John Green, a 33-year-old individual of Caucasian ethnicity, visits the clinic to establish himself as a new patient. It’s noteworthy that John’s assigned sex at birth is female, but he identifies as male, having undergone a complete transition two years ago, both within his family and socially, culminating in his move back home. Currently unemployed, John has been self-administering testosterone acquired from the internet. He has not sought healthcare since deciding to transition, except for obtaining suppression medications through Telehealth three months ago.
John’s medical history reveals a prolonged habit of smoking two packages of cigarettes daily for the past decade. Additionally, he engages in weekend marijuana use, with a consistent green card authorizing this activity. Despite facing depressive episodes, he has remained HIV positive for the last three years, managing to achieve viral suppression in his last blood draw six months ago. Recently, John has been experiencing significant weakness, prompting his return to his parents’ home. His current medication regimen includes once-daily Biktarvy, received by mail at no cost, and self-administered 100 mg testosterone intramuscularly every seven days. Notably, his past medical history is non-contributory, with no history of marriage and no significant family medical background.
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John expresses concerns about being a burden on his family since his return home and unemployment. Furthermore, he fears a decline in his health. The intersection of gender identity, sexual health, mental health, and substance use in John’s case underscores the importance of a comprehensive and sensitive approach to address his unique healthcare needs.
Follow Up Sick Visit: Musculoskeletal Shoshanna Tillman Shadow Health treatment plan
BY DAY 3 OF WEEK 2
Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks
BY DAY 6 OF WEEK 2
Respond on or before Day 6 on 2 different days to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.
DIVERSITY AND HEALTH ASSESSMENT
John’s unemployment, a socioeconomic factor, has the potential to significantly impact his access to healthcare and basic necessities. The financial strain may lead to his reliance on internet-sourced testosterone, possibly indicating a self-treatment approach due to financial constraints or limited healthcare accessibility (Amiri, 2022). Moreover, the burden he perceives on his family due to unemployment can contribute to mental health challenges.
His history of smoking and marijuana use, coupled with his HIV status, poses potential health risks that need careful consideration. Depression episodes further complicate his ability to maintain a healthy lifestyle. The recent onset of weakness may impact his physical activity levels and dietary habits.
As a transgender individual, John may have encountered discrimination and hurdles in accessing healthcare, highlighting the importance of creating a supportive and non-judgmental environment during interactions (Westwood, 2022). His concerns about finding a healthcare provider who is knowledgeable and respectful of his gender identity should be acknowledged.
Approaching discussions with sensitivity and respect for John’s chosen gender identity, utilizing appropriate pronouns, and understanding potential financial constraints are crucial. The targeted questions aim to explore John’s experiences, challenges, and concerns comprehensively, fostering open communication and a patient-centered approach.
When interacting with John, it is essential to respect his chosen gender identity and use appropriate pronouns (Brummett & Campo-Engelstein, 2021). It is also essential to approach discussions of his health history and behaviors in a non-judgmental and supportive manner. Additionally, sensitivity should be given to John’s potential financial constraints and concerns about burdening his family. Targeted Questions:
- Can you describe your gender identity and any experiences you have had accessing healthcare as a transgender individual?
- How has your recent unemployment affected your ability to maintain your health?
- Can you discuss your smoking and marijuana use and any concerns you have about the impact on your health?
- Have you experienced any symptoms related to your HIV status or medication regimen?
- How have your recent experiences affected your mental health and emotional well-being?
References
Brummett, A., & Campo-Engelstein, L. (2021). Conscientious objection and LGBTQ discrimination in the United States. Journal of public health policy, 42(2), 322-330.
Amiri, S. (2022). Unemployment associated with major depressive disorder and depressive symptoms: A systematic review and meta-analysis. International journal of occupational safety and ergonomics, 28(4), 2080-2092.
Westwood, S. (2022). Religious‐based negative attitudes towards LGBTQ people among healthcare, social care, and social work students and professionals: A review of the international literature. Health & Social Care in the Community, 30(5), e1449-e1470.
Shawn Billings, a 28 year-old African American patient
RESPONSES
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Great job on your post! Discrimination and stigma are unfortunate realities for many individuals in the transgender community, impacting their daily lives and potentially hindering their access to healthcare. Addressing these challenges is crucial to fostering a welcoming healthcare environment. According to the Centers for Disease Control and Prevention (CDC, 2022), using preferred names and pronouns is a fundamental step in creating such an inclusive space for transgender individuals. Recent studies also suggest the avoidance of gendered terms like “women’s health” to ensure an inclusive approach to healthcare services (Vermeir et al., 2018).
