Session 9 Flashcards
(14 cards)
Give reasons why sexual issues may not be raised in medical consultations
[*] Uncomfortable with discussing such an intimate matter with the GP due to age/gender
[*] Patients may believe sexual issues are a specialised area, therefore do not believe GP is capable of treating them. They believe their sexual issues are not at all medically relevant, worried about doctors not perceiving their sexual issues as serious or ma y not know about appropriate services
[*] Patients may not to discuss due to lack of time or privacy in consultations.
[*] May not want to publicly admit they have “something wrong with them” – fear of being judged/discriminated.
[*] GPs may feel uncomfortable in initiating these types of discussions – if patient doesn’t bring it up, they assume there are no problems/
[*] GPs may be worried about overstepping professional boundaries.
Give examples of ways to facilitate discussion about sexual issues
[*] Let patients know you are comfortable talking about these issues in a non-judgemental way.
[*] SEE GROUPWORK SESSION9!!
Describe what is meant by Sexual Orientation
[*] Sexual Orientation
- Term used to describe what gender you are attracted. May be life-long from early age or vary over a lifetime.
- Sexual attraction includes feelings, behaviour and identity: these 3 may or may not coincide!
[*] Identity: Gay, Lesbian and Bisexual
- Polite terms to describe these self-identified groups in public life
- Terms of identity
- NB: some people prefer no labels or different labels. Always use terms people use to describe themselves.
[*] Behaviour
- Men who have Sex with Men (MSM)
- Women who have Sex with Women (WSW)
- Be careful not to confuse behaviour with identity
Facts and figures…
- 5-7% of the UK population are thought to be LGB (UK government estimate).
- But hard to measure: What do you ask? Who will answer? Not on UK census.
- Across the world approx. 2% of women and 4% of men live exclusively homosexual lives.
- There is no clear evidence for a ‘gay gene’ and no evidence that being gay is a neurosis (functional mental disorder)
How do you understand gender?
Gender binary model
- There are 2 separate categories: male and female
- Clearly distinguished by anatomy
- Men should look and act masculine, women should look and act feminine
Nature loves diversity
- There is a whole rainbow spectrum of diversity when it comes to gender in terms of anatomy, gender identity and gender expression
What is meant by Gender Identity and Gender Role/Expression
[*] Gender Identity: someone’s internal perception and experience of their gender
[*] Gender role or expression: the way the person lives in society and interacts with others
What is meant by Transgender and Transsexual?
[*] Transgender (also ‘Trans’):
- Umbrella term for those whose gender identity and/or gender expression differs from their birth sex
- This may include transsexuals, transvestites, cross-dressers, genderqueer
[*] Transsexual person
- Someone who feels a consistent and overwhelming desire to transition and fulfil their life as a member of the opposite sex.
- Some transsexual people undergo gender reassignment under medical supervision.
[*] Not all Trans people are Transsexual!
Many people do not conform to gender norms and do not wish to surgically alter their bodies to fit either gender category
Does the LGB and Trans population suffer poorer health?
- 35% suffer anxiety
- 52% suffer depression
- 50% are smokers
- This is about discrimination and marginalisation
[*] LGB life experiences
- School: more than half experienced abuse
- Family: 12% rejected by their families
- At work: Bullying (20%) and unfair treatment
- Older LGB people: More likely to live alone and 5 times less likely to access services for older people
- Neighbourhood and hate crime most LGBT people feel unsafe, isolated and avoid showing same sex affection in public; verbal abuse (50%), physical violence (15%)
[*] Trans people and discrimination
- Job loss, social isolation are the norm
- Rejection by family is common
- High risk of violence if fail to ‘pass’ in public
- Mental health: depression, self harm and suicidality
- Gender reassignment: long, difficult to access, unsupported.
How does discrimination lead to poorer health?
- Increased stress
- Low self-esteem
- Isolation
- Increased conflict
- Sub-culture
- Distrust of authorities e.g. trans people not reporting mental health problems
- Discriminatory healthcare e.g. lesbians refused smears
Describe and give examples of heterosexism
[*] Heterosexism is the assumption that all people are heterosexual and that heterosexuality is superior and more desirable than homosexuality or bisexuality. Heterosexism is also the stigmatization, denial and/or denigration of anything non-heterosexual. Examples are
[*] E.g. the attitude that gay men aren’t “real” men or lesbians aren’t “real” women because of the socially pervasive view that heterosexual attractions or activities are the “norm” and therefore superior.
[*] Homosexuality is a sin, evil or subhuman.
