Guest ral Posted January 28, 2019 Share Posted January 28, 2019 With the most recent update, we now have a “Gender Identity” tab, so that we can address the patient by their preferred sexual orientation. Link to comment Share on other sites More sharing options...
PAceMe Posted January 28, 2019 Share Posted January 28, 2019 Gender identity is not the same as sexual orientation. Please educate yourself. Link to comment Share on other sites More sharing options...
sas5814 Posted January 28, 2019 Share Posted January 28, 2019 Easy there snappy. One of the reasons these discussions can get difficult is because someone like you is wandering around with a giant chip on their shoulder waiting for a chance to be offended. How about you take some time to educate and share in a constructive way instead of provoking a fight. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 28, 2019 Share Posted January 28, 2019 I avoid this by just saying who “I” am....since it’s all about me anyway. Link to comment Share on other sites More sharing options...
sas5814 Posted January 28, 2019 Share Posted January 28, 2019 I'm from Texas. How y'all? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 29, 2019 Administrator Share Posted January 29, 2019 It is important to distinguish between biological sex--because that determines risk factors and how you counsel the patient--and gender identity. Just changing the patient's sex in an EMR because they're now presenting differently is not OK because of the negative impact to the patient's health and well being. And while I do agree with @sas5814 about approaching other posters positively, gender identity and sexual orientation are certainly not the same thing and anyone providing care needs to know that. I'm assuming Ral misspoke (mistyped?). Link to comment Share on other sites More sharing options...
Guest ral Posted January 29, 2019 Share Posted January 29, 2019 Yes Rev, I seemingly misspoke/mis-typed. Sorry to PAceME if I used the wrong terminology. My old brain is still trying to grasp all this new lingo. I also listen to too many Jordan Peterson talks but, I won't apologize for agreeing with the majority of his opinions. I went on a search to educate myself, as you suggested. I am now even more confused. Here is a quote from one of the first sites I landed on while looking for information on the difference between gender identity and orientation: " dating apps like Tinder amended their profile options to be more inclusive of the transgender and gender non-conforming community. Rather than just male or female, gay or straight, there are now 37 descriptions to choose from on the app, as well as the option to write in your gender identity. This feature not only recognizes and accepts trans users, but also gives them the choice of how to disclose their gender to a potential parter." Baby steps. Link to comment Share on other sites More sharing options...
charlottew Posted January 29, 2019 Share Posted January 29, 2019 Like Rev, I respect the difference between biological sex and gender identity. When they rolled out this feature in our Epic however, it defaulted so that any patient who had answered the 'gender identity' question, when you opened their chart there was a big banner that you had to click past, informing you that the patient had a stated gender identity, and that all of us need to be aware of that fact. Despite the fact that >95% of those asked, have a gender identity congruent with their biological sex. So in effect, opening anyone's chart took 10 seconds longer. Anyway, they fixed that feature promptly. As I said, I try to respect gender identity whenever I can. I had a trauma patient, young biological male who identified as female. Before the patient came to the unit, the nurse and I had a discussion about this, that we would call the pt by their female name and use female pronouns, etc etc etc. The patient arrives, then the pt's mother comes to the bedside, and starts referring to the patient with a male name and male pronouns. It hurt my head trying to negotiate this - I retreated to gender-neutral ('they', 'them') because the patient was semi-conscious and I didn't want to offend anyone! Link to comment Share on other sites More sharing options...
Boatswain2PA Posted January 29, 2019 Share Posted January 29, 2019 I don't care what somebody's gender identity is, just like I don't care about what their favorite flavor of ice cream is. I certainly don't have time to go through all 37 damn flavors trying to figgure it out. Worse yet, with 37 flavors, one might have a different favorite flavor every week, or even a different favorite flavor every DAY! So please excuse me if you identify as a man who thinks they are a woman who wants to be a man who used to be a woman (is that one of the 37 flavors?? - legit question!), and I mistakenly refer to you as one of the more bland flavors like chocolate, or vanilla. I'm not doing this to be rude, it's just that I'm trying to save my remaining cognitive resources for things that I might be able to influence, like whether or not you're going to DIE! This could be another factor in why this survey says HALF of physicians want to leave medicine.https://www.studyfinds.org/survey-half-doctors-consider-leaving-medicine-insurance-company-headaches/ Link to comment Share on other sites More sharing options...
