John Green, 33 year-old Caucasian male

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.

  DIVERSITY AND HEALTH ASSESSMENT

John’s unemployment which is a socioeconomic aspect may impact his ability to afford healthcare and other basic needs. He may also feel like a burden on his family, affecting his mental health (Amiri, 2022). His use of internet-sourced testosterone suggests he may be attempting to self-treat due to financial limitations or lack of access to proper healthcare. John’s smoking history and use of marijuana could have adverse effects on his health, especially when combined with his HIV status. His depression episodes may also impact his ability to maintain a healthy lifestyle. His recent weakness could also affect his physical activity levels and diet. As a transgender individual, John may have faced discrimination and challenges accessing healthcare services (Westwood, 2022). He may also be concerned about finding a healthcare provider knowledgeable and respectful of his gender identity.

GET A CUSTOM-WRITTEN ESSAY OR SHADOW HEALTH HELP 

When interacting with John, it is essential to respect his chosen gender identity and use appropriate pronouns (Brummett & Campo-Engelstein, 2021). It is also essential to approach discussions of his health history and behaviors in a non-judgmental and supportive manner. Additionally, sensitivity should be given to John’s potential financial constraints and concerns about burdening his family. Targeted Questions:

• Can you describe your gender identity and any experiences you have had accessing healthcare as a transgender individual?
• How has your recent unemployment affected your ability to maintain your health?
• Can you discuss your smoking and marijuana use and any concerns you have about the impact on your health?
• Have you experienced any symptoms related to your HIV status or medication regimen?
• How have your recent experiences affected your mental health and emotional well-being?

 

                                                                                                                     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

• Great job on your post! It is not uncommon for the transgender population to experience discrimination and stigma in their day to day lives. These effects can easily affect their willingness participate in and access healthcare. An article by the (Centers for Disease Control and Prevention, 2022) states that “One of the most important steps in creating a welcoming environment for transgender people (and all people) is to address patients using their preferred names and pronouns” (para. 22). It is also worth mentioning that based on some recent studies, it is recommended that health care providers avoid using gendered terms like “women’s heath”.  A journal by (Vermeir et al., 2018) stresses the “importance of health care providers being aware that individuals with diverse gender identities are utilizing traditionally “gendered” services and that these individuals should not be isolated, called-out, or rudely questioned for appearing to be “out of place” (para. 13).

  I also believe the questions you chose to ask can assist in extracting the necessary data to build this patients health history. Additional questions to consider might include: 1. What symptoms are you experience that cause you to believe your health is declining? 2. Are you currently sexually active? If so, are you using protection? 3. Would you be open to exploring the different treatment options available for depression?

        Centers for Disease Control and Prevention. (2022, February 18). Patient-centered care. Centers for Disease Control and Prevention. Retrieved March 8, 2023, from https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/affirmative-care.html#understandingLinks to an external site.

       Vermeir, E., Jackson, L. A., & Marshall, E. G. (2018, August). Improving healthcare providers’ interactions with trans patients: Recommendations to promote cultural competence. Healthcare policy = Politiques de sante. Retrieved March 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147364/Links to an external site.

• RESPONSE 2

  Thank you for your post!  It provided a lot of good information. Assessing his readiness to quit smoking is beneficial and can aid further preventative healthcare. In addition to the smoking cessation questions, this patient could also benefit from a mental health and depression screening. Stachowicz & Sowa-Kućma (2022) suggests that individuals over 18 should be screened for depression and notes that those who are unemployed, have a poor health status, and have a history of depression are at the most significant risk. The Patient Health Questionnaire-9 (PHQ-9) is a tool that can be used to screen for depression.  I believe that this depression screening could benefit this patient and lead to the patient seeking treatment or the provider suggesting therapy for this patient.

  References:

  Kroenke, K. (n.d.). PHQ-9 (patient health questionnaire-9). MDCalc. https://www.mdcalc.com/phq-9-patient-health-questionnaire-9Links to an external site.

  Stachowicz, K., & Sowa-Kućma, M. (2022). The treatment of depression — searching for new ideas. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.988648

• RESPONSE 3

  Hi XX

  Thanks for providing such an insightful assessment of John’s situation. You have brought up some crucial points about how his unemployment, smoking, marijuana use, HIV status, depression, and gender identity could significantly impact his health. John requires a non-judgmental and supportive interaction and sensitivity to his potential financial constraints and concerns (Pratap et al., 2021). Your targeted questions are also beneficial in understanding his situation better. For further exploration with John, looking into the effects of job loss and lack of access to healthcare services on his mental and physical health would be beneficial. Additionally, considering his gender identity, it may be beneficial to look into how his access to healthcare and mental health services has been impacted by discrimination and other social stigmas (Cicero et al., 2019). Also, looking into the socioeconomic impacts of unemployment might give us some additional insight into his current situation and how it affects his health (Pratap et al., 2021).

   

   References

  Cicero, E. C., Reisner, S. L., Silva, S. G., Merwin, E. I., & Humphreys, J. C. (2019). Health care experiences of transgender adults. Advances in Nursing Science, 42(2), 123–138. https://doi.org/10.1097/ans.0000000000000256

  Pratap, P., Dickson, A., Love, M., Zanoni, J., Donato, C., Flynn, M. A., & Schulte, P. A. (2021, September 23). Public health impacts of underemployment and unemployment in the United States: Exploring Perceptions, gaps, and opportunities. International journal of environmental research and public health. Retrieved March 11, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8508259/