Last edited:
Does your school devote adequate time to sexual health and LGBT health?
- Thread starter PhysioMD
- Start date
- Status
- Joined
- Apr 4, 2009
- Messages
- 17,237
- Reaction score
- 13,023
So I'm going to write for a different strength of acyclovir based on whether they're gay or not?
- Joined
- Apr 4, 2009
- Messages
- 17,237
- Reaction score
- 13,023
I know this is going to shock you, but anal sex can be practiced by the heterosexual community as well. This is not what I was referring to.
- Joined
- Apr 4, 2009
- Messages
- 17,237
- Reaction score
- 13,023
Yeah, bc substance abuse NEVER happens in the heterosexual population.
and health disparities don't exist with the heterosexual population
and heterosexuals don't smoke cigarettes either
and heterosexuals don't age
- Joined
- Apr 4, 2009
- Messages
- 17,237
- Reaction score
- 13,023
I have absolutely nothing against LGBTs at all whatsoever. I do have a problem with wet behind the ears medical students who think they know better than everyone else and think that medical school curriculums should be changed to accommodate their pet causes - insert group here ___________.
The curriculum is already hard enough as it is without every single person having to insert their own special medicine for their specific group.
Medicine is a life-long learning profession where not every diddly thing you think should be taught is present in the medical school curriculum. That's why we have journals.
- Joined
- Jan 2, 2014
- Messages
- 11,384
- Reaction score
- 24,014
Are you even a medical student? Being black or German definitely can definitely change how meds are prescribed or how a surgery is run. Some people are faster hepatic metabolizers than others, etc. Some diseases are more prevalent in some populations than others. The gender you prefer doesn't matter.
- Joined
- Dec 21, 2007
- Messages
- 2,077
- Reaction score
- 2,929
You treat the STI the same way regardless, can you educate us on LGBT-specific medical issues?
Why just the LGBT community? We don't learn enough about traditional hispanic healing practices....chinese herbs....the list goes on.
Again, what is the LGBT specific medical issue you are referring to? I really have not seen anything in clinic and am curious. The transgendered breast cancer patient has merit but is a pretty niche case.
- Joined
- Jun 22, 2009
- Messages
- 2,374
- Reaction score
- 61
For reference:
Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education.
http://www.ncbi.nlm.nih.gov/pubmed/21900137
Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education.
http://www.ncbi.nlm.nih.gov/pubmed/21900137
As a member of the LGBT community, I would like chime in on this topic. Honestly, I fail to see how this could possibly be something that needs to be covered in medical school. All STD's (which I assume is what you are referring to) contracted by those of the LGBT community can be contracted by heterosexuals in the same manner. There is no need to separate the two since they exhibit no anatomical differences. When treating a patient for AIDS, how could learning about their sexuality make any difference? Although I can see a medical school including some information about transexuals. If you want to learn about the LGBT culture and the health issues its members present then that's awesome, just do it on your own time. Honestly, this whole thing seems like such a non-issue.
- Joined
- Apr 4, 2009
- Messages
- 17,237
- Reaction score
- 13,023
Thank you. Here's a great way to learn how to treat LGBT patients: Treat them with respect like all other human beings.
- Joined
- Jul 5, 2011
- Messages
- 124
- Reaction score
- 46
The primary problem with gender and sexual minority community health is, frankly, discrimination within the medical community. *All* physicians treat gender and sexual minorities. They just don't know it. GSM patients frequently stay closeted with their physicians because their physicians mock them or refuse them care. This is really, at its core, about respect.
Case in point: Transgender people.
No, it's not just trans people - they're just the people who end up getting the harshest end of the stick. Here are more stats that are also GLB inclusive: http://www.nwlc.org/resource/health...at-lgbt-people-and-individuals-living-hivaids
And for transgender people, they face the additional hurdle of needing the assistance of a medical professional in order to transition. For many, it's "transition or die". No, I'm not exaggerating. Do you know how to administer cross-sex hormones? If not, do you know where to look to find out? Do you know the basics about genital surgeries, and who to refer your patients to? Did your school touch on any of this?
I've been a volunteer at a transgender health clinic for about a year and a half at this point. I've picked up the phone before to have someone who was a four hour drive away on the other end ....they called because we were the closest health center that would treat them. Seriously. This isn't about name politics. This is about real people who can't get medical care or who are refused medical care because of who they are. The HHS has officially declared LGBT communities a medically underserved group.
