Dr. Manlio Converti
Publication date: May 20, 2014
Last update: June 05, 2014
I am translating this text of the American colleague so that you can reflect and comment, avoiding vulgarity and flame, on the Lgbt theme (Lesbian-Gay-Bisexual-Transgender but also Intersexual, Queer, Questioning, Transsexuals and partners of people T or I) or rather on the profound ignorance and prejudice that exists in the healthcare world that prefers to ignore LGBT people, causing them, or rather causing us serious personal harm rather than producing well-being.
Betty went to her family doctor for depression. She is 75 years old and a retired secretary who for months has been unable to eat, sleep or take pleasure in anything. Her doctor, taking note of her symptoms, prescribes Betty a new generation antidepressant.
The problem is that the doctor didn’t get the patient’s entire history. He didn’t specifically ask for anything and Betty didn’t spontaneously say that her depression started when her partner Judith died .
Betty and Judith lived together for 40 years, never openly declared themselves as a couple, never had contact with the LGBT community and were known in their community only as “the two ladies who live in the yellow house”. Judith’s death, however, also meant the end of the entire support system for Betty, so the antidepressant wouldn’t be enough.
Betty’s doctor was unable to help her because he didn’t get all of her information. Not asking about her sexual orientation about her and her significant vital relationships has resulted in misdiagnosis and inadequate therapy.
Medical problems of all kinds do not arise in an existential vacuum, and patients are not just a collection of symptoms. Having a doctor who doesn’t know you as a person is not only a disheartening and uncomfortable experience, it can also lead to misdiagnosis and incorrect treatment. As LGBT people, it is not only pleasant to find healthcare workers who are at ease when they know and care for us: it is essential!
BJ is a 22-year-old male-looking transgender person who came to the emergency room of the Manhattan hospital after being beaten. As a teenager BJ was kicked out of his home by his parents living in NY because of his gender identity and has lived like a bum all over the place since. The emergency room doctors treated BJ’s face wounds, but seeing him agitated and out of sorts called the psychiatrist.
BJ was unhappy to talk to the psychiatrist, as he claimed that he only wanted his face fixed and not that he was considered mentally ill. The psychiatrist admitted to the BJ psychiatry ward for “psychomotor agitation”.
During hospitalization the staff of the ward always called him Barbara, which was his “registry” name, they stopped using the testosterone he had been taking for years, thinking it was the cause of the agitation and forced him to take a neuroleptic ( haloperidol). No doctor ever asked BJ what had happened that day and who had attacked him. After his discharge, BJ stopped taking haloperidol and I swear I will never see a doctor again alive than him.
Due to the doctors’ ignorance and their macho anxiety about BJ’s gender identity, they did not obtain essential information on the reason for admission to the ER, subjected him to nightmare treatment and forced hospitalization in psychiatry, during which his needs were not taken into consideration and they never even called him by the name he had chosen.
They fought against him rather than cure him, depriving him of hormone therapy and forcing him into unnecessary psychiatric therapy. Worst of all was that they left him on discharge in a position of possible risk, since BJ’s assailant had been ignored by them and therefore no one thought that BJ could be in danger at the time of his discharge.
Certainly our LGBT brothers and sisters who are “locked in the closet” and do not declare themselves homosexual, who are forced to be homosexuals or prostitutes and who are somehow less socially privileged are at greater risk of wrong treatment by the system. health care, but we should all learn something from these stories.
Those of us who work in the health professions have a duty to those of us who are LGBT patients to educate our colleagues so that they become culturally competent and provide better care . As patients, each of us has the duty to seek competent doctors and health professionals on LGBT issues (and to inform others about their identity and role. Note from the Translator).
The Commission has produced a guidance document for hospitals to become competent and sensitive when treating LGBT people. The Institute of Medicine has printed a report to search for specific data on inequities in the health sector and on the health needs of LGBT people. These are not just good advice. For LGBT people who need medical care (so each of us, in other words, sooner or later) this information could save our lives!
Source:
Mary Barber Psychiatrist Physician, Huffington Post of 5/15/2014
http://www.huffingtonpost.com/mary-barber-md/know-us-as-people_b_5330963.html
17 comments
# 1
I don’t know what LGBT means. In a few seconds, by googling, I would find out, but it seems appropriate for the reader to avoid acronyms.
If the doctor had asked patient Betty, how she should have been, “She has recently had problems, grief, grief
” which is part of the history of depression, the picture would have been clearer.
