This information was compiled by the Duke Doctor of Physical Therapy Gay-Straight Alliance in 2014, after recognizing that the LGBT community can often times go under-represented in clinical education. As a result we wanted to create a brief introduction into the importance of understanding who your patient is, and preparing future clinicians for competent interactions with individuals from this community.
3. •Sex – Classification of people as male or female
•Gender Identity – One’s personal sense of being a man or
woman
•Gender Expression – External manifestation of gender identity
•Sexual Orientation – Describes a person’s physical and
emotional attraction to another person
•Transgender – People whose gender identity/expression differs
from the sex they were assigned at birth (Transsexual, GID)
•Transitioning – Complex process of altering one’s birth sex
•Intersex – A person whose biologic sex is ambiguous
www.glaad.org
4. •Lesbian – A woman attracted to other women
•Gay – A man attracted to other men (sometimes an umbrella term)
•Bisexual – A person who is attracted to the two genders, not
necessarily equally or simultaneously
•Asexual – A person who does not have sexual attraction
•Questioning – A person who is exploring their sexual identity or
orientation
•Ally – A person who advocates for/supports the LGBT community
•Queer – Traditionally a pejorative term, queer has been
appropriated by some LGBT people to describe themselves or
straight allies that support them
•Homophobia – The irrational fear/intolerance of LGBT people
•Heterosexism – Assuming everyone is heterosexual
www.glaad.org
5. Provision of Excellent Healthcare
for All Patients
*It’s Your Professional
Responsibility*
6. Within the field of physical therapy we recognize and
accept the professional obligations of all physical
therapists to:
• Treat each patient with dignity and respect
• Respond effectively, compassionately and professionally
to the needs of all types of patients for excellent,
comprehensive health care
• Facilitate greater health, wellness, independence and
enhanced quality of life in each of our patients
7. Principle #1: Physical therapists shall respect the inherent dignity
and rights of all individuals.
(Core Values: Compassion, Integrity)
1A. Physical therapists shall act in a respectful manner toward
each person regardless of age, gender, race, nationality, religion,
ethnicity, social or economic status, sexual orientation,
health condition, or disability.
1B. Physical therapists shall recognize their personal biases and
shall not discriminate against others in physical therapist practice,
consultation, education, research, and administration.
http://www.apta.org/uploadedFiles/APTAorg/About_US/Policies/HOD/Ethics/Codeofethics.pdf
8. Principle # 2, 3, 6, 8 state that we also commit to
• Act in the best interests of patients
• Provide compassionate care that incorporates the individual and
cultural differences of patients
• Adhere to evidence-based practice
• Take responsibility for professional development based on critical self-
assessment and reflection
• Advocate to reduce health disparities and health care inequalities
• Improve access to health care services
• Address the health, wellness and preventive health needs of all people
http://www.apta.org/uploadedFiles/APTAorg/About_US/Policies/HOD/Ethics/Codeofethics.pdf
9. • In the 2012 Healthcare Equality Index, Duke
University Hospital was identified as one of 234
facilities in the United States that:
• protect LGBT patients and employees from discrimination
• ensure equal visitation access for LGBT people through
explicitly inclusive policies
• provide staff training in LGBT patient-centered care
• Duke is the only hospital system in all of North
Carolina to meet this standard.
• As a Duke DPT student, you are now part of our
institution's commitment to providing high-quality
care to LGBT patients.
http://www.hrc.org/hei/hei-leaders#.UcR1r_nCaSo
10. • Furthermore, as part of the oath we take in the
annual White Coat Ceremony, we pledge to:
• Uphold the standards of excellence set forth by the
institution of Duke University.
• Practice with integrity, compassion, humility, and
purpose.
• Uphold my sense of social responsibility and
promote health, while lending my hands and
knowledge to those in need.
11. As a healthcare provider why
is knowledge about LGBT
issues necessary for
competent care?
12. “A recent literature review found that self-identified
LGB individuals are more likely than
heterosexuals to rate their health as
poor, have more chronic conditions, and
have higher prevalence and earlier
onset of disabilities.”
(http://kaiserfamilyfoundation.files.wordpress.com/2014/01/8539-health-and-access-to-careand-coveragefor-lesbian-gay-
bisexual-and-transgender-individuals-in-the-u-s.pdf)
Medical education does not routinely encompass LGBT health
issues. More than half of medical schools and public
health school curricula lack instruction about the
health concerns of LGBT people.
14. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662085/
• As a physical therapist you will be closer to your patient
than much of the medical community. It is important to know
your patient and understand possible risks such as
depression, and mental health when implementing
treatment.
15. (http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25)
• Screening and interventions can be life saving aspects of
your career. LGBT individuals tend to have lower
rates of health insurance due to issues of coverage
resulting from unmarried partners. Additionally, Fear of
discrimination and negative experiences with healthcare
providers result in decreased screening in lesbian and
bisexual women despite an increased risk for developing
illnesses such as breast cancer, asthma, UTI’s, and
cardiovascular disease.
(http://kaiserfamilyfoundation.files.wordpress.com/2014/01/8539-health-and-access-to-careand-coveragefor-lesbian-gay-bisexual-and-
transgender-individuals-in-the-u-s.pdf)
17. • What are the health risks specific to a population that can not
always be readily identified? In order to treat your patients
with complete competence you need to know who they
are.
Gay and Lesbian Medical Association. “Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender patients”
20. It is essential to understand that these risk
factors do not identify an inherent flaw within the
LGBT community. These factors represent the
compounding effects of: social stigmatization,
harassment, discrimination, denial of civil and
human rights, community and family abandonment,
use of alcohol or illicit drugs as coping
mechanisms, and failure of the medical community
to reach out with effective intervention or
prevention education.
