28.10.2021

Our Doctors Just Do Not Know Enough

Liam Gal Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Israel Published JIMS Issue 25.04.2021
Background: Many procedures requiring sedation in the pediatric emergency department are performed by consultants from outside the department. This team usually includes orthopedic surgeons and general surgeons. As sedation is now a standard of care in such cases, we evaluated consultants' views on sedation.
Objectives: To evaluate consultants' views on sedation.
Methods: A questionnaire with both open-ended questions and Likert-type scores was distributed to all orthopedic surgeons and general surgeons performing procedures during the study period. The questionnaire was presented at three medical centers.
Results: The questionnaire was completed by 31 orthopedic surgeons and 16 general surgeons. Although the vast majority (93–100%) considered sedation important, a high percentage (64–75%) would still perform such procedures without sedation if not readily available.
Conclusions: Sedation is very important for patients and although consultants understand its importance, the emergency department staff must be vigilant in both being available and not allowing procedures to "escape" the use of sedation.

Lesbian, gay, bisexual, transgender and queer (LGBTQ) patients may experience the medical institutions differently from other patients. This derives from a difficult social background, being a minority in society, and in some cases, a harmful experience with doctors. Unfortunately, medical schools don’t place enough emphasis on this issue, and it might impairour qualification as future clinicians. Therefore, it is our duty to demand from our deans to integrate LGBTQ-health in the medical school curriculum.

At times, the clinician's office is not a safe environment for LGBTQ patients. It even may be harmful, due to discrimination and harassment. 7% of LGBTQ patients claimed that they have experienced unwanted physical contact from a doctor or other health care provider. 8% were refused needed healthcare, and an equal percentage have avoided medical care due to fear of discrimination1, 2. In transgender patients, the numbers are much higher3.

In a study by Meyer4, the author found that minorities are more vulnerable to stress than the general population - both external and internal stress. The internal stress is due to mismatch between one's self-perception in contrast to society's heteronormal5 ideation.  The external stress is caused by events inflicted by society, such as violence, discrimination and abuse. LGBTQ patients avoid treatment because of the fear from external stressors such as discrimination, harsh and abusive language, and contempt1,6. Many LGBTQ patients (40-50%) of do not talk to their physician about sexuality or gender7,8, thus creating a vicious cycle, when stressors lead to anxiety, which increase patients' vulnerability to stress4. In turn, the stress leads to more mental health disorders, suicidal ideation, substance misuse, and deliberate self-harm9.


In addition, men who have sex with men (MSM) are at higher risk of having sexual transmitted diseases (STDs)10. In 2014, 83% of secondary syphilis cases diagnosed in the United States were MSM patients1. It is plausible, that this is an example of the combination of the higher rates of STDs and the avoidance from medical care. How else would a solitary lesion advance to a full-body rash10?

In conclusion, LGBTQ patients require a special medical approach. This is the reason why most of LGBTQ would prefer a gay-friendly clinic11. Nevertheless, every clinician can change his or her approach towards LGBTQ patients, by creating a welcoming environment (for example by hanging a flag or a sign), changing the forms for being more applicable for patients with non-conforming gender, using the correct pronoun for your patients, saying "parents" instead of "mom and dad" and knowing a bit more about LGBTQ medicine8.

 

These changes depend on education. Since we are students we can ask the dean of your institute to integrate LGBTQ medicine as a part of med-school curriculum.

 
If you want to learn more, please join the Studential Forum for LGBTQ Medicine.

 

References

1. J. Larry Jameson, Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, Joseph Loscalzo, Harrison’s principles of internal medicine, 20th edition, chapter 393, 2018.

2. Rooney, Shabab Ahmed Mirza and Caitlin, Discrimination Prevents LGBTQ People from Accessing Health Care, Center for American Progress, 2018.

3. Grant J, Mottet L, Tanis J, et al. National transgender discrimination survey report on health and healthcare. National Center for Transgender Equality and the National Gay and Lesbian Task Force, 2010.

4. Meyer, I. H. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence, 2003.

5. Ramona Faith Oswald, Libby Balter Blume, & Stephen R. Marks, Decentering Heteronormativity: A Model for Family Studies, Sourcebook of Family Theory and Research, 2005.

6. Buchmueller, T., and C. S. Carpenter, Disparities in Health Insurance Coverage, Access, and Outcomes for Individuals in Same-Sex Versus Different-Sex Relationships, American Journal of Public Health 100(3), pp. 489-495. 2010.

7. Dadrick, L, Grady, KE, Openness between gay persons and health care professionals. Annals of internal medicine, 1980

8. GLMA, 2011a. Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients, Washington DC: Gay and Lesbian Medical Association

9. King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, Nazareth I. A systematic review of mental disorder, suicide, and deliberate self-harm in lesbian, gay and bisexual people. BMC Psychiatry, 2008

10. Syphilis- CDC Facts Sheet, Center for disease control and prevention, 2021.

11. Frazer, M. Somjen , lgbt health and human services needs in new york state,. 2009.