On the need for awareness of the health professions towards transgender people, I fully agree. Unfortunately, there is also ignorance in medicine about psychiatric patients: many times in the hospital our patients are suspended from psychoactive drug therapies for no reason other than injury. Greetings
# 2
Dear Colleague,
the situation of LGBT people is undoubtedly more difficult than those who are in the “statistical major” on gender orientation! We are working on it. We observe, for example, that LGBT access to couple therapy or sexual therapy is gradually increasing, not a sign that the problems are increasing, but that they know that they can talk about it.
Regarding Your Statement “Betty’s doctor was unable to help her because she didn’t get all the information. Don’t ask about her sexual orientation etc.” puzzles me. In the situation described (depressive traits), the question – in my opinion – was not about sexual orientation, but about the reasons for unhappiness, about grief, about heart pain … and in this I believe that straight and LGBT are united by the common existential story. It is the attitude of the doctor / psychologist / therapist / sexologist that signals his willingness to go “beyond” traditional status; and this happens – I believe – whether the health specialist is homo, hetero, or transgender.
What do you think
# 3
User 171XXX
May 20, 2014
but sorry, I’m not a doctor, but if a person comes to me for problems, I don’t ask him what sexual tastes he has
. “okay, but look, she is transsexual
”
# 4
User 171XXX
May 20, 2014
sorry for the stupid joke, but I am convinced that if we behaved like this there would be no more discrimination!
# 5
I agree with Dr. Scapellato: in the first case – if the patient did not spontaneously say that the triggering event was the death of her partner – asking her questions about sexual orientation would have been risky (given her age, she could have been offended). Much better an “open” question like: “she has had some bereavement / loss / traumatic event
“. also because she could have been depressed about the death of a male partner!
The direct question should only be asked if there is something particular that guides the hypothesis.
Let me give two examples from my professional life: in one case I asked an elderly patient if she was married and she replied no; when I asked her if she had had children she replied with an air between offended and scandalized: “But what if I told you I didn’t get married!”. On that occasion, I saved myself by saying “You know, I thought you might also be a widow”, but since then the question about the children always precedes the question about marriage.
A few days ago I visited an HIV-positive patient accompanied by another who seemed less young. At first glance seeing them I thought they were gay, but I didn’t know for sure. When the patient told me he smokes two paccehtti a day and I addressed the issue of health risk, the other intervened saying “Yes, I tell him; but he is self-destructive, he does what hurts him!” and the patient attacked him saying “Either shut up or go out of the clinic!”. I thought he might be the older brother. At a certain point -to understand who I was dealing with (HIV-positive because ex-addict or sexual infection
) and how to manage the interview- I switched to the direct question, accompanied by a smile (possible loophole: “I was joking!”): ”
“and when they replied:” a couple “I good-naturedly scolded the patient saying that having the good fortune of having a partner who loves him and cares about his health, he should have kept him close instead of treating him badly; indeed, that by quitting smoking they could have taken a nice cruise with the money saved.
As for transgender patients, in our hospital (specialized in HIV positive since the 80s, when almost all of them were drug addicts or gay / transgender) we have a certain quota and they are naturally respected without effort. but it has been peaceful for years. Elsewhere they are probably less used.
# 6
@ Franca. LGBT abbreviation means: Lesbian Gay Bisexual Transsexual. Basically everyone who is not heterosexual. (But hermaphrodites are not contemplated
Or are included in
transvestites And transvestites
I want to buy – for the moment it is not yet translated into Italian – the book “A strange tribe” by John Hemingway, about his father Gregory who is getting married 5 times – with 4 wives – and had 7 children. Since he was a child he was attracted to transvestism, and during his fourth marriage he changed sex, but he was neither gay nor transsexual, and always only falls in love with women. Or maybe he was a lesbian transsexual
)
# 7
@ Chiara: yes, I saw that it is a “politically correct” acronym, so I learned something new, but in my opinion, since users and seasoned psychiatrists may not know it, it would be nice to insert at least an explanation in the text. When I talk about panic or obsessive disorder I don’t shoot DAP or DOC if I turn to everyone, and to give an example not of disease, otherwise I am accused of sexism when I say that I am from the Csi I explain: Italian sports center, not everyone knows it .
# 8
very useful and shareable reflection. Thanks
# 9
User 258XXX
20 May 2014
Thanks Dr.ssa Lestuzzi for the necessary explanation of the acronym, even if ….. and that unknown initials of the title that led the writer, a simple user, to read the article !.
# 10
Thank you for the notes, I modified the text to make the initials clear and I introduce it in the Medicitalia dictionary.