In addition to the proposed questions, further inquiries can enhance the depth of information gathered for this patient’s health history:
1. What specific symptoms are you currently experiencing that lead you to believe your health is on the decline?
2. Are you presently sexually active, and if so, are you taking precautions such as using protection?
3. Would you be open to exploring various treatment options available for managing depression?
These additional questions aim to provide a more comprehensive understanding of the patient’s health status, symptoms, and preferences, fostering a patient-centered and holistic approach to care. Open communication and sensitivity to the unique needs of transgender individuals are essential in delivering effective and inclusive healthcare services.
Centers for Disease Control and Prevention. (2022, February 18). Patient-centered care. Centers for Disease Control and Prevention. Retrieved March 8, 2023, from https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/affirmative-care.html#understandingLinks to an external site.
Vermeir, E., Jackson, L. A., & Marshall, E. G. (2018, August). Improving healthcare providers’ interactions with trans patients: Recommendations to promote cultural competence. Healthcare policy = Politiques de sante. Retrieved March 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147364/Links to an external site.
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RESPONSE 2
Thank you for your post! Assessing the patient’s readiness to quit smoking indeed plays a crucial role in promoting preventative healthcare. Expanding on the smoking cessation questions, incorporating a mental health and depression screening can provide valuable insights into the patient’s overall well-being. According to Stachowicz & Sowa-Kućma (2022), individuals over the age of 18, especially those who are unemployed, have poor health status, and a history of depression, are at a higher risk for depression.
Implementing a tool like the Patient Health Questionnaire-9 (PHQ-9) for depression screening can offer a structured approach to evaluating the patient’s mental health status. This screening tool assesses various aspects of depression, and positive results could prompt further discussions about potential treatment options or therapeutic interventions. By addressing mental health concerns in conjunction with smoking cessation, a comprehensive healthcare plan can be developed to address multiple facets of the patient’s well-being.
Moreover, engaging the patient in a conversation about mental health can contribute to reducing the stigma associated with seeking help for mental health issues. It fosters a patient-centered approach that acknowledges the interconnectedness of physical and mental health, promoting holistic and tailored healthcare strategies for the individual.
References:
Kroenke, K. (n.d.). PHQ-9 (patient health questionnaire-9). MDCalc. https://www.mdcalc.com/phq-9-patient-health-questionnaire-9Links to an external site.
Stachowicz, K., & Sowa-Kućma, M. (2022). The treatment of depression — searching for new ideas. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.988648
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Hi XX
Thanks for providing such an insightful assessment of John’s situation. Expanding on the crucial points mentioned, exploring the effects of job loss and the lack of access to healthcare services on both his mental and physical health would indeed offer valuable insights. Understanding the multifaceted impact of unemployment on various aspects of his life can contribute to a more comprehensive understanding of his current situation.
Considering John’s gender identity, delving into the challenges he may have faced related to discrimination and social stigmas when accessing healthcare and mental health services aligns with a patient-centered approach. Uncovering these aspects can shed light on the barriers he might have encountered and help tailor interventions that address both his healthcare needs and the unique challenges associated with his gender identity.
Furthermore, exploring the socioeconomic impacts of unemployment provides an additional layer of understanding into John’s current circumstances. It offers insights into how financial constraints may be influencing his access to healthcare, medication adherence, and overall well-being. This holistic exploration ensures a thorough understanding of the interconnected factors influencing his health and aids in developing a targeted and effective healthcare plan.
References
Cicero, E. C., Reisner, S. L., Silva, S. G., Merwin, E. I., & Humphreys, J. C. (2019). Health care experiences of transgender adults. Advances in Nursing Science, 42(2), 123–138. https://doi.org/10.1097/ans.0000000000000256
Pratap, P., Dickson, A., Love, M., Zanoni, J., Donato, C., Flynn, M. A., & Schulte, P. A. (2021, September 23). Public health impacts of underemployment and unemployment in the United States: Exploring Perceptions, gaps, and opportunities. International journal of environmental research and public health. Retrieved March 11, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8508259/
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