Rainbowpageralert

Rainbow Pager Blog

Every once in awhile the Rainbow Pager goes off and Dr. Rainbow responds!  Questions from every area of healthcare and patient contact are coming across the pager screen and we are dedicated to finding the answers.

Follow our blog here and on Facebook for exiting updates and expert opinions on LGBTQI healthcare!  As always we are dedicated to starting and helping along the conversation.

Remember, These posts will be supported by data and evidence from the best authorities. They are intended for informational and discussion purposes. They are not intended to diagnose, treat or provide medical advice.


RAINBOW PAGER ALERT

November 2018

Time to get back to work!
We are so lucky to have a contribution from the very awesome Jessica Halem, MBA who happens to be the LGBT program director for Harvard Medical School.

Jessica we had the following question sent to the rainbow pager:

"Hello! I have a question for the experts: Do any medical organizations have established guidelines against the usage of the term "homosexual"? I know GLAAD, The Associated Press, the NYT and many media sources and universities advise against usage of the term, but do we still use it in a medical setting? I had a lecturer today say that MSM, MSW, WSW, WSWM, etc. are incorrect and to use the terms, "heterosexual, homosexual, and bisexual" when giving a case presentation. I challenged the idea and was told they are "medical terms" and we always use the "medical terms." So, help a student out!"
-PA in training seeking better answers

Dear PA in training seeking better answers:

First off, let me say how pleased I am to hear that you have cases with LGBTQ patients in your education. It wasn’t that long ago that cases like this weren’t available, discussed, or appreciated as an important part of patient care. We have come a long way.

Language that describes the LGBTQ community has changed and will continue to change. But language is just a tool to use to describe what we observe, learn, or hear from our patients. So, everyone will have to be a bit flexible as we continue to listen better and illicit more information from patients. In fact, at the turn of the last century in the US, the “medical term” was “invert” which represented the conflation of gender and sexual orientation and then the word “homosexual” became more widely used. Both were terms used more with derision and judgement than care from the medical community. So, there’s that history.

Today, we know “nonbinary” is a widely used word to describe a gender identity or expression that some would have called “androgynous” just a few years ago. And of course, transsexual was a word we used to use as well, but now use the word transgender. I am sure there are cases and textbooks that haven’t been updated accordingly.

So, finding an authority on “medical terms” seems to be the issue with your lecturer. I can say with authority -- we do not use the word “homosexual” to describe patients anymore. It actually isn’t a word that people use to describe themselves or does a good job of describing behavior that needs to be discussed.

What is key here is appreciating two distinct differences in discussing sexual orientation – first, language that describes the SEXUAL BEHAVIOR of our patients and secondly, language that patients use to describe themselves. What we still like about MSM is that it describes sexual behavior and doesn’t assume identity. We know plenty of men have sex with other men and are married to women. We also know plenty of women describe themselves as lesbians but have had or will have sex with men.

In terms of who else is an authority on medical terms for the LGBTQ community – the NIH now uses the phrase “sexual and gender minorities” and the hospitals you will work with have electronic health records that probably already have SOGI (sexual orientation and gender identity) data collection in place and use words like “gay” and “cisgender”.

Medical terms are only authoritative if they are helpful in understanding, valuing, and supporting the patients you are being trained to care for in the future.

If this analysis doesn’t work, attached here are guidelines from Harvard Medical School:

https://mfdp.med.harvard.edu/…/HMS%20SOGI%20terminology%203…

Jessica Halem, MBA
LGBT Program Director
Harvard Medical School

Thank you Jessica for your awesome contribution to our blog! What an amazing conversation starter you have been!

Rainbow Pager End of the Year 2017:

Rainbow Page is Ringing like crazy...let's see if we can help out!

Barbara Wolf, PhD

Corporate Director, Behavioral Health Education and Physician Wellness

McLaren Health Care

Associate Professor, Family Medicine and Psychiatry Departments

Michigan State University Colleges of Human and Osteopathic Medicine

Dr. Wolf we have the following message on the rainbow pager:

"Dr. Rainbow,

I am a counselor in a college setting, however, not in the most forward thinking of places.  I often get students who are struggling with sexuality and we usually can get somewhere by talking things through and creating a support network, or introducing them to resources I am aware of around our campus.  However, this time I had a student who is struggling with gender identity.  He, as he still identifies with his birth sex, feels that he is “living a lie in his body”, however, is uncomfortable with words like “trans” or “gender, identity problems".  I do not have a lot of resources for student’s with this struggle.  I know this is a complex question, however, I just want to identify something we can work on, to get started.  What are some good questions or conversation starters that might help me guide him to next steps?"

