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Improving Healthcare for LGBT Communities

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Uhhhh.. Sorry to be so behind the time.. LGBT healthcare disparities???

Gotta source?

 

Or do you mean increasing provider awareness of LGBT risk factors ( if any, other than receptive unprotected anal intercourse of oral anal contact)

 

I am not being a wise guy here, I truely am unaware of the veracity of your premise

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Wtf!

 

How about answering a straightforward question.?

 

I am not a newbie here, and know when to, and not, " do my homework."

 

On second thought, don't answer the question. You just made it a non issue for me.

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Wtf!

 

How about answering a straightforward question.?

 

I am not a newbie here, and know when to, and not, " do my homework."

 

On second thought, don't answer the question. You just made it a non issue for me.

I think cbcsmurf was talking to the original poster, not you RC.

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Guys, I have a question.

How can a PA improve the health disparities in the LGBT community?

Thanks!

 

Here are some facts:

 

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25

 

 

 

  • LGBT youth are 2 to 3 times more likely to attempt suicide.14
  • LGBT youth are more likely to be homeless.15, 16, 17
  • Lesbians are less likely to get preventive services for cancer.18, 19
  • Gay men are at higher risk of HIV and other STDs, especially among communities of color.20
  • Lesbians and bisexual females are more likely to be overweight or obese.21
  • Transgender individuals have a high prevalence of HIV/STDs,22 victimization,23 mental health issues,24 and suicide25 and are less likely to have health insurance than heterosexual or LGB individuals.26
  • Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.27
  • LGBT populations have the highest rates of tobacco,28, 29 alcohol,29, 30 and other drug use.29, 31, 32

 

 

Thanks for bringing the topic up, it's an important one for those of us who have entered the profession of caring for other human beings.

 

This was actually partially behind the beginning of my entrance into medicine, although at that time things were very, very bad. My interest in helping the sick began back in the late 80s/early 90s when AIDS was in full-force, especially in inner cities. People were dying and it was either from AIDS and associated illnesses or else it was from the AZT which was the only drug at that time and highly toxic. Nothing was being done, no one wanted to help the lepers. Having always been a scientist at heart and educating myself on the issue, I knew that the virus couldn't be transferred through casual contact. I knew these people were victims, not cursed. So I started with Project Angel Food, a group that made hot meals and delivered them to the homes.

 

In my PA program, we used a tablet on rotations where we had to enter every patient we saw. In the choice of gender, it was, M, F, MtF or FtM. That, I thought, was one of the most comprehensive tools, not only for the patients we might encounter, but also for the students, many who had little to no experience working with LGBT patient populations. Sort of a, hey guys, these patients are out there, so be prepared. My program, Drexel-Hahnemann was so direct and non-biased when it came to education on LGBT issues and we had lectures on various topics related, including availability of care, bias of providers, misunderstandings and ignorance related to health issues (such as the one mentioned by RC above, but which should be remembered is also a consideration in the heterosexual community as well).

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I that is true, then I take no offense to non-attitude.

 

to the OP: please do tell me about the LGBT health care disparieties... I truly wasnt aware there was an issue

 

OHH THE ABOVE POSTER ANSWERED MY QUESTIONS. oops .. I knew most of the these stats.. at least I intuited them.

 

no so the homeless risk factor, nor the not seeking cancer treatment

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no so the homeless risk factor

 

Age 13, for me. You learn how to find shelter and eat out of good dumpsters real quick ... you'd be surprised at how much donut and pizza gets thrown out at the end of the day.

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I took an amazing women's studies class in college that talked discussed this issue. I was shocked to learn that some healthcare providers were refusing to treat certain patients just based on sexual orientation.

 

http://transequality.org/PDFs/NTDSReportonHealth_final.pdf

 

I could not open the link.

 

But your statement about HCPs refusing to treat certain patients, based solely of the patient's orientation, intrigued me.

 

When I was in Vietnam, I treated NVA, but only after treating US and ARVN troops, even if the NVA had a more serious wound (differences in civilian versus military triage systems notwithstanding).

 

However, excluding for the basis of this discussion emergent or urgent issues, does a provider have any obligation to treat all comers, even comers who live a lifestyle with which the provider finds moral issues?

 

I know, I know. Hippocratic oath and all.

 

Would you treat hitler if he came to your door?

 

Would you treat and discharge someone who comes to the hospital and signs in under a false name ( at least not the name you have seen him under previously), primarily to perpetrate insurance or hospital fraud?

 

If, after a medical screening exam to assure the absence of an emergent medical condition, do you have an obligation to provide abortion information to a young lady who has told you she doesn't want the sex her fetus is, and wants to abort her 20 week fetus?

 

I am of an age that actively treated HIV/AIDS in the very early 80s, when it was exclusively a gay sexually transmitted disease, or acquired through tainted transfusions, or IVDA. I remember doctors who refused to treat HIV pos patients with open sores/lacerations, partially out of fear of transmission, and partially out of disdain of the "promiscuous" gay lifestyle.