Like the breast cancer example... here's a more common scenario:
You have a transgender male patient (assigned female at birth, identifies as male) who also happens to have asthma. He's been on testosterone for a year at this point and is transitioning well, and presents as male in all environments including work. Unfortunately he's also well-endowed in the breast department. To ensure his safety and his ability to pass, he wears a "binder", which restricts his breathing to the point that he now has frequent asthma attacks. He cannot go without the binder or risk being "outed". If he gets outed, he will likely lose his job and risks being assaulted (yes, this happens). He also does not have the money to pay out-of-pocket for chest reconstruction. What do you do?
Or here's another...
(US-specific) You have a transgender female patient (assigned male at birth, identifies as female) who you started on "standard" hormone therapy 6 months ago (spironolactone + estradiol). She has a long history of depression and multiple suicide attempts, one just prior to starting hormone therapy. With the initiation of hormone therapy, her depression has almost entirely gone away. She's enormously happy, and has been able to discontinue her antidepressants, and has had no suicidal ideation. On a routine blood screen you spot an elevated potassium level. It does not appear to be associated with her food intake. What do you do? Do you take her off the spironolactone? There is no effective replacement in the US. Without spiro, estradiol needs to be at a much higher dose, one that's associated with additional risks (DVT primarily). If you take her off the spironolactone, she may very well go back into suicidal depression.
As for medical issues specific to GSMs... No, there is very little that is truly unique. We're human too. We have MIs and cancers and depression and diabetes and all that crap. But there are some things that are at a different frequency in GSM populations...
The core here really is: Don't be a jerk. Respect people for who they are and what they do, be willing to learn.
Case in point: Transgender people.
- 19% have been flat out refused medical care because they were trans.
- Roughly half of all trans people have to teach their own doctor how to care for them - this kind of ignorance has lead to a LOT of trans people doing DIY hormones. I'm sure you all can see exactly what's wrong with DIY hormones...
- 52% of trans people who recently went to the emergency department (in Ontario) were refused care, or had a physician refuse to touch them, or a similar discriminatory event. 21% of trans people in this study reported avoiding the ED because of fear of an event like these.
- 41% of transgender people attempt suicide within their lifetime. Among trans people who have been refused medical care, that increases to 60%.
- There are a number of cases like that of Tyra Hunter, who was a trans woman who was in a car accident. Once the EMTs found out she was trans (she was pre-vaginoplasty), they gave inadequate treatment. So did the ED physicians. She died as a result. Citation: http://en.wikipedia.org/wiki/Tyra_Hunter
No, it's not just trans people - they're just the people who end up getting the harshest end of the stick. Here are more stats that are also GLB inclusive: http://www.nwlc.org/resource/health...at-lgbt-people-and-individuals-living-hivaids
And for transgender people, they face the additional hurdle of needing the assistance of a medical professional in order to transition. For many, it's "transition or die". No, I'm not exaggerating. Do you know how to administer cross-sex hormones? If not, do you know where to look to find out? Do you know the basics about genital surgeries, and who to refer your patients to? Did your school touch on any of this?
I've been a volunteer at a transgender health clinic for about a year and a half at this point. I've picked up the phone before to have someone who was a four hour drive away on the other end ....they called because we were the closest health center that would treat them. Seriously. This isn't about name politics. This is about real people who can't get medical care or who are refused medical care because of who they are. The HHS has officially declared LGBT communities a medically underserved group.
Like the breast cancer example... here's a more common scenario:
You have a transgender male patient (assigned female at birth, identifies as male) who also happens to have asthma. He's been on testosterone for a year at this point and is transitioning well, and presents as male in all environments including work. Unfortunately he's also well-endowed in the breast department. To ensure his safety and his ability to pass, he wears a "binder", which restricts his breathing to the point that he now has frequent asthma attacks. He cannot go without the binder or risk being "outed". If he gets outed, he will likely lose his job and risks being assaulted (yes, this happens). He also does not have the money to pay out-of-pocket for chest reconstruction. What do you do?
Or here's another...