Dear Counselor in the Boonies!

How nice that this young man has someone like you to begin this conversation with... Since he is a college student, he may be interested to know some interesting facts, like the fact that 22 scientific societies think of gender on a continuum. AND, that about 6% of our population feels like your student does, that perhaps his body does not match his feelings about it. He may feel like no one else is thinking this and it is good to not feel alone And finally, that some traditional native american cultures identified three genders, male female and those who felt differently about themselves. It is very common for teens who are beginning to think differently about themselves in terms of their gender to have already faced some taunting or bullying at school. I would have a conversation about that with this young man. That may lead you further Into the conversation about gender and his reluctance to talk about it as he describes any situations he has been through Ask him about people who have been gender non conforming and what he admires about them. He may not know anyone personally, but I would imagine he has seen this in the media. Reassure him that it is not crazy to be different. But you must remember that as a counselor you will need to evaluate him just any other college student you would see. This, as you know covers assessing depression, anxiety, substance use disorders, sleep disturbances and any psychotic symptoms he may be experiencing. And since violence is a serious problem that non conforming youth often contend with, ask about harm from others as well as thoughts about suicide. Finally, as a professional, you will need to be mindful of your own prejudices and judgements you might have about this sensitive topic. It is difficult to be aware while working with others but is vital And lastly, your student will need to be aware of services he can access in his search. Here are some he might find helpful.

The national LGBT hotline: http://www.lgbt.org LGBT Youth Resouces , Center for Disease Control and Prevention

http://cdc.gov/lgbtheath Youthresources.htm

Glaad. http://glaad.org/resourcelist

Each state has its own services and you can access your own state resources through the above website.

Thank you Dr. Wolf! I think our counselor has some great ways to keep the conversation going! We'll take the pager back now and wait for the next alarm. 


Rainbow Pager 5/2017:

The Rainbow Pager is going off again!

We have a new midwife who needs some help! So we sought out the expert help and found a great clinician to start the conversation:

Tanya Vaughn-Deneen, DNP, CNM, FNP-BC

Certified Nurse Midwife

Partridge Creek Obstetrics and Gynecology

Dr. Vaughn-Deneen, our new midwife has asked, "I have a wonderful lesbian couple that has come to my practice…How do I make the mom (that’s not the pregnant mom) feel included? I mean she isn’t pregnant…Do I just act like I do with my male dads?" What would you tell our new midwife and our community?

Great question! The heart of midwifery focuses on having a trusting relationship with the gestational woman and her partner. It is important to incorporate the non-gestational partner into prenatal care and education regardless of sexual orientation. The key is personalization. I start at the very first obstetric visit by incorporating both people in the conversation.

How do you incorporate both partners?

You can use appropriate eye contact and ask questions related to their desires for prenatal care and birth support. It is also important to listen. Let the non-gestational person tell you what this pregnancy and birth means to them. Inquire about the type of participation that they would like to have for example assisting with the birth process, induction of lactation for dual breastfeeding or skin to skin care soon after the baby is born. This is a great time to review concerns they have and answer questions. Many lesbian couples have a fear of rejection from their healthcare providers. They want to know that they are receiving care in a safe place and once this is established they will feel better about disclosure of their sexual identity.

You talked about rejection and fear in healthcare...can you touch a little on that topic?

Developing trust is significant when caring for lesbian couples. There are several health disparities associated with the LGBTQ population including: 1) lower rates of health insurance coverage, 2) high stress levels, 3) higher risks for mental illness, 4) increased likelihood of smoking, alcohol or drug abuse, 5) and an increased risk of engaging in risky behaviors (Krehely, 2009). This is important to understand because without trust we may not be able to address some of these issues to reduce health disparities and improve the lives of the lesbian people we serve. Midwifery care seeks to better understand the person and meet them where they are, not where we think they should be.

It sounds like you are awesome at establishing a trusting relationship with your parents to be... What about the community surrounding a birth?