I always thought less of those doctors.

 

But, the question is; is there a legal obligation to treat everyone who requests it?

 

Suppose they cannot pay?

 

Suppose they already owe us money?

 

Suppose they don't immunize their kids?

 

Suppose they belong to a radicalized Muslim group?

 

Or are members of the KKK? ( and you are black?)

 

Or a member of Arian brotherhood ( and you are Jewish or nonwhite)?

 

I find abhorrent the idea of limiting my expertise due to sexual orientation.. Seems antithetical to why I do this job...

But, assuming I could live with myself, am I obligated to not having a choice?

 

Before you answer and slam me, I would request that you think about your answer and ask yourself: is there ANY circumstance you would deny care?

 

( what a great Adcom interview question...)

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I try to treat every one of my patients the same, and give them the best medical care I can. Just this week I took care of a bunch of a bunch of people who couldn't pay, already owed the hospital money, one lady who didn't immunize her kids. In the past I've taken care of some pretty radical Muslims, and a KKK/Aryan brotherhood member (or, at least his tattoo's inferred he agreed with their ideology). I've also treated child molester's, rapists, spousal abuser's, and drunk drivers. Also I get a surprising number of LGBT.

 

I only care about these issues if they directly involve their health care. I talked to the lady about immunizing her kids to ensure she wasn't brainwashed by the idiotic media....turns out she had religious beliefs. The KKK/Aryan nation guy got rushed to surgery the same way anyone else would. As to the child molester's, rapists, spousal abuser's, and drunk drivers---well, oftentimes these "allegations" turn out to be not so true, and I certainly won't know the whole story in the ER, so I just treat them the best I can. Oh, you're LGBT? I only care because it may change your disease processes.

 

Doesn't mean I agree with any of these ideologies, but I won't let your belief system interfere with the way I practice medicine.

 

By the way, recently proved the "tooth-to-tattoo ratio survivability theory" for me. No teeth, lots of tattoo's, run over by car AND beat the crap out of by numerous people....nothing wrong. Apparently schizophrenia, meth, and alcohol has a protective effect to people with said low ratio. I still treated him the same I would have for anyone else.

Edited by Boatswain2PA

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I find abhorrent the idea of limiting my expertise due to sexual orientation.. Seems antithetical to why I do this job...

But, assuming I could live with myself, am I obligated to not having a choice?

 

I could write a term paper on the others rc but I'm at work right now so I can't lol. One thing I will say in response to my quoting your words above, specifically ... I don't think you have a choice when others don't. http://www.sciencedaily.com/releases/2008/06/080617151845.htm

 

That would, imo, apply to people who cannot pay as well, which is what the FQHC and NHSC programs are all about.

Edited by Hemegroup

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haha, yes, i meant OP

 

the OP's one and only post strikes me as a topic assigned by a teacher who wants them to write a 5 page argument of which I'm sure the he or she will use 2.5 paragraph spacing with 13 font.

 

and quadruple space between paragraphs.

 

All I'll say is I work in San Diego, there's a large LBGT community, screening guidelines for various diseases, especially STI's in MSM's are different than the average population and depression rates are higher. Hopefully, most providers are aware of that as it wasn't taught to me during PA school.

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My psych rotation was on a locked ward that housed pedophiles with various psychoses. That was very difficult for me, to view those ... people, in a manner as I would another patient. The Doctor had been there for 7 years. A very hardened woman.

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although I have not treated a large population of LGBT, I have had some exposure especially to transgender.

 

for me it took leaving any preconceived notions behind, asking honest questions, caring, not being judgmental in any way. Strange. When you do that with a few patients more seek you out.

 

I don't know how you apply this on a larger sense. There have been a few patients in my career where I have struggled very hard to treat can remain neutral, typically something like a pedophile. I find I do better by not asking, i.e. somebody coming in from the local jail. Just treating them.

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I think there needs to be more homework done up front to determine if the disparities are related to medical provider prejudices, part of a psychological desire of the LGBT community to reject all of the norms of the culture as a hole due to its prejudices against the LGBT community, any number of other issues or a combination of all of the above. The posted stats by Hemegroup demonstrate a health disparity though they do not necessarily represent a healthcare disparity. These stats do nothing to discuss access to care, community clinics, ER wait times, free clinics, provider to patient ratios, or any other marker that one could cite to demonstrate a "healthcare disparity". It would be my suggestion that more bean counter research be put into observing the "why" before we try to come up with a solution to a problem without knowing all of the factors.