(US-specific) You have a transgender female patient (assigned male at birth, identifies as female) who you started on "standard" hormone therapy 6 months ago (spironolactone + estradiol). She has a long history of depression and multiple suicide attempts, one just prior to starting hormone therapy. With the initiation of hormone therapy, her depression has almost entirely gone away. She's enormously happy, and has been able to discontinue her antidepressants, and has had no suicidal ideation. On a routine blood screen you spot an elevated potassium level. It does not appear to be associated with her food intake. What do you do? Do you take her off the spironolactone? There is no effective replacement in the US. Without spiro, estradiol needs to be at a much higher dose, one that's associated with additional risks (DVT primarily). If you take her off the spironolactone, she may very well go back into suicidal depression.
As for medical issues specific to GSMs... No, there is very little that is truly unique. We're human too. We have MIs and cancers and depression and diabetes and all that crap. But there are some things that are at a different frequency in GSM populations...
- HIV/AIDS: more frequent in MSM and trans women (who frequently have to resort to sex work, btw), rare in women who only have sex with women. There's been a rise in HIV in MSM recently.
- Cancers: gay men are at elevated risk for anal cancer -- as I recall this is correlated with HPV status (HPV vaccination is now recommended for MSM). Lesbians may be at elevated risk for reproductive cancers because of poor screening and correlated factors (because of the minority status). Breast, "female" reproductive, and prostate cancer risk for trans people is still a big unknown, but trans women are at risk for prolactinomas when they start hormone therapy.
- Substance use, depression, anxiety: Very, VERY elevated in GSM communities. High rates of suicide, also non-suicidal self injury. There's also a long history of both alcohol and tobacco industries targeting LGB(T) communities, and a long history of bars being the only "safe" place for us.
- Obesity: also higher in GSM populations
- Silicone injections: Some trans women, because they have had no other option, have silicone injected into their hips, breasts, etc. HUGELY dangerous
The core here really is: Don't be a jerk. Respect people for who they are and what they do, be willing to learn.
- Joined
- Oct 10, 2011
- Messages
- 8,619
- Reaction score
- 10,675
In regards to the above block of text - denying service to LGBT people (or ANY people) is bad and not condonable. Regarding the two scenarios you posted, you have a chat with the patient, discuss their options, and let them make their own decision.
1 - You talk about why the patient is getting recurrent asthma attacks. If the binder is absolutely necessary per patient's beliefs, then you control his asthma the best you can using standard protocols.
2 - Discuss the elevated potassium level with the patient. How elevated is it? 5.1 or 7+? What about giving intermittent kayexalate? Educate them on the risks of a high potassium level compared to risks of d/cing it to increase estradiol dosages. Give the patient all the relevant information and let them make an educated decision (like every other patient in the entire world).
Regarding the rest of the thread -
While we learn to not assume that a person is straight during a sexual history questioning (the question we are supposed to ask is "Are you sexually active? With men, women, or both?), that's pretty much it.
I have no problem with LGBT people living their lives however they want. However, when they are sick, I will treat them the same as a non-LGBT person.
Gay man comes in with STDs? Advise him to wrap his junk up (along with treatment obviously). That's the same advice I'd give to a straight man.
M-to-F transgender comes in with breast cancer due to HRT? Treat them for the breast cancer. Educate them on the risks of re-developing breast cancer after resuming HRT, and ask them if they would want to risk getting breast cancer again to become a hormonal woman. Document very carefully so that if they re-develop breast cancer, they can't sue you for it.
I'm not sure what these LGBT-specific health issues are. Sure there may be some surprising decisions due to the patient's beliefs, but we see things like that in the medical field already (Jehovah's Witnesses dying because they don't want blood transfusions), so it's not a special concern. If a patient doesn't want to do what his/her physician recommends, then the physician and patient need to have a chat about why that is. I don't see this as a bigger issue in the LGBT community than in the non-LGBT community.
1 - You talk about why the patient is getting recurrent asthma attacks. If the binder is absolutely necessary per patient's beliefs, then you control his asthma the best you can using standard protocols.
2 - Discuss the elevated potassium level with the patient. How elevated is it? 5.1 or 7+? What about giving intermittent kayexalate? Educate them on the risks of a high potassium level compared to risks of d/cing it to increase estradiol dosages. Give the patient all the relevant information and let them make an educated decision (like every other patient in the entire world).
Regarding the rest of the thread -
While we learn to not assume that a person is straight during a sexual history questioning (the question we are supposed to ask is "Are you sexually active? With men, women, or both?), that's pretty much it.
I have no problem with LGBT people living their lives however they want. However, when they are sick, I will treat them the same as a non-LGBT person.
Gay man comes in with STDs? Advise him to wrap his junk up (along with treatment obviously). That's the same advice I'd give to a straight man.
