress in the social environment as a result of stigma, discrimination, and prejudice has been referred to as
minority stress and is a topic of interest in sexual minority individuals (Baptiste-Roberts et al., 2017). The minority stress model focuses on mental health but there is some evidence that mental health also affects physical health. Meyer (2003) identifies the processes of minority stress, as related to LGBTQ, as having distal to proximal factors. These range from external objective stressors to expecting such events to take place and the vigilance this entails and internalizing negative attitudes. Individual response to stressors varies as do stress-relieving factors. Many minority groups respond with group solidarity, which serves to support morale and protect individuals from adverse stressors (Meyer, 2003). When a person does not have access to group level resources it can lead to increased stress and alienation. Mental health issues are prevalent among LGBTQQ people of all ages. Much of the risk for mental health conditions is thought to result from discrimination, bullying, violence, and loss of support. LGB identified youth were more than eight times more likely to have attempted suicide if their family rejected them than LGB peers with low or no level of family rejection (Veltman & La Rose, 2019). LGB individuals have a two-to-six-time higher lifetime risk of suicide and/ or depression (Herman et al., 2019). A 2015 US study on transgender individuals found that 81.7% contemplated suicide and 40.4% had attempted suicide at
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Book Code: SWTX1525
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