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OBJECTIVES

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  • Understand the social and medical context in which lesbian, gay, bisexual, and transgender (LGBT) patients seek health care.

  • Describe major medical and psychosocial concerns in LGBT patients.

  • Summarize strategies to promote culturally appropriate care for LGBT patients.

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Dr. Nguyen is in the middle of her busy family practice clinic. She enters the room to see her new patient “Mr. John S.” and is puzzled to see the notation “due for Pap” among the reminder notations. The patient is male appearing and appears quite apprehensive and angry. Dr. Good asks what can she do to help and Mr. S explains with some hesitation that he is a transgender man and has female anatomy and therefore requires a Pap smear. His previous medical provider was uncomfortable with this and suggested that Mr. S. see a “gay friendly” doctor. Dr. Good was listed on a Web site so Mr. S made an appointment but is now upset because the front desk staff had loudly stated, “there must be a mistake, it says here you need a Pap smear” and then began to stare at Mr. S and laugh nervously.

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INTRODUCTION

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Lesbian, gay, bisexual, and transgender (LGBT) Americans and Western Europeans now experience a degree of equality, visibility, and support that was unimaginable in the past. LGBT people are much more visible in the media, workplaces, schools, government, places of worship, and a host of other settings. As LGBT people have gained visibility, equality, and support throughout our society, they have received increasing attention in health care and health education.

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Health-care providers are likelier than ever before to be personally acquainted with someone LGBT and to have a general familiarity with LGBT experiences and concerns. Consequently, health-care providers must be equipped to offer truly welcoming, knowledgeable, and sensitive care to LGBT patients, who face particular challenges in health care. This chapter describes the health-care concerns of LGBT patients and explains how health professionals can best address them, creating optimal medical outcomes and building relationships of comfort and trust.

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“LGBT” TERMINOLOGY

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Optimal care for LGBT patients begins with an understanding of those to whom the “LGBT” acronym refers. This chapter uses “lesbian” to refer to women primarily attracted to other women; “gay” to refer to men primarily attracted to other men; “bisexual” to refer to those attracted to both men and women; and “transgender” to refer to two groups: those who identify with and transition to a gender other than the one assigned to them at birth, and those who express gender differently from prevailing norms in our society. In other words, the terms “lesbian,” “gay,” and “bisexual” refer to sexual orientation, while “transgender” refers to gender identity or gender expression. A patient who is transgender could have any sexual orientation: heterosexual, lesbian, gay, or bisexual. For this reason, laws and policies prohibiting discrimination against LGBT people ...

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