lemurcatta Posted January 29, 2019 Share Posted January 29, 2019 3 hours ago, ral said: Yes Rev, I seemingly misspoke/mis-typed. Sorry to PAceME if I used the wrong terminology. My old brain is still trying to grasp all this new lingo. I also listen to too many Jordan Peterson talks but, I won't apologize for agreeing with the majority of his opinions. I went on a search to educate myself, as you suggested. I am now even more confused. Here is a quote from one of the first sites I landed on while looking for information on the difference between gender identity and orientation: " dating apps like Tinder amended their profile options to be more inclusive of the transgender and gender non-conforming community. Rather than just male or female, gay or straight, there are now 37 descriptions to choose from on the app, as well as the option to write in your gender identity. This feature not only recognizes and accepts trans users, but also gives them the choice of how to disclose their gender to a potential parter." Baby steps. I hope you don't agree with his new diet... lol Anyways, I actually think it is pretty simple. A lot of people get hung up over things like the 37 genders of Tindr or whatever. But as part of intake on a new patient or admission its pretty simple for someone along the line (receptionist or admissions person even) to just ask the patient either on a form or verbally which pronouns they prefer. And we should respect that. Very few people will go by anything other than his/him/he or she/her/hers - and when they do its usually just "they". The more outlandish ones you hear about like "zer;" how many of those have you even met? It's not really a problem anyone should be getting upset about or spending inordinate amounts of time thinking about like Jordan Peterson. Gender identity- how you feel you identify as far as man, woman, or something else. People commonly use the term "cis gender" to refer to those people whose biological sex matches their gender identity (the overwhelming majority of everyone). "Trans gender" means you identify with something other than your biological sex. Sexual orientation- gay/lesbian, straight, bisexual, asexual. Its about your attraction. Link to comment Share on other sites More sharing options...
Guest thatgirlonabike Posted January 29, 2019 Share Posted January 29, 2019 12 hours ago, Boatswain2PA said: I don't care what somebody's gender identity is, just like I don't care about what their favorite flavor of ice cream is. I certainly don't have time to go through all 37 damn flavors trying to figgure it out. Worse yet, with 37 flavors, one might have a different favorite flavor every week, or even a different favorite flavor every DAY! As a provider, you should care because gender identity and sexual orientation can have a big effect on mental health which is just as important as what their BP is........ Link to comment Share on other sites More sharing options...
Boatswain2PA Posted January 29, 2019 Share Posted January 29, 2019 I dont fix mental health problems in the ED. Its arguable if anyone fixes them anywhere, but I certainly dont in the ED. I dont care if someone self-identifies as a squirrel. If they wanna be a squirrel, they can be a squirrel. Link to comment Share on other sites More sharing options...
Guest ral Posted January 29, 2019 Share Posted January 29, 2019 3 minutes ago, Boatswain2PA said: I dont care if someone self-identifies as a squirrel. If they wanna be a squirrel, they can be a squirrel. Waiting for the punchline about nuts. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted January 29, 2019 Share Posted January 29, 2019 1 minute ago, ral said: Waiting for the punchline about nuts. Didnt even think about that! Lol Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted January 29, 2019 Share Posted January 29, 2019 Patients with mental health issues and also ones with sexually transmitted diseases have been a significant part of the patient population I've treated over my time in EM. So, this is relevant. Gender: biologically, patient identified, attraction, and sexual practices all matter when assessing the patient. Stress from being a minority group that's often not very well accepted, status of hormone and/or surgical treatment, how to test for STDs, all are things that have made a difference in treatment. It's not just admit vs discharge decisions for mental health patients, it includes other things like what would be an appropriate mental health facility if admission is indicated, what areas to swab or examine for STD's, or PE risk factors. If smoking and OCPs or hormone replacement are risk factors for PE that extends to a smoker who's taking hormones for gender change who's dyspneic, tachycardic, etc. Link to comment Share on other sites More sharing options...
sas5814 Posted January 29, 2019 Share Posted January 29, 2019 I haven't been in the ER for a while but everything happens in the ER and when it lands there its the provider's responsibility. Gender identity may or may not be relevant to the presenting complaint. My wife is a RN at an inpatient psych facility and lots and lots of admits come from the ER. Link to comment Share on other sites More sharing options...