M-to-F transgender comes in with breast cancer due to HRT? Treat them for the breast cancer. Educate them on the risks of re-developing breast cancer after resuming HRT, and ask them if they would want to risk getting breast cancer again to become a hormonal woman. Document very carefully so that if they re-develop breast cancer, they can't sue you for it.
I'm not sure what these LGBT-specific health issues are. Sure there may be some surprising decisions due to the patient's beliefs, but we see things like that in the medical field already (Jehovah's Witnesses dying because they don't want blood transfusions), so it's not a special concern. If a patient doesn't want to do what his/her physician recommends, then the physician and patient need to have a chat about why that is. I don't see this as a bigger issue in the LGBT community than in the non-LGBT community.
Last edited:
- Joined
- Jul 28, 2004
- Messages
- 27,965
- Reaction score
- 56,403
Well thought about post, but the last line is the part that really matters. You can't teach that in a class, either people will or will not treat others respectfully.
- Joined
- Mar 6, 2014
- Messages
- 1,019
- Reaction score
- 599
So you have an obese patient. Obesity is a huge risk factor for about a bajillion diseases so of course you tell your patient "we need to work on changing your lifestyle so you can lose some weight because right now you're at a very high risk for x, y, and z".
Now you have a LGBT male patient. Since male-to-male sex results in increased risk for STIs (according to you.. I have no idea if this is actually true) you tell your LGBT male patient "we need to work on changing your lifestyle so you can lose some homosexual tendencies because right now you're at a very high risk for STIs".
Both are legitimate healthcare decisions, according to you, but only one results in accusations of bigotry and only one results in an uprising of the local obese/LGBT community. Guess which one?
As a physician I am not going to tip-toe around sensitive subjects. If I have a patient who I know will not comply or will be excessively offended by my medical suggestions I will simply fire them as a patient.
- Joined
- Oct 10, 2011
- Messages
- 8,619
- Reaction score
- 10,675
Wait, what? Why not just tell the patient to wear a condom (or tell his partner to wear a condom)? That would be like telling a heterosexual man to stop having sex to prevent STDs...
- Joined
- Mar 6, 2014
- Messages
- 1,019
- Reaction score
- 599
No, because touchpause13 made it clear that LGBT men have an increased risk. Unless you're going to show me a study that says heterosexual men use condoms more often than LGBT men, then clearly condoms are not the main reason for the discrepancy between LGBT men and hetero men.
The point is that the LGBT community don't have diseases specific to them. My previous post was merely to point out how ludicrous it is to believe LGBTs are special (medically).
- Joined
- Jul 28, 2004
- Messages
- 27,965
- Reaction score
- 56,403
Actually, the T part of that IS special medically, but that's not the important point here.
Maybe I read this wrong, but it looks to me that you're equating being fat with being gay. Except in very rare cases (Cushing's disease, for example), being obese is a choice you make. Last I checked, being gay isn't.
- Joined
- Jul 28, 2004
- Messages
- 27,965
- Reaction score
- 56,403
Hahahaha.... yeah, you go fire all your noncompliant patients. Let us know how well that practice model works out for you.
- Joined
- Jun 25, 2012
- Messages
- 14,115
- Reaction score
- 13,739
Actually right now there is a pretty big syphilis outbreak amoung HIV+ men who have sex with men. If they are only have sex with other positive guys, or are taking Truvada, they think oh, hey, I can bareback, no big deal. That kind of creates a perfect storm for other STIs to spread.
Source: http://gawker.com/what-is-safe-sex-the-raw-and-uncomfortable-truth-about-1535583252
My point is, men who have sex with men may not be wearing condoms for a variety of complex reasons and ignoring their unique issues isn't doing them any favors
Source: http://gawker.com/what-is-safe-sex-the-raw-and-uncomfortable-truth-about-1535583252
My point is, men who have sex with men may not be wearing condoms for a variety of complex reasons and ignoring their unique issues isn't doing them any favors
- Joined
- Mar 6, 2014
- Messages
- 1,019
- Reaction score
- 599
Pretty sure having sex with a man (or a woman) is a choice you make. Having urges to murder someone isn't a choice, but murdering someone is.
The whole "being gay isn't a choice" argument is moot.
- Joined
- Jun 25, 2012
- Messages
- 14,115
- Reaction score
- 13,739
I'm sorry did you just compare being gay and wanting to murder someone?
