2. How to Use this Module
This educational module is intended to provide you with information
using an interactive case study.
You can always get back to the case profile by clicking:
Any Green button that looks like this
can be clicked on for more information
or to move forward in the module
Onward!
Back to
Case
3. Learning Objectives
• At the end of this module, users should be able to:
• Identify concerns unique to LGBT in rural areas
• Understand the importance of knowing a patient’s gender identity or sexual
orientation.
• Have resources that can shared with LGBT populations in rural areas.
Continue to Module
4. Today’s Schedule
Welcome to Clinic! I will be
guiding you through your
patient encounter today.
You will be seeing a patient
at our rural community
clinic. It’s a busy day, click
the button below to take a
look at your schedule.
5. APPT TIME PT NAME/MRN DOB (AGE) CHIEF COMPLAINT
8:00 Smith, Greg 5/20/82 (34) New Patient/ Establish Care
8:40 Jones, Gina 4/30/87 (29) UTI
9:00 Harris, Rick 8/19/50 (66) HTN/DM follow up
9:20 Guest, Jane 12/20/65 (51) hospital f/u
9:40 Welch, Karen 1/13/75(41) Well Woman Exam
10:00 Rice, Tommy 9/14/03 (3) Ear Pain
Go See First Patient
6. PATIENT PROFILE:
• Patient: Greg Smith, 34 year old
male. Here to establish care.
• He recently got health insurance
after not having any for several
years and is here to discuss
preventive care.
• No notable Past Medical History
• What else would you like to know
about Greg?
Family Life
Relationship
Status/Sexual History
Drug/Alcohol Use
Occupation
7. Why do we need to know his
sexual orientation/ gender
identity? Isn’t this just a routine
visit?
8. Our Case: Sexual Orientation and Gender
Identity
Greg feels comfortable with you as a provider and shares that he gay.
He is currently sexually active. Past sexual partners were men.
He identifies as a man and uses male pronouns.
LGBT Health Disparities
Rural LGBT Health
Disparities
Discussing Gender
Identity/ Sexual
Orientation
Why is this
important?
Read a
script of the
full
discussion
Back to
Case
9. LGBT Health Disparities
• Healthy People 2020, a report put out by Federal Interagency
Workgroup, identified some key health disparities for LGBTQI
individuals:
• Increased risk of STDs and HIV in gay men
• Increased risk of obesity in lesbians and bisexual females
• Lower cancer screening rates for lesbians
• LGBT populations have the highest rates of tobacco, alcohol and other drug use
• Lack of social services for LGBT elders
Back to
Case
Rural LGBT Health
Disparities
10. Rural LGBT compared to Urban Counterparts:
• Less access to care, lack of support system and LGBT
community
• Lower social engagement and not as out to familial or social
circles
• Less likely to be out to their providers
• Lower rates of STD testing but higher rates of positive
diagnoses.
• Trans women have similar rates of risky sexual behavior
compared to urban areas, but fewer facilities with which to
obtain HIV preventive services
• Less likely to have health insurance, more likely to smoke or
binge drink
Back to
Case
11. Discussing Gender Identity/Sexual Orientation
• Do:
• Use gender-neutral language
• Normalize discussion about sexual
health by emphasizing that it is
routine with all patients
• Use the terms that the patient
uses to describe their sexual
orientation or gender identity.
• Explain to patients why you are
asking questions about gender
identity and sexual orientation
• Don’t:
• Make assumptions: ask “Are you in
a relationship?” versus “Do you
have a wife?”
• Ask questions that are
unnecessary, i.e. out of curiosity,
etc.
Back to
Case
Sample Script Additional Exercises for
Practice
12. Back to
Case
Are you in a relationship? I am seeing someone, I’m not
sure how serious it is yet.
To get a better idea of your
health, I ask all of my patients
some questions about sexual
health. Everything we discuss is
confidential. Are you currently
sexually active?
Yes.
With men, women, or both?
Men, however I have had sex
with women in the past.
Do you have any concerns
related to your gender identity
or your sex of assignment?
I sometimes feel that I’m not
sure that I fully identify as a
man, but I don’t feel that I
identify as a woman either.
Do you have any concerns about
your sexual health?
Not really. I recently had STD and
HIV testing at a health center in
a nearby city.
13. Additional Practice:
Use the following hypothetical scenarios to practice discussing sexual orientation and
gender identity with patients
• During a routine history, a male patient tells you that he is
sexually active with men and identifies as gay. He then asks
how this makes you feel. How do you respond?
• A new patient named Lauren is waiting in the exam room for
a routine check up and pap smear. When you walk in to the
room, you see a patient that looks like a man. How would
you respond?
• During a routine visit, a patient tells you she has been feeling
down and isn’t sleeping well. Later, she tells you that she
recently had sex with a woman but “definitely isn’t a
lesbian”. How would you respond? Back to
Case
14. Occupation
Greg recently got his teaching credentials and is now teaching 2nd grade at a local elementary
school. He is worried about his coworkers or parents finding out he is gay- he is afraid he could lose
his job.
Sometimes we have biases or make assumptions without even being aware of it. Being able to
recognize and examine your own biases is an important step in creating an open and
nonjudgmental relationship with your patients.
As providers, it is important for us to examine our own attitudes and unconscious biases.
Personal Biases
Exercise
Values and Attitudes
Exercise
Back to
Case
15. Personal Biases Exercise
Answer the questions below with your initial response. These answers are
not recorded, this is for you to evaluate your own gut reactions to these
questions:
16. Values and Attitudes Exercise
• What are your first reactions to the following statements? How
strongly do you agree or disagree and why?
• I am comfortable talking with my patients about sexual behaviors other than
penile-vaginal intercourse
• Being gay or lesbian is a lifestyle choice
• I feel uncomfortable when I see two men holding hands in public
• I would be upset if someone thought I was gay or lesbian.
• If a child of mine came out as transgender, I would think I did something
wrong as a parent
Back to
Case
18. Family Life
I recently came out to my
father, which has put a
significant strain on our
relationship. I currently live
in a second house on my
father’s property.
Back to
Case
20. Drug and Alcohol Use
I drink only on occasion,
maybe 2-3 drinks a week. I
am an every day smoker,
about ½ a pack a day.
Back to
Case
21. PATIENT PROFILE:
• Patient: Greg Smith, 34 year old
male. Here to establish care.
• He recently got health insurance
after not having any for several
years and is here to discuss
preventive care.
• No notable Past Medical History
Family Life
Relationship
Status/Sexual History
Drug/Alcohol Use
Occupation
Ready to Make Some Treatment
Recommendations?
23. Resources for Rural LGBT I would definitely be interested in
some sort of support group and
also mental health services, but
have no idea where to find them.
I’m also worried about finding
counseling services that are
familiar with LGBTQI issues.
Let’s use the UC Davis resources
map to find some resources for
our patient. Click the link below
and select your county to find
advocacy groups, support
groups, mental health services,
and more:
http://improvingoutcomesconfer
ence.com/map/
24. Congratulations! Your patient is very happy with the care he
received today and will be back to see you for future visits.
I hope that you feel more confident in understanding the
importance of discussing
