Explanation of the specific socioeconomic, spiritual, lifestyle
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.
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.
Sample Solution
John is part of a marginalized and at-risk population, as he is both transgender and HIV positive. As such, there are several socioeconomic, spiritual, lifestyle, and other cultural factors associated with his identity that must be taken into account when interacting with him. These include the mental health stressors associated with discrimination and stigma due to societal norms and expectations; economic insecurity that may arise from employment instability or lack of access to basic resources; lack of access to appropriate healthcare services; limited social networks for support systems; difficulty in obtaining culturally competent medical care due to language/cultural barriers; difficulty accessing medication/treatment options due to costs or insurance restrictions; potential criminalization issues related to substance use (e.g., marijuana); risk of exposure to violence or abuse based on gender identity/expression or sexuality; etc.
When interacting with John it is important to be sensitively aware of these factors by being respectful towards his identity and demonstrating empathy for his unique experience. It would also be beneficial for you as a clinician to provide him with a safe space in which he can talk openly about his concerns without fear judgement or ridicule. To build an effective health history and assess any health risks, some targeted questions could include:
1) Could you tell me more about your transition process?
2) What has been the most difficult aspect of transitioning so far?
3) Are you able identify any support systems available if needed?
4) How do your parents feel about your transition process?
5) Have you ever felt discriminated against based on your sexual orientation /gender identity?