You need to stop honey.
- Joined
- Jul 6, 2006
- Messages
- 7,471
- Reaction score
- 2,424
At my school, we had an optional lecture on how to create a safe space in our offices, but our whole sexual interviewing session emphasized not to alienate anyone by assuming male-female monogamous partnerships. A lot of people get weirded out when we ask 'men, women, or both', but most also understand that we aren't there to make assumptions about anyone's sexual orientation.
- Joined
- Jun 25, 2012
- Messages
- 14,115
- Reaction score
- 13,739
I've almost always been pegged as straight by doctors. And it immediately makes me have less confidence in the physician when it happens. It may seem silly to you guys, but having a doctor wrongly assume something about you sucks.
- Joined
- Oct 10, 2011
- Messages
- 8,619
- Reaction score
- 10,675
Okay, so these people are uneducated. I'm not saying the incidence of STD's in the gay community is less (or even equal to) than straight populations. Just tell the people that going bareback is a no-no and that should do it. It likely won't, but welcome to the world of non-compliant patients. I fail to see what the issue is here. All you can do is educate the patient that having intercourse without a condom (male or female) puts them at risk of STDs. If they don't want STDs (or don't want to spread them) then they can put a condom on.
- Joined
- Jun 22, 2009
- Messages
- 2,374
- Reaction score
- 61
I'm gonna chime in here as someone who actually does research on sexual orientation and gender topics in undergraduate medical education. I also do large, population-based, epidemiological research on investigating health disparities on specific health outcomes as they differ by sexual orientation and gender identity. Some key points:
800,000 Americans identify as transgender (0.3%)
9 million identify as lesbian, gay or bisexual (3.5%)
18 million have participated in same-sex sexual behavior (8.2%)
Thus, there are almost twice as many individuals in the United States who participate in same-sex sexual behaviors (8.2%) as there are Asian-Americans (4.8%) in the United States. This is a huge part of our population. I could talk at length about how knowledge of sexual orientation and sexual practices is important in almost every specialty (non-primary care included)- this could change differential diagnosis, management decisions, risk-stratification, etc. If any of the dermie's on here are interested, I have a lot of unpublished data that demonstrates sexual orientation is actually extremely relevant to a disease you have a complete monopoly over treating
Finally, environments where patients feel welcome and able to disclose their sexual orientation lead to improved patient satisfaction and, potentially, improved outcomes from compliance, follow-up and buy-in to treatment.
Many institutions have addressed these issues in medical education in a variety of ways. Special, optional elective courses in LGBT health, optional certificate programs in LGBT health, integrated PBL cases that integrate sexual orientation and gender identity themes, patient simulation exercises that involve LGB or T patients, and integrating knowledge into the pre-clinical curriculum. I tend to prefer the last one as the bare minimum.
In my opinion, LGBT health is too extensive of a topic to be taught completely in the standard medical curriculum. There are so many other various competing interest groups (religion, race/ethnicity, age, etc.) and there isn't enough time in the standard curriculum to devote adequate time to any of these issues. Optional opportunities for extending learning should exist, especially to empower interested medical students that want to address these issues. However, I think it's silly that all medical students show be expected, let's say, to take a week-long seminar course on LGBT health.
However, there is a minimum knowledge base and cultural competency that should be expected of all medical school graduates as pertaining to theses issues. Again, we're talking about a chunk of the population that includes about 8% of people walking into a doctors office. Many undergraduate medical institutions still fail in this regard.
In terms of knowledge base, this merely means that LGBT-content needs to be better integrated into existing lecture structures. In other words, in the same way that a lecture on sickle cell anemia will talk about disease epidemiology (i.e. African Americans), a lecture on breast cancer or cervical cancer should discuss the increased risk among lesbian woman. A lecture on HPV might also mention increased risk of anal SCC in gay men. Mental health lectures on depression and suicide might concentrate on the increased risk of these diseases in sexual orientation minorities, particularly gay youth, even more particularly among gay homeless youth. The fact is, most medical schools haven't taken the time to make sure any of these very relevant and simple knowledge points are integrated into the curriculum. Medical schools also need to make sure that clinical instructors are knowledgeable about these issues when teaching. I once was told from a medical student that a lecturer from another school referred to transgender patients as "it". This sort of behavior is unacceptable.