It is essential to find a supportive childbirth education class for the couple within your community. Some prenatal class instructors use the terms father, daddy or dad to insinuate the non-gestational person. On other occasions the person is viewed as the mother, sister or friend. This can really make that person feel uncomfortable and lead to increased, unwarranted minority stress. Do not assume! Inclusion can be achieved using an open, non-heteronormative communication style. The language you choose to use speaks volumes. If you are unsure what terminology or pronouns should be used simply ask the person what they prefer. You can also ask “how are you related?" or “what is your relationship?”. This type of communication is open and allows the individuals to respond in a way they respect and honor. Sometimes doulas have same-sex couple classes or can help with a private childbirth education class. Heteronormative communication should not be used for any woman.

Dr. Vaughn-Deneen, you have been very active in helping to start the conversation within midwifery to better the care of LGBTQI individuals. Can you tell us some of the ways you have helped?

Education is fundamental to making system wide changes. As midwives we must take time to educate ourselves the best way we can so in turn, we can better care for our communities. Take a closer look at your intake forms to avoid heteronormative choices, offer brochures that relate to lesbian healthcare, and critically appraise the images that appear in your office setting. Do you see diversity in the family photos or mothers and babies that are displayed? There are several publications that support LGBTQ health and can be set out in the waiting room for review by your patients. Another idea is to evaluate your labor, delivery and postpartum units to see what the care looks like in those units. It is possible to set up an education session to help the nurses better understand the needs of the LGBTQ population. Change takes time but it is part of our mission to make the world a better place, one birth at a time.

Here is a list of some websites that I have found to be supportive:

1) Fenway Health: fenwayhealth.org

2) Gay and Lesbian Medical Association: www.glma.org

3) Human Rights Campaign: www.hrc.org

4) The National Association of Lesbian, Gay, Bisexual, Transgender Addiction Professional and their Allies: NALGAP.org

5) The National LGBT Cancer Network: cancer-network.org

As midwives, our goal is to provide safe, competent care that honors the couple regardless of sexual orientation and just by asking this question you are well on your way to make differences!

http://www.partridgecreekobgyn.com

Thank you for answering the Rainbow Pager Dr. Vaughn-Deneen! I feel like our new midwife has all the information to get started on being part of the conversation


Rainbow Pager 3/2017: 

The following question was submitted and we sought out an expert to help us with starting the conversation:

Dr. Sawni, M.D. FAAP, FSAHM
Director of Adolescent Medicine
Hurley Children’s Hospital/Hurley Medical Center
Assistant Professor, Department of Pediatrics and Human Medicine, Michigan State University-College of Human Medicine


Here's our conversation:

Dr. Sawni, when counseling or seeing an adolescent in your office. How would you approach a youth that you sense has a concern related to sexuality or gender, but hasn’t directly asked?

Thanks for the great question! When I'm talking to an adolescent or young adult in my office and i'm doing a sexual history (confidentially of course without a parent/guardian in the room & after explaining confidentiality to the team first)

I ask all my adolescent patients:
-If they've got somebody special in their life?
-If they're involved in a relationship with either a guy or a girl or both, if they've got a girlfriend or boyfriend or both? 
-I ask if they've ever had sex with anybody & if so with a guy/girl or both?

Regardless of whether my patient is a male or female. I try and ask these questions in an open and nonjudgmental way.

This way opening the door to allow the teen to answer honestly about their sexual identity/or sexual feelings; whether they see themselves as homosexual or bisexual or not sure. 

Then depending on their answer & if I ask in an open, nonjudgmental, and confidential way most teens are really honest with respect to their sexual behavior and sexual identity & will tell me. They pretty much know what I'm asking them (-ie how they view their Sex identity).

Then depending on their answer I'll ask more detailed questions especially if if they say they are homosexual/bisexual...etc. 
- How they are coping?
- Who knows? 
- If they have come out to family and friends?
- About their support system?

I always discuss high risk sexual behavior. But, I counsel all my teens on high risk sexual behaviors: contraception, condoms, sex with drug and alcohol use irregardless of their sexual identity. 

I ask about depression and also support groups in the community and maybe refer them to those groups. 

WOW! Great information Dr. Sawni! I am sure this will get the conversation started. The Rainbow Pager has been answered!