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.

League’s targeted questions

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.

This is the case study that my colleagues are responding to

Case Study:

John Green, 33 year-old Caucasian male, presents to the office to establish as a new patient. John’s natal sex is female but he identifies as a male. He transitioned from female to male 2 years ago. He has made a full transition with family and socially last year. He just moved back home and is unemployed at this time. He has been obtaining testosterone from the internet to give to himself. He has not had any health care since he decided to change other than getting his suppression medications through Telehealth 3 months ago. His past medical history includes smoking 2 packages of cigarettes per day for the last 10 years, smokes 3-6 marijuana joints every weekend (has an active green card), and does suffer from depression episodes. He is HIV positive for the last 3 years but remains virally suppressed at his last blood draw 6 months ago. He has been feeling very weak over the last few weeks which prompted him to move back home with his parents. He takes Biktarvy once daily that comes in the mail for free, tolerates it well, and 100 mg Testosterone IM every 7 days. His PMH is non-contributory. No past medical history. He has never been married. No significant family history. He is worried since moving back home and unemployed he will be a burden on his family, and he thinks his health may be declining.

 

Kathy C.

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.

 

The patient assigned is J.G., a 33-year-old male who transitioned from female to male two years ago. He obtains testosterone from the internet and takes intramuscular injections every seven days. The patient is currently depending on his family since he is unemployed. Given this information, he is of low socio-economic status. It is also worth noting that the patient has not had any health care since transitioning besides the suppression medication he got through telehealth. This is common among the transgender community: avoiding healthcare due to anticipated discrimination, low quality of care offered to the LGBT (lesbian, gay, bisexual, transgender) community, and lack of insurance (Kcomt et al., 2020).

In communicating with the patient, the provider will use a question-centered approach to bridge the gap between the patient and provider direct questions about the patient’s physical health instead of avoiding making them uncomfortable as they had never been to a hospital in person since their transitioning. Another strategy to gain pertinent information may be exploring the patient’s ideas about the issue, trying to understand the person and family influences, telling the patient what is wrong and seeking common ground and partnership, and finally, striving for a provider-patient relationship (King & Hoppe, 2013).  Using these ten questions would aid in demonstrating to the patient that the provider is culturally competent and knowledgeable on the health risks and disparities of the transgender community and his eagerness to personalize their care (Kcomt et al., 2020).

The few things that caught attention were that the patient had been smoking two packets of cigarettes daily for ten years and 3-6 marijuana joins every weekend, which may have been the leading contributing factors to his depressive episodes. He has been HIV positive for three years which is virally suppressed from his last blood draw six months ago. Additionally, he takes biktarvy daily, and his body tolerates it well. The provider should have doubts about the patient’s lifestyle. Still, it would be impossible to get more information because of society’s stereotypical view of what kind of people the LGBT (lesbian, gay, bisexual, transgender) (Suonpera et al., 2019). To assess the lifestyle context, the provider will inquire about his sense of life control and support networks. The patient reported that they have been feeling weak in the past few weeks and are concerned that their health is deteriorating. I suspect that this is a result of them taking their biktarvy medication, chain-smoking cigarettes, and high consumption of marijuana (Suonpera et al., 2019).

Targeted questions 

The questions I would ask to build up the health history and asses any health risks are:

• How long have you been taking your biktarvy?
• How active is your sex life?
• How long have you been having depressive episodes?
• How do smoking cigarettes and marijuana help you?
• What brought you in today?

Even though the patient is transgender and somewhat challenging to assess, it is necessary to attend to the cues and findings that cannot be communicated and should not be ignored.

References

Kcomt, L., Gorey, K. M., Barrett, B. J., & McCabe, S. E. (2020). undefined. SSM – Population Health, 11, 100608. https://doi.org/10.1016/j.ssmph.2020.100608

 

Maria. C

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.

Cultural competency is necessary to provide the best care and avoid inequalities of care, as one of its main goals is to alleviate minority health disparities (Aggarwal & Others, 2016). As the LGBTQ community experiences and will keep experiencing a challenging history, health professionals must learn to provide compassionate, comprehensive, and high-quality care with education (Bass & Nagy, 2021).

Understanding their terms is a way to be sensitive and better approach the LGBTQ community, as the client belongs to it. Specifically, for the scenario provided the term is F2M/FTM (female to male) – Female at birth but identifies as a male (Bass & Nagy, 2021).

Below are five specific proposed questions for the patient that would help not only build his health history but also assess his health risks and allow him to initiate health care actions proposed for the state of Maryland.

1. What interventions have you considered to affirm your own gender identity?

The responses to this question will allow exploring the client’s information about the resources needed to achieve his gender identity, his expectations for accessing them, and his knowledge of the available resources in the area. It will also allow connecting the client with gender clinics like Chase Brexton.

1. Are you afraid of someone, or have you been afraid of someone in the past?

The LGBTQ community usually is subject to violence. It is a population with higher rates of depression, sometimes related to a lack of acceptance by friends or family or the lack of a support network. The responses will guide to step toward screening for depression, trauma assessment, suicidal assessment, or if there is present a reportable situation and to identify if  is a need to refer to behavioral services.

1. Let us talk now about your current health condition

This open-ended question will encourage the client to express his chief complaint, his medical history, and continuous interaction with the provider to obtain detailed information and understand the social and cultural context.

1. Could you describe the health care do you need right now?

Health care providers’ negative attitudes toward HIV-positive patients could lead to suboptimal care. The client’s case could be afraid due to his unemployment, not income, no health coverage, past experiences and not feeling well. Also, he has not money, needs care for his health condition, access to the antiretroviral medication and the testosterone he is auto prescribing. If client admits the need of health care, it will an opportunity to link him to the Maryland AIDS Drug Assistance Program (MADAP), which provides health insurance and pays for the antiretroviral he is currently taking. It will also allow exploring all his medical needs, to interchange suggestions of his current health needs, for example, complete and extensive lab work including viral load, chest RX, and update his immunizations, among others.

1. Is any other topic do you want to discuss today?

This last question proposed will promote confidence, strengthen the initial rapport, and a feeling of listening. It confirms that the session is client’s focused promoting trust and allowing the interchange of additional information about his social and health history.

References

Aggarwal, N. K., Cedeño, K., Guarnaccia, P., Kleinman, A., & Lewis-Fernández, R. (2016). The meanings of cultural competence in mental health: an exploratory focus group study with patients, clinicians, and administrators. SpringerPlus, 5, 384. https://doi.org/10.1186/s40064-016-2037-4