In terms of cultural competency, medical students should not be expected to be "experts" on how to speak and interact with LGBT patients. A lot of that happens in the "hidden curriculum" of working on the wards and in the outpatient setting and actually caring for LGBT patients. However, medical students need to be at least actively aware of the discrimination and disparities that LGBT people face when accessing care. Most medical schools implement some sort of patient-actor based simulation training. I'm sure that most of you do more than 10 of these throughout your entire medical school curriculum. Given how common these individuals are represented in our population, this is an easy opportunity to add an LGB or T patient and provide an opportunity for students to practice speaking with these individuals and/or revealing to them to their own knowledge or cultural competency gaps that can be addressed in their own time.
There are many topics in undergraduate medical education that need to be improved, and not enough time in the curriculum to improve them. However, LGBT topics are unique in that many institutions have failed to meet even any bare minimum standard of training medical students to address these issues. I prefer the approach of integrating LGBT content into existing lecture structures and/or existing competency trainings like simulated patient encounters and/or PBL learning. This does not eat up significant time in the curriculum and, at the bare minimum, helps expose medical students to issues they will encounter while in practice.
800,000 Americans identify as transgender (0.3%)
9 million identify as lesbian, gay or bisexual (3.5%)
18 million have participated in same-sex sexual behavior (8.2%)
Thus, there are almost twice as many individuals in the United States who participate in same-sex sexual behaviors (8.2%) as there are Asian-Americans (4.8%) in the United States. This is a huge part of our population. I could talk at length about how knowledge of sexual orientation and sexual practices is important in almost every specialty (non-primary care included)- this could change differential diagnosis, management decisions, risk-stratification, etc. If any of the dermie's on here are interested, I have a lot of unpublished data that demonstrates sexual orientation is actually extremely relevant to a disease you have a complete monopoly over treating
Finally, environments where patients feel welcome and able to disclose their sexual orientation lead to improved patient satisfaction and, potentially, improved outcomes from compliance, follow-up and buy-in to treatment. Many institutions have addressed these issues in medical education in a variety of ways. Special, optional elective courses in LGBT health, optional certificate programs in LGBT health, integrated PBL cases that integrate sexual orientation and gender identity themes, patient simulation exercises that involve LGB or T patients, and integrating knowledge into the pre-clinical curriculum. I tend to prefer the last one as the bare minimum.
In my opinion, LGBT health is too extensive of a topic to be taught completely in the standard medical curriculum. There are so many other various competing interest groups (religion, race/ethnicity, age, etc.) and there isn't enough time in the standard curriculum to devote adequate time to any of these issues. Optional opportunities for extending learning should exist, especially to empower interested medical students that want to address these issues. However, I think it's silly that all medical students show be expected, let's say, to take a week-long seminar course on LGBT health.
However, there is a minimum knowledge base and cultural competency that should be expected of all medical school graduates as pertaining to theses issues. Again, we're talking about a chunk of the population that includes about 8% of people walking into a doctors office. Many undergraduate medical institutions still fail in this regard.
In terms of knowledge base, this merely means that LGBT-content needs to be better integrated into existing lecture structures. In other words, in the same way that a lecture on sickle cell anemia will talk about disease epidemiology (i.e. African Americans), a lecture on breast cancer or cervical cancer should discuss the increased risk among lesbian woman. A lecture on HPV might also mention increased risk of anal SCC in gay men. Mental health lectures on depression and suicide might concentrate on the increased risk of these diseases in sexual orientation minorities, particularly gay youth, even more particularly among gay homeless youth. The fact is, most medical schools haven't taken the time to make sure any of these very relevant and simple knowledge points are integrated into the curriculum. Medical schools also need to make sure that clinical instructors are knowledgeable about these issues when teaching. I once was told from a medical student that a lecturer from another school referred to transgender patients as "it". This sort of behavior is unacceptable.
In terms of cultural competency, medical students should not be expected to be "experts" on how to speak and interact with LGBT patients. A lot of that happens in the "hidden curriculum" of working on the wards and in the outpatient setting and actually caring for LGBT patients. However, medical students need to be at least actively aware of the discrimination and disparities that LGBT people face when accessing care. Most medical schools implement some sort of patient-actor based simulation training. I'm sure that most of you do more than 10 of these throughout your entire medical school curriculum. Given how common these individuals are represented in our population, this is an easy opportunity to add an LGB or T patient and provide an opportunity for students to practice speaking with these individuals and/or revealing to them to their own knowledge or cultural competency gaps that can be addressed in their own time.