I have not written it, I have only translated it and I also find the explanation of the anamnesis to Betty very limited, which perhaps was cut by a less competent editorial staff.
However, this is the level of public discussion in the rest of the world, there are videos from Uruguay for example on data collection, but there is no compromise on one point: it is hypocritical not to ask if the user is gay! It is precisely because one does not ask serenely that the conversation is prejudiced and overturning any prejudices about who is gay produces existential damage. The ways to ask for it depend on the circumstances, but if someone asks for an investment he asks him if he plans to do it for the children assuming he is heterosexual, maybe or if he has a girlfriend to marry … right
Yes, there are lesbian transsexuals, because the partners of transsexual people can be men, women and transsexuals of any sexual orientation. Most people confuse gender orientation and identity: gender is male, female, intersex, transgender, queer, transsexual ….; orientation is heterosexual, bisexual, homosexual and loving of transsexual or intersex people … then there is behavior and social role, which make the “statistical majority” completely disappear, which is a cultural invention, which denies the complexity of the real human phenomenon.
The boy in the pink pants who committed suicide, for example, could have been heterosexual or bi-sexual or gay, but he still killed himself for homophobia, and his mother, violently denying his possible homosexuality, made it clear how violent homophobia was in that family despite appearances.
Since you have left your conversation public, this implies that I will be able to publish elsewhere with your signature, at least the very interesting story of the colleague. I invite you to write others, if you can, not only those related to the HIV = Gay-Transgender prejudice, because this is also very serious, so much so as to prevent the prevention or treatment of many LGBT people who refuse to approach a doctor, in addition to fact that he would ignore us, perhaps, so as not to disturb us with our homosexuality …
# 11
“it is hypocritical not to ask if the user is gay! It is precisely because one does not ask serenely that the conversation is prejudiced”
Manlio, I disagree. If there are unmarried women who get offended if you ask them if they have had children, what do you think happens if you ask for sexual orientation . From
personal experience, it is sometimes difficult even in HIV positive!
The open question (in the case of the financial promoter it can be: “Is there any person to whom you would like to leave a possible income
“) without specifying role or gender (that is, not husband, wife, boyfriend, but DEAR PERSON) allows you to investigate with discretion and without forcing. Then if someone tells me that he has a friend who is very tied, this may be enough without going into the merits of sexual relations (which then may not even exist, since there are also platonic loves). Or, if I see that the patient (in our case) likes to open up I speak calmly to make it clear that it is not a problem (the couple I was talking about then spoke freely about a relationship that is now more than ten years old, about the concerns of the healthy partner for the sick one, about the need for mutual hearing, and in the end she went away very happy because she felt “welcomed”,also because I went further by praising my partner and inviting them – as soon as the law allowed – to get married).
In other cases, I
think we must stop, precisely out of respect for those who – perhaps only out of modesty – do not intend to deepen the details of their sexual life (and this also applies to many straight people, and not just elderly!)
# 12
discussion, agreeing with the fact that open questions are respectful of the patient and his willingness to open up without forcing. However, I find it important that Dr. Converti put the accent on the subject, as our Italian culture is much more backward on the subject and much more
, often secretly, moralistic.
# 13
Sorry if I come back to the subject after a long time.
I am organizing courses on the merits, given the importance and difficulty of the subject, precisely to obtain the maximum public discussion on the subject live.
If you want we can organize them live for Medicitalia or for your specific locations.
In any case, many more homosexual or transsexual people are offended because they are ignored, harassed, or heterosexualized by a history that makes us exist only if we have HIV or change the genital organs.
Perhaps it is also this double stigma that causes further problems, while everyone is asked without problems about their private heterosexual life in detail.
# 15
A colleague in private mode pointed out to me that even heterosexuals have a hard time talking about their private life, and she didn’t understand my phrase “everyone is easily asked about their private heterosexual life in detail.”
Try to look at the registry of your folder and think about the questions you spontaneously ask also to children and the elderly.
I read from my file:
Sex (limited to M and F, excludes transgender and transsexual people, which from a medical point of view is absurd since this radically changes health needs).
Marital status (single / single, married, divorced, separated, cohabiting, widower) These questions are not embarrassing but imply the patient’s heterosexuality, canceling any license from the patient to answer truthfully if homosexual if not with great difficulty or in a way that will be interpreted as hostile or provocative.
If a person replies that he is single, the petty psychology requires us to also ask, without embarrassment, if you have girlfriends or boyfriends even with children and adolescents, using the opposite sex of the patient in charge.
This is embarrassing twice and wipes out trust in your doctor, reducing your chance of being cured.
# 16
# 15