(http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25)
21. How can I take an LGBT-
sensitive social history?
22. Intake form utilized from:
(http://www.kingcounty.gov/healthservices/health/personal/glbt/IntakeForm.aspx#__utma=149406063.1503028756.1372082685.1372099408.1372102112.3&__
utmb=149406063.1.10.1372102112&__utmc=149406063&__utmx=-
&__utmz=149406063.1372102112.3.2.utmcsr=google|utmccn=(organic)|utmcmd=organic|utmctr=lgbt%20friendly%20intake%20form&__utmv=-
23. Questions to consider when taking
your social history
“Do you have a partner or significant other?”
“What name would you prefer to be called?”
“What kind of support structure do you have?”
“Do you currently, or have you ever, used hormones?”
Gay and Lesbian Medical Association. “Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender
patients”
24. Tips to consider when conducting
your interview:
-Ask your patient to clarify any terms or behaviors
you may be unfamiliar with.
-Address each interview showing empathy, open
mindedness and reservation of judgment.
-Stress the confidential patient-provider interaction
“Gay and Lesbian Medical Association. “Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender
patients”
25.
26. Coming out is a risky decision...
- Physical Threats
- Risk of Being Stereotyped
- Troubling Discrimination In Health Care
- Loss of Social Support
- Risk of Losing Employment
27. According to 2012 FBI published reports,
Sexual orientation ranks as the second-
highest motivator for hate crime
incidents (19.6% of reported cases)
(htp://www.fbi.gov/news/stories/2013/november/annual-hate-crime-statistics-show-slight-decease/annual-hate-crime-statistics-show-
slight-decrease)
• Understand how social aspects affect your patients
health and life decisions.
• Coming out to a healthcare provider is often difficult and
may be perceived as exposing oneself to potential
threat. It is essential that you create a safe environment
for your patients.
28. There are many misconceptions about the health status of
the gay community from long standing (often incorrect)
stereotypes.
Gay people Gay Men Gay Women
- not religious
- non-monogomous
- sexually promiscuous
- estranged from family
- pedophiles/predators
- weak
- clearly identifiable
- are all effeminate
- all engage in risky
sexual behavior
- are generally HIV+
- HIV is a gay male
disease or gay disease
- masculine
- sexually abused as
children
- negative opinion of men
Due to longstanding stereotypes, misinformation, and inappropriate beliefs, members of the
LGBT community are still legally prohibited from donating blood
despite health officials admitting that "it is a persons behavior, not their sexual orientation, that
puts them at risk" for acquiring HIV and then transmitting the virus via the blood donation
process.
(http://www.cnn.com/2012/07/06/health/gay-men-blood-ban)
29. -Lambda Legal Health Care Report (2010)
4,916 LGBT patients were asked if they had experienced discrimination from health
care services in the following ways
*Being refused needed care
-LGB 8% -Transgender: 27%
*Professionals refusing to touch them or using extreme precautions
-LGB: 10.6% -Transgender: 15.4%
*Professionals using harsh or abusive language
-LGB: 10.7% -Transgender: 20.9%
*Being blamed for their health status
-LGB: 12.2% -Transgender: 20.3%
*Professionals being physically rough or abusive
-LGB: 4.1% -Transgender: 8%
-An overall look reveals:
>56% of LGB patients having at least one of these experiences
>70% of transgender patients having at least one of these experiences
>8% LGB denied health care outright
30. -LGBT youth are most often dependent on family for
emotional, financial, and healthcare
support.
Disclosure of one's sexual orientation may often
result in catastrophic loss of these support
systems.
31. -Relationships in a work or health care environment may be
affected if an individual chooses to come out.
Individuals can legally be fired for being gay In
29 states, and in 34 states for being
transgender. Consider how this may affect your
patients, your colleagues, your coworkers......
(http://www.upworthy.com/29-states-can-fire-you-for-being-gay-is-your-state-one-of-them)
33. You!
• A person who is a member of the dominant
group who works to end oppression and
discrimination of an oppressed population.
• A person who supports and advocates for a
group other than her/his own in both her/his
private and professional life.
35. • Use inclusive language in
conversation and paperwork
• Post “Safe Zone” or other
signals of your acceptance
• Educate yourself:
• Familiarize yourself with resources available to
LGBTQ individuals and communities
• Take time to learn about LGBTQ issues
• Don't make assumptions
• Don't be afraid to ask questions!
36. • Make it known that your clinic, office, home, desk, or
personal bubble is a safe space.
• Stand up to homophobic, intolerant, or ignorant language
and actions when you see them.
• Challenge stereotypes (your own and those of others).
• Do not make jokes about LGBTQ individuals, and let
others know that their jokes are hurtful and
inappropriate.
37. For more information please contact:
Justin.Stambaugh@dm.duke.edu
Keenan.Whitesides@dm.duke.edu
Christine.ulses@dm.duke.edu
Or visit our website at:
http://dukegsa.wix.com/duke-health-gsa
Or check us out on facebook at:
https://www.facebook.com/groups/426601734085179/
Thank You For Watching!
38. If you’re interested in the Duke Doctor of Physical
Therapy Gay-Straight Alliance please join us for an
Ally Discussion group at:
5:00 on Wednesday, June 4th
in Conference Room A.
Hinweis der Redaktion
It’s important to never assume that your patients or coworkers identify with a particular sexual orientation. A patient interview, conversation, or casual dialogue with coworkers and peers can become uncomfortable or even inappropriate when this oversight is made.