There are many topics in undergraduate medical education that need to be improved, and not enough time in the curriculum to improve them. However, LGBT topics are unique in that many institutions have failed to meet even any bare minimum standard of training medical students to address these issues. I prefer the approach of integrating LGBT content into existing lecture structures and/or existing competency trainings like simulated patient encounters and/or PBL learning. This does not eat up significant time in the curriculum and, at the bare minimum, helps expose medical students to issues they will encounter while in practice.
- Joined
- Jun 22, 2009
- Messages
- 2,374
- Reaction score
- 61
Just an FYI. They've done follow-up studies of gay men on Truvada and found that it actually does not increase unsafe sex practices.
http://www.ncbi.nlm.nih.gov/pubmed/24367497
- Joined
- Jun 25, 2012
- Messages
- 14,115
- Reaction score
- 13,739
Thanks for that! I have been trying to increase my knowledge on HIV health in the community and I will check that out.
- Joined
- Jul 5, 2011
- Messages
- 124
- Reaction score
- 46
Thank you!! Honestly that's all we want. Or at least, that's all I want. Suppose I can't speak for all communities.
GSM folk aren't asking for special stuff. They're/We're asking to be acknowledged and treated as humans.Be aware we exist, be aware about basic issues and disparities that affect us, ask screening questions in an inclusive way, be respectful, talk with us as individuals, and be open to feedback and you've just gone a million miles toward eliminating those disparities.
I certainly can't force you to do otherwise, but if I may make a suggestion: Don't just "fire" them. Be aware of who in your local medical community is willing to handle these cases and refer your "fired" patients to them. They still need medical care, even if you're not willing to do it yourself.
Ugh. So sorry.
Personally I've always hated the "Are you sexually active?"question because I then have to ask what they mean by "sexually active". That phrase is so incredibly vague.
But also be careful about assumptions that you can make based on orientation. There's orientation and then there's behavior. There are plenty of men out there who identify as straight but are having sex with men. But just boiling it down to behavior ignores the psychosocial aspects of identity/orientation which do influence mental health and thus disease states. It's complicated, and most of it, it's true, isn't relevant to a 15 minute consultation.
- Joined
- Jul 28, 2004
- Messages
- 27,965
- Reaction score
- 56,403
Ignoring the acting on gay impulses = acting on murderous impulses...
You're right, actually having sex (any type of sex) is a choice. That said, you've got to do better than "Don't ever have sex again" for your treatment plan if you don't want to suck as a doctor.
- Joined
- Sep 13, 2012
- Messages
- 189
- Reaction score
- 19
In our second year, in our "medicine and society" unit, we had an online forum discussion on the topic of LGBT and medicine. It wasn't mandatory, it was optional and worth some extra credit. It wasn't anonymous so it was a mature, positive discussion (unlike SDN lol).
- Joined
- Mar 13, 2014
- Messages
- 1,012
- Reaction score
- 813
Good write up mdeast
- Joined
- Apr 4, 2009
- Messages
- 17,237
- Reaction score
- 13,023
Keywords: OPTIONAL and extra-credit.
- Joined
- Apr 4, 2009
- Messages
- 17,237
- Reaction score
- 13,023
@PhysioMD
The point is medical school is not your political playground or your captive audience for your pet cause. Medical students are paying a darn LOT of money for the goal of getting to match into their specialty of choice ESPECIALLY if it is a competitive one by doing well in basic sciences, acing for Step 1, getting Honors in clinicals, expanding one's CV and going thru the match. Stop trying to make the above process harder by inserting your BS into it, as if somehow LGBT patients are some extra-terrestrial beings that you would treat differently than your heterosexual patients. Go to Pubmed YOURSELF and read about it in journals.
You want people to learn more about LGBT issues. Create an interest group, get speakers to come talk, do a journal club, etc. as an EXTRAcurricular activity.
The point is medical school is not your political playground or your captive audience for your pet cause. Medical students are paying a darn LOT of money for the goal of getting to match into their specialty of choice ESPECIALLY if it is a competitive one by doing well in basic sciences, acing for Step 1, getting Honors in clinicals, expanding one's CV and going thru the match. Stop trying to make the above process harder by inserting your BS into it, as if somehow LGBT patients are some extra-terrestrial beings that you would treat differently than your heterosexual patients. Go to Pubmed YOURSELF and read about it in journals.