[*] Homosexuality is an affection or mental disorder, or simply a social ill, therefore, it can be cured or stamped out. If it is not eradicated, it will lead to social disintegration and societal collapse.
[*] Schools may implement these attitudes and ideas through unequal and inconsistent disciplinary actions such as meting out harsher punishment to a same-sex couple violating the school ground rules while allowing a heterosexual couple to pass with an easier and more subtle disciplinary action for an equal or identical violation.
[*] Hospitals may limit patient visiting only to immediate family i.e. relatives and exclude same sex partners.
[*] In many countries around the world, same-sex marriage is not allowed. Many countries also deny rights and benefits to same-sex couples including custodial and adoption rights for children, Social Security benefits, and automatic durable power of attorney and hospital spousal rights.
Describe LGB and healthcare
[*] Aversion therapy for sexual and gender minorities continued into the 1980s: electric shock, lobotomy, emetics hormones
[*] Psychological ‘reparative therapy’ still practiced today by fringe organisations. Ineffective and damaging.
[*] ‘Gay Affirmative Therapy’ now ethical standard in counselling/psychotherapy
[*] Trans identities still seen as as mental disorders but attitudes now changing
[*] Recent experiences in healthcare
- Inappropriate questions and comments, prejudice, not respecting confidentiality
- 70% of lesbian and bisexual women said healthcare workers made inappropriate comments about their sexual orientation
- Most LGB people are not ‘out’ to their GP
- Trans people: when seeking help with their Trans orientation, GPS sometimes reluctant or refuse to help.
[*] What LGBT people want from healthcare professionals …
- Validate patient’s identity: more than being ‘neutral’
- Do not pathologies or moralise patient’s identity
- Confidentiality: Don’t out them without their consent: to family, community, workplace, colleagues, other authorities (Trans people are protected by law from disclosure of trans identity)
- Respect patient’s lifestyle and identity: do not show inappropriate, prurient interest
- Knowledge: don’t rely on patient for information; do your homework. Be able to distinguish between patient’s problems and their identity.
How can stereotypes, prejudice and discrimination affect healthcare?
[*] Stereotypes (limiting generalisations about groups of people): we all hold stereotypes and so may make wrong assumptions about people which can affect their healthcare e.g.
- Gay men are effeminate/promiscuous/well-groomed
- In lesbian relationships one person ‘wears the trousers’
- Bi people are indecisive or greedy
[*] How assumptions and stereotypes can affect healthcare:
- Assuming a patient has an opposite sex partner
- Assuming a same sex partner is not ‘next of kin’
- Assuming a butch-looking woman does not need contraception
- Assuming a masculine-looking man does not have anal sex
- Assuming a married man does not need an STI test
- Assuming a lesbian does not want to have children
[*] Homophobia - Prejudice and discrimination against gay people
- Homophobic comments and jokes from patients or staff
- Ignoring or isolating LGBT colleague
- Giving patient poorer care
[*] Institutional homophobia:
- Only having paternity leave for male doctors
- Failure of organisation to tackle homophobic attitudes at work
Describe the specific health needs that are prevalent in the LGBT community
[*] Mental health: LGBT people experience higher levels of stress-related mental health problems than average: anxiety (35%), depression (52%) and suicidality
Mental health seems to be worse amongst bisexual and transgender people than amongst lesbians and gay men
[*] Substance use: LGBT people have higher rates of substance use e.g. smoking (50%), alcohol, recreational drugs (37%)
[*] Cancer
- Lesbians should have smears
- Many lesbians have had sex with men
- HPV can be transmitted between women
- 10% of lesbians have abnormal smears
- MSM: more likely to contract anal cancer.
- Risk doubles if HIV positive
[*] Sexually transmitted infections
- MSM: HIV and syphilis more common amongst MSM
- NB: not all gay/bi men are high risk – depends on lifestyle and condom use
- 44% of gay and bisexual men in Leicester have never had an HIV test
- WSW can and do contract STIs even if they have only had sex with women in last 5 years.
Explain the ethical and legal requirement of doctors in providing good care for LGBT patients
[*] Being a good doctor to LGBT patients
- Be pro-active to build trust
- Assumptions
- Language
- Confidentiality
- Reflect upon and think about how to deal with your own feelings
- Challenge homophobia
[*] Your Duties
GMC 06:
- Do not let your views prejudice treatment
- Challenge colleagues’ behaviour
Tomorrow’s Doctors 2009:
- Respect all patients, colleagues and others regardless of their sexual orientation
The law: Equality Act 2010
Illegal to discriminate on grounds of sexual orientation or gender identity
…In provision of grounds and services, in education and in the workplace.