PAceMe Posted January 29, 2019 Share Posted January 29, 2019 This figure can sometimes help people understand differences between gender identity, biological sex, and sexual orientation Link to comment Share on other sites More sharing options...
sas5814 Posted January 29, 2019 Share Posted January 29, 2019 I miss the days where everyone was either an innie or an outie..... Link to comment Share on other sites More sharing options...
CAdamsPAC Posted January 29, 2019 Share Posted January 29, 2019 4 hours ago, thatgirlonabike said: As a provider, you should care because gender identity and sexual orientation can have a big effect on mental health which is just as important as what their BP is........ So you are saying this "gender identity" is a mental health issue? Link to comment Share on other sites More sharing options...
lemurcatta Posted January 29, 2019 Share Posted January 29, 2019 7 minutes ago, CAdamsPAC said: So you are saying this "gender identity" is a mental health issue? It’s probably the social isolation and descrimination people face from being LGBT (in many states and now military can lose job, face rejection from family, face hostility in public, etc) that leads to the higher prevalence of mental health issues in these populations. I feel like there are two far ends of a spectrum operating when we talk about gender and sex incinical medicine. Those who think it should be a central issue in providing care to patients, and those who don’t even want to think about it. My thoughts: normalize it as a very tiny part of getting to know your patients and ignore the noise. What you hear from people like Jordan’s Peterson just doesn’t match the lives experience of nearly everyone else on the planet who interacts with LGBTQ Link to comment Share on other sites More sharing options...
CAdamsPAC Posted January 29, 2019 Share Posted January 29, 2019 1 hour ago, lemurcatta said: It’s probably the social isolation and descrimination people face from being LGBT (in many states and now military can lose job, face rejection from family, face hostility in public, etc) that leads to the higher prevalence of mental health issues in these populations. I feel like there are two far ends of a spectrum operating when we talk about gender and sex incinical medicine. Those who think it should be a central issue in providing care to patients, and those who don’t even want to think about it. My thoughts: normalize it as a very tiny part of getting to know your patients and ignore the noise. What you hear from people like Jordan’s Peterson just doesn’t match the lives experience of nearly everyone else on the planet who interacts with LGBTQ How can "and now military can lose job"?I'm still trying to understand the process of how this issue has evolved from gender and sex being congruent into being diametrically opposed. Happily, I don't use ANY EMR in my infrequent workplace visits! Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted January 29, 2019 Share Posted January 29, 2019 @lemur - agree. It's a portion of who the patient is that has greater or lesser impact depending upon what they are being seen for. I recall in PA school hearing about different recommendations for certain classes of medications like anti-hypertensives based on ethnic background. This matters in the same way. @ boats - I agree with you. I don't fix any mental health issues in the ED. However, I am often the intial contact and router to the next steps. That's pretty much true for much of what I treat: never taken out an appy but sure have figured out whether RLQ pain went to gen surg or OB many times. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 29, 2019 Moderator Share Posted January 29, 2019 yup. if it is an ankle sprain and you are not their pcp it is a non-issue. if it is abd pain, you need to know what parts they have... Link to comment Share on other sites More sharing options...
lemurcatta Posted January 30, 2019 Share Posted January 30, 2019 2 hours ago, CAdamsPAC said: How can "and now military can lose job"?I'm still trying to understand the process of how this issue has evolved from gender and sex being congruent into being diametrically opposed. Happily, I don't use ANY EMR in my infrequent workplace visits! I was responding to your post re: mental illness and trans gender. All I meant is that trans people face challenges in their life that you and I likely don’t, which is almost certainly a factor in their high rates of mental illness. My reference to the military relates to the Trump admin’s executive order banning most people who ID as trans from serving in the armed forces (and if they already are, they will be barred from re-enlisting). So they will lose their jobs. Also, most states in the US do not offer protections from being fired from any job for being gay or trans. Link to comment Share on other sites More sharing options...
Guest thatgirlonabike Posted January 30, 2019 Share Posted January 30, 2019 2 hours ago, CAdamsPAC said: So you are saying this "gender identity" is a mental health issue? No. I'm saying people with attitudes like Boatswain can drive people to suffer from mental illness. Not to mention in our political climate these days many LGBTQ people are being pushed to the fringe of society and told they are not welcome into our straight, cisgender world. Link to comment Share on other sites More sharing options...
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