You want people to learn more about LGBT issues. Create an interest group, get speakers to come talk, do a journal club, etc. as an EXTRAcurricular activity.
- Joined
- Apr 25, 2008
- Messages
- 8,793
- Reaction score
- 9,019
Yes it will. Being Black most certainly changes how I prescribe medications to people. Is it relevant 100% of the time? No. But it affects how I measure their renal function. It affects what medications are first line agents for their blood pressure. It changes my risk assessment for coronary artery disease.
On the other hand, a patient's sexuality is irrelevant to me 99.9% of the time. I ask it when someone has specific complaints related to their urogenital system, mostly so (if they have an STI) I can appropriately counsel them on safe practices. I also speak with patient's about stressors in their life when I have concerns regarding mood disorders or anxiety, and that involves discussing whatever their home situation is like. I have a number of patients who (for whatever reason) I know are homosexual, and I take no special care in how I treat the vast majority of their medical conditions. (Due to various factors such as stress, poverty, and discrimination, many of them very well might be at higher risk for htn or other possibly preventable disorders. But the advice they get is the exact same as anyone else with the same status of disease.)
My school did have a few specific lectures on sexuality, both during our m2 psych and (if I remember right) our m3 ob/gyn. Otherwise, it was mentioned when relevant (i.e. when we were covering what behaviors are higher risk for HIV for example). Our LGBT interest group also put on a few events over the years that explored things like factors to keep in mind when treating trans patients (such as what pronouns to use).
- Joined
- Feb 6, 2014
- Messages
- 686
- Reaction score
- 497
Your point is well taken. I also think it's fair to learn about other communities so we can understand them better and also be more accepting of them. Even though it may not change treatment.
We are doctors for all. Understanding groups of people, especially ones that are marginalized can make us better people and better doctors.
- Joined
- Dec 17, 2008
- Messages
- 4,303
- Reaction score
- 22,293
Don't get suckered in by the troll. It's hard enough to wade through this thread with even the legitimate posters being so polarized, much less if we all get sidetracked by hardcore trolling.
- Joined
- May 3, 2006
- Messages
- 4,698
- Reaction score
- 1,675
To be fair, hormonal treatment for trans individuals is not something a majority of physicians are educated about. I mean....if a trans person walked into my clinic, I wouldn't even know where to begin in regards to managing hormonal therapy for a transitioning individual...I don't even know who to call to do a phone consult on? D:
Last edited:
- Joined
- May 3, 2006
- Messages
- 4,698
- Reaction score
- 1,675
Prepare to fire 75% of the American population.
- Joined
- May 3, 2006
- Messages
- 4,698
- Reaction score
- 1,675
Well, yes, people can make a choice to have sex or not. However, being attracted to the same sex is NOT a choice, by a longshot. But, noone with a brain larger than a pea believes that.
I mean, I don't wake up one day and think "Hm....I don't feel like blowing guys, I'll go for some blond chick with plump Double D's tonight! Then next week, I'll choose guys again if the weather is still nice."
- Joined
- May 3, 2006
- Messages
- 4,698
- Reaction score
- 1,675
the LGBT peeps are a hidden minority, and especially as a society in general, the usual assumption is people are heterosexual until proven otherwise. Although it would ideally be great if people didn't jump to everyone being heterosexual, to most people, the quick assumption is if you're a guy, you will be wanting a wife, and if you're a girl, you would want a husband. And you wouldn't want both. And you are the gender you appear.
Change can happen, but it's gonna take a while...
- Joined
- Apr 21, 2013
- Messages
- 274
- Reaction score
- 320
Guys I want to take this opportunity to tell you all I am Gay. I haven't told my family yet but you all seem like very considerate people and will accept my ways, because its not a choice, its a right.
- Joined
- May 3, 2006
- Messages
- 4,698
- Reaction score
- 1,675
lol....the thing about the silly little people that assume sexual attraction is a choice, is when I ask them to choose to find attraction in a guy, they can't. Or when asked why do you like girls, the response is "Uh...because I just do, DUH!" which is the same thing I say when people ask why I like guys.
- Joined
- Jun 25, 2012
- Messages
- 14,115
- Reaction score
- 13,739
My favorite thing about the choice thing is why on earth would anyone chose to be gay? I've never gotten a good answer for that haha.
- Joined
- May 8, 2013
- Messages
- 1,693
- Reaction score
- 1,106
Yes.
- Status
Similar threads
