He comes to the doctor’s office as a new patient. John was born female but now identifies as male. He started living as a man two years ago and completed his transition with his family and in social settings last year. Recently, he moved back in with his parents and is currently not working. He has been getting testosterone from the internet and giving it to himself. Apart from getting some medications online three months ago, he hasn’t seen a doctor since he decided to transition. John’s medical history includes smoking two packs of cigarettes every day for the past decade, smoking 3-6 marijuana joints every weekend (he has a medical marijuana card), and experiencing episodes of depression. He has been HIV positive for three years but his last blood test six months ago showed that the virus was under control. Lately, he has been feeling very weak, which led him to move back in with his parents. He takes Biktarvy, a medication for HIV, once a day, which he receives for free in the mail, and injects 100 mg of testosterone every 7 days. He has no significant medical history besides this. John has never been married, and there’s nothing notable in his family’s medical history. He’s worried about being a burden on his family since he’s moved back home and doesn’t have a job, and he’s concerned that his health might be getting worse.
CASE STUDY 1
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.
BY DAY 3 OF WEEK 2
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
BY DAY 6 OF WEEK 2
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.
DIVERSITY AND HEALTH ASSESSMENT
John’s lack of a job, which is a part of society and money, might make it hard for him to pay for healthcare and other basic things he needs. It might also make him feel like he’s causing problems for his family, which could make him feel bad mentally. He’s been getting testosterone from the internet, which might mean he’s trying to treat himself because he doesn’t have enough money or can’t get proper healthcare. John has smoked before and uses marijuana, which could be really bad for his health, especially since he also has HIV. His times of feeling really sad could also make it hard for him to live in a healthy way. Feeling weak lately might also make it hard for him to move around much or eat well. Being transgender, John might have had problems with people treating him badly and finding healthcare that understands him (Westwood, 2022). He might also be worried about finding a doctor who knows about and respects his gender.
When talking to John, it’s important to use the right words for how he sees himself and to be nice about his health history and actions. Also, it’s important to understand that John might not have a lot of money and might be worried about making his family worry about him.
Questions for John:
– Can you tell me about how you see yourself and if you’ve had any trouble getting healthcare because of that?
– How has not having a job lately made it hard for you to stay healthy?
– Can you talk about smoking and using marijuana and if you’re worried about how it’s affecting you?
– Have you felt anything related to having HIV or taking medicine for it?
– How have things been lately for your feelings and how you’re doing emotionally?
References
Brummett, A., & Campo-Engelstein, L. (2021). Conscientious objection and LGBTQ discrimination in the United States. Journal of public health policy, 42 (2), 322-330.
Amiri, S. (2022). Unemployment associated with major depressive disorder and depressive symptoms: A systematic review and meta-analysis. International journal of occupational safety and ergonomics, 28 (4), 2080-2092.
Westwood, S. (2022). Religious‐based negative attitudes towards LGBTQ people among healthcare, social care, and social work students and professionals: A review of the international literature. Health & Social Care in the Community, 30(5), e1449-e1470.
RESPONSES
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RESPONSE 3