 

I can imagine provider prejudices play a major role. I have many gay and lesbian patients and I frankly don't care what their sexual predisposition is. That's personal. It may contribute to why they are in my clinic but there are safe ways to do non-sadistic sex no matter what your flavor so I have something for everyone when it comes to preventive medicine and patient education. I have done absolutely no research and haven't the slightest clue on transgender medical issues for one main reason, I'm in the military and I have no transgender patients. I have a hard enough time keeping up with the changes in medicine for the patients I do see to try to be relevant to patients I don't see. If I resign from the Army and move to Trinidad, Colorado I would be highly informed on post-op complications of gender change procedures. I don't deal in too much psychology because I'm in the Army and I am a blunt instrument. If it's not basic Depression, Anxiety, or PTSD it goes to our behavioral health clinic. Not because I don't care, but because I have 20+ patients lined up every day and the military has huge clinics staffed with Social Workers, Psychologists, NP/PAs and Psychiatrists to spend hours in counseling. I do fine talking with my gay and lesbian patients because I have gay and lesbian friends. I think it would be difficult to claim to do be relevant psychologically to patients you have only read about. To know people is to know the issues they face. I suppose the same would go for the transgender community.

 

To another subject, the predators... My most recent patient I saw for shoulder pain. I worked up his shoulder pain to the "T" and I didn't pay too much attention to his last name because it was a common last name. At the end of the visit, I read his behavioral health screening questionnaire and come to find out, he was under a ton of stress as he was pending charges for hitting on a little 13 year old girl sheep who was a 35 year old FBI agent wolf instead. I kept my composure and set the patient straight. When I walked out of the room I thought two things, I am glad he was caught and I'm glad I found out later. I'd like to think I'm altruistic enough for there to be no difference in the detail of my exam or the extent of my education on home physical therapy etc. but the inside looking in view isn't objective by any means.

 

It's tough, I look at the LGBT community and though I'm no member, I don't see a different patient. Maybe that's the missing piece to the stats, maybe it's not. I don't know. As far as the predator types, I think if you'd quote some stats about their healthcare I'd be fighting some inner monologue down. I'm not making a comparison, I'm saying there is no comparison. Maybe I have some growing to do but you wont have to worry about me going into prison medicine by any means.

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Guest Paula
although I have not treated a large population of LGBT, I have had some exposure especially to transgender.

 

for me it took leaving any preconceived notions behind, asking honest questions, caring, not being judgmental in any way. Strange. When you do that with a few patients more seek you out.

 

I don't know how you apply this on a larger sense. There have been a few patients in my career where I have struggled very hard to treat can remain neutral, typically something like a pedophile. I find I do better by not asking, i.e. somebody coming in from the local jail. Just treating them.

 

Agree. I've learned not to ask why someone was in jail. It's none of my business anyway. I just need to know that they were in jail so I would think about infections, etc. they might have acquired in jail or prison. I have several patients who are pedophiles. I finally asked the nurses to stop telling me all the social history behind the patients that they know from living in small town rural american reservation. It has helped me to be non-judgemental to the best of my ability.....and I'm human too...so.......I recognize my failures as well.

 

What it comes down to for me is to remember everyone is human and we all walk this path of life together....be caring, honest, and treat the patients issues/diseases/medical conditions, etc. to the best of your ability. Life is good.

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most of the issues presented were at their root, an issue of poor self worth, poor self esteem and to some degree self destructive. it seems self evident to me. if the problem is behavior, change it or deal with it . do not expect others to deal with you and your problems because you just want to do what you want to do, consequences be damned. all actions and behaviors have consequences ...learn it, live it, love it. No one is "obligated" to care for anyone. it is a decision, again with consequences for treating and for not treating but it is a personal decision for each of us. Personal resonsibility anyone??

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most of the issues presented were at their root, an issue of poor self worth, poor self esteem and to some degree self destructive. it seems self evident to me. if the problem is behavior, change it or deal with it . do not expect others to deal with you and your problems because you just want to do what you want to do, consequences be damned. all actions and behaviors have consequences ...learn it, live it, love it. No one is "obligated" to care for anyone. it is a decision, again with consequences for treating and for not treating but it is a personal decision for each of us. Personal resonsibility anyone??

 

Wow, remind me never to ever send a patient to you. Your lack of compassion is staggering. Society has created lepers of certain groups and I would say that same society has an obligation to help repair that effect. It's your choice to disagree, but again, I would not send patients to you, no matter who or what they were.

 

Speaking of want, you have a lot to learn about nicotine addiction, apparently, as nicotine is the most addictive chemical known to our species along with morphine, only surpassed by heroin. Do you speak to all smokers this way, or just the ones with different sexual orientation? You have a lot to learn about addiction issues, apparently. Further, your blatant disregard for ANYone with self-worth or self-esteem issues needs a serious second look, imo. What a sadly cruel post from someone I up until now had respected as a colleague. I definitely would not want you seeing a single Psych patient. Environmental factors can have a profound impact on development of depression.

 

Orientation.

Is.

Not.

A.

Choice.

http://www.sciencedaily.com/releases/2008/06/080617151845.htm

 

But guess what, how we treat people is.

Edited by Hemegroup

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