Fourth Tuesday Blogs
My Fourth Tuesday Blogs are dedicated to LGBT Health. Please tune in to learn and to share more about these topics. Even if you are not LGBT you may discover it useful or even necessary for you to become a more sensitive, understanding and caring human being. Furthermore, you might be surprised to learn the multiple aspects of heterosexual health topics that overlap with LGBT health. If you associate as LGBT, please share your expertise and perspectives. I am a physician and healer who believes in health equity and am committed to the elimination of health disparities of all types.
The Healthcare Safety Net
I love my work in the Emergency Department. It brings me in contact with every aspect of human society. Each day, when I dare to believe I have pretty much seen everything, new experiences surface in my practice on a regular basis. I guess I should come to accept that something different happens pretty regularly in my experience as an Emergency Physician. No two days in the “ER” are EVER the same. Being the safety net for the current healthcare system is no small task.
“He”, I mean “She”
The scenario of inspiration for my Fourth Tuesday Blog was this – a female patient discovered that our electronic medical record system had her sex listed as male… and she went OFF. There was a lot of drama associated with this discovery that escalated to the highest administrative level that day. I couldn’t understand the emotion. It just seemed so out of proportion to the earnest error in the medical record. I mean, sometimes during registration of patients, demographic information gets entered incorrectly by mistake. But this was not exactly the case. That’s when I discovered that it was not a mistake of the entry in the electronic medical record. It was a failure to have made the change/update. It was her post-traumatic experience of emotional trauma and discrimination she endured going through a (years previous) tedious process as a man in order to become a woman. She had taken a multitude of legal steps to have what was once a “he” be transformed complete to a “she” and was very successfully living her life as a female. It made me reflect earnestly and deeply on the drastic steps that sometimes become crucial to the health and well being of individuals who believe their souls inhabit the wrong type of body.
Free Flow
This experience lead me to start this series off with a simple introductory discussion on sex and gender. My goal is to educate and discuss these topics – with every attempt to flow free from judgment and religious dogma – in an effort to promote mind, body, spirit optimal health.
Sex and Gender: Not the Same Thing
Sex and gender are terms that are often confused by even the most well-meaning individuals. An important aspect of increased LGBT cultural sensitivity is understanding the difference between these terms and using them appropriately.
Biological Designation
Sex is a biological designation. A person’s sex is determined by the chromosomes they randomly receive, and that determines the physiological traits that differentiate males and females. Humans have 23 pairs of chromosomes. One copy of each chromosome is inherited from the female parent and one copy from the male parent. This explains why children inherit some of their traits from their mother and others from their father. You have seen daughters that resemble their fathers and sons that look like their moms. Of the 23 pair of chromosomes, 22 are called “autosomes” and the 23rd pair are called “allosomes” – or sex chromosomes. Females have an XX pair of allosomes and males have an XY pair. But guess what? About one or two in every 1,000 males may be born with an XXY or XYY allosome although many of these males do not necessarily exhibit any physical or behavioral symptoms related to it. Likewise about one in every 1,000 females is born with an XXX allosomes but these females also often have no distinguishable difference from the general population.
Had Enough Sex? Then Let’s Talk about Gender
Gender, conversely, is a social construction of a person’s biological sex, as are the cultural roles and stereotypes associated with it. These can include dress and physical appearance, mannerisms and behavior, and family and societal roles. Gender categories, and the roles associated with them, can vary widely from one culture to another and also change over time within a culture. Certain cultures recognize a third gender that is neither man nor woman, such as the hijras in Mumbai or the kathoeys of Thailand.
Black and White and Gray
Gender identity is an individual’s personal sense of their own gender, and is not necessarily linked to their sex. In most Western societies, this exists as part of a gender binary, with individuals identifying as either masculine or feminine. A person who is physically male may identify as a woman, and vice versa. It should be noted, however, that gender lines can be blurred, and individuals can exhibit varying degrees of masculinity or femininity along a spectrum. Likewise individuals may present as more masculine or more feminine given the social context and their own level of comfort.
Get it Right
There are two areas in health care where the distinction is important. The first is in medical writing. Often sex and gender are treated as interchangeable terms, as in, “gender differences in morbidity and mortality.” When referring to the physical aspects of being male or female, the term “sex” should be used exclusively. That is not to say that “gender” has no place in medical writing; on the contrary, when discussing men and women as social groups, gender identity may be of particular interest in research, and should not be avoided altogether. Context is important, however.
Are You a Boy or a Girl?
The second area is in a health care provider’s cultural sensitivity to her patients. Using myself as an example, I have found it sometimes necessary to simply ask my patients out of respect, what gender would you like me to refer to you as? What is your sexual orientation? It is important for health care providers to be clear that they do not discriminate based on sexual orientation or gender identity, and to create safe spaces where their patients can disclose their gender identity. Likewise health care providers should educate themselves about culturally sensitive providers in their area that target LGBT, and particularly transgendered, populations. The Human Rights Campaign provides a Health Care Equality Index that ranks providers by state in terms of cultural sensitivity to the LGBT community. The Transgender Health Network and RU12? Community Center also list trans-friendly health care providers.
