1. Opening Doors Providing Quality Care to LGBTQ Patients Opening Doors Providing Quality Care to LGBTQ Patients Skamania Lodge, OAFP Annual Conference, April 18 th, 2015 Mali Nakhai, MD R2 Providence Oregon Family Medicine Residency Carol Blenning, MD Associate Professor, OHSU Department of Family Medicine

2. What you will learn: AAFP recommended curriculum guidelines for FM Residents Communication Health history Primary care counseling Patient-centered treatment

3. Word Cloud Lesbian Gay Bisexual Transgender

4. Sex What’s the definition of… Biological and physiological characteristics that define men and women. Determined by chromosomes and anatomy.

5. LGBTQ(IQ) What’s the definition of… Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Questioning

6. Gender What’s the definition of… Socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women.

7. Gender Expression What’s the definition of… The way that a person manipulates their appearance and/or mannerisms to expresses their gender, whether it is feminine, androgynous, or masculine.

8. Gender Identity What’s the definition of… Psychological awareness or sense of where one fits on the man-woman spectrum.

9. Gender Role What’s the definition of… The part of behavior that is influenced by society’s expectation of what is gender-appropriate.

10. Gender Variant Gender Non-Conforming Transgender Trans What’s the definition of… Umbrella terms: a person whose gender identity or expression differs from the sex assigned to them at birth.

11. Transsexual What’s the definition of… Occasionally used to describe trans people who have undergone gender reassignment surgery

12. Gender Queer What’s the definition of… People whose gender identity does not fit neatly into stereotypical male or female roles

13. Cross-dresser What’s the definition of… Individuals with desire to wear the clothing of another sex but not to change their gender

14. Sexual Orientation Sexual Attraction What’s the definition of… Who a person is attracted to sexually and romantically. (heterosexual, homosexual, bisexual)

15. Sexual Behavior What’s the definition of… Who a person chooses to have sex with

16. Sexual Identity What’s the definition of… A label a person chooses to call themselves to help explain sexual orientation

17. Risk Factors, Preventive Care

19. Lesbian Physical Health Heart disease Cancer Fitness Obesity Injury/violence

20. Lesbian Behavioral Health Mental Health Suicide Substance Abuse

21. Gay Physical Health Heart disease Cancer Injury and violence Fitness

22. Gay Behavioral health Mental health Suicide Substance abuse

23. Gay Sexual health HIV/AIDS Syphilis HPV Hepatitis

24. Bisexual Physical Health Cancer Heart disease Injury/violence

25. Bisexual Sexual Health Men Women Behavioral Health Mental Health Suicide Substance abuse

26. Transgender Physical Health Heart disease, Cancer Silicone Injury/violence Harm reduction

27. Transgender Behavioral Health Mental health Suicide Substance abuse Transition-related Hormones Surgery

28. Youth Violence bullying homophobic victimization Substance abuse Depression Suicide and suicide attempts (twice as much as heterosexual counterparts). Homelessness Sex work Heteronormative language/culture

29. Reproductive Health Adoption Surrogacy Alternative insemination

30. Safety “the truth, the whole truth, and nothing but the truth” Communication, open-mindedness Safer sex Routine and targeted preventive care

31. Making your practice LGBT friendly Create a welcoming environment Visual environment non-discrimination statement Inclusive language Forms Interactions Educational handouts

32. Making your practice LGBT friendly Avoid assumptions AND unrelated probing Get the facts Be aware of Health Issues that may impact LGBT patients Show your commitment to providing care to all in our community Treat patients like people too!

33. Resources-Local Q Center TransActive Gender Center SMYRC

34. Resources-Internet Top Health Issues for LGBT Populations Information & Resource Kit http://store.samhsa.gov/shin/content//SMA12-4684/SMA12-4684.pdf http://store.samhsa.gov/shin/content//SMA12-4684/SMA12-4684.pdf GLMA.org The Fenway Institute: LGBThealtheducation.org Kaiser Family Foundation bulletin on LGBT health and access to care and coverage UCSF Transgender Center for Excellence: transhealth.ucsf.edu www.WPATH.org Sarabecker.com/t LGBTdata.com lesbianSTD.com OutForHealth.org/for-providers.html

35. Q&A