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LGBTQ+a health concepts: unique health needs of queer and gender-diverse patients
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Social and behavioral determinants of health |
Environmental, situational, and behavioral characteristics affect health care access and a wide range of health outcomes. With respect to this course and the care of queer patients, examples include substance use, minority stress, familial rejection, access to health care, sexual practices, and victimization. |
“[I will] be more mindful in incorporating social and behavioral determinants of LGBTQ health, and how it relates to negative health outcomes and sequelae.” “[I will] incorporate social determinants of health in LGBTQ+ teaching with all levels of learners.”
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Medicolegal issues |
Unique legal challenges and health disparities experienced by sexual and gender minority groups, whether individually or as couples. Examples include advance directives, surrogate decision maker designations, and visitor policies. |
“[I will] teach students to ask about trauma (both physical and mental) and to review chart and make sure there is advanced directives, teaching students about legal issues that may affect LBGQT+ populations, in particular.”
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Chosen families |
Chosen families consist of nonbiological individuals who have deep bonds of support and mutual love. As reflected in our Teaching LGBTQ+ Health cases, chosen families result from engagement in supportive communities or rejection by nuclear families. |
“Teaching about a person’s chosen family and prioritization of healthcare proxies that may not be legally recognized in certain states is an important thing to learn as a physician.” “[I will teach] clinical simulations where students can gain experience having discussions around advanced directives, priority lists, and chosen family.”
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Sexual health |
LGBTQ+ health is more than just HIV and AIDS. It includes a global discussion of sexual practices and behaviors that affect health, among other topics. An example from our course includes the use of the CDCb 5 P’s of sexual behavior history taking. |
“The 5 P’s of sexual health should be included in history taking from the beginning of medical school. A lot of times the sexual history is brushed over, but it is important to obtain this information from the onset.” “I will make a presentation about my students with the 5 Ps model and explain to them why we need to use this technique when speaking with all patients about their sexual health. I will then select a few patients and test my students with those patients.”
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Affirming care |
Clinical practices that respect sexual and gender minority groups. Examples include the use of nonjudgmental and inclusive interviewing techniques, correct vocabulary, inclusive clinical environments, and trauma-informed care. |
“[I will] Incorporate elements of safe space in office, such as Queer Patient Bill of Rights, educating front desk staff on gender affirming language, having signs that suggest LGBTQ plus welcome, and installing gender neutral bathrooms.” “When teaching the pelvic exam to students, it would be important to teach the effects of gender-affirming medical therapies (such as testosterone) on the exam and how to provide trauma-informed care.”
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Instructional techniques: the maturation of daily, routine teaching activities to include LGBTQ+ health
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Role modeling |
A teaching modality that is historically important in medicine and timeless and requires faculty competence. Key is the demonstration of “how to say” and “how to do” simultaneously to students, generally at the bedside. |
“The suggestion for role modeling is absolutely a good first step. These are conversations that students would typically approach with caution, so it would be important to show them how to have these conversations.” “Modeling how to take a sexual history can be very helpful for students and learners. This can be accomplished by discussing the ‘5 Ps’ methodology and practicing this method when obtaining sexual histories.”
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Student practice |
Students need distinct opportunities to practice what they learn in safe spaces, with feedback from trained faculty, and before clinical encounters. |
“I would follow the ‘see one, do one, teach one model,’ first modeling the use of the 5 P’s, then observing my student using them and provide feedback, and then once they feel comfortable, encourage them to teach the skill to others.” “During my school’s introduction to clinical medicine course, we practiced the 5 P’s of Sexual Health and were given the opportunity to practice our communication with transgender patients. I thought that this was a really great opportunity to learn about how to make patients feel comfortable when asking questions about sexual history.”
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