John Green, 33 year-old Caucasian male

John Green, 33 year-old Caucasian male

John Green is a 33-year-old Caucasian male, but it’s important to note that his natal sex is female, and he identifies as male. He underwent a transition from female to male two years ago, fully embracing this change in his family and social life. Currently, he’s unemployed and has been acquiring testosterone from the internet to self-administer. He hasn’t received any healthcare services apart from obtaining suppression medications via Telehealth three months ago. His medical history includes smoking two packs of cigarettes daily for the last decade, along with smoking 3-6 marijuana joints every weekend. John also experiences depression episodes and has been HIV positive for the last three years, with viral suppression achieved at his last blood test six months ago. Lately, he’s been feeling weak, which led him to move back in with his parents.

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His medication regimen consists of daily Biktarvy, received by mail, and 100 mg of Testosterone IM administered every seven days. He has never been married, and there is no significant family medical history. He’s concerned that being unemployed and living with his family might burden them, and he’s worried about his declining health.

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Exploring John’s case, there are several factors to consider. His unemployment, which is a socioeconomic factor, might affect his ability to afford healthcare and other basic necessities. It could also lead to feelings of being a burden on his family, impacting his mental health (Amiri, 2022). His use of internet-sourced testosterone may suggest that he’s trying to self-treat due to financial constraints or limited access to proper healthcare. The combination of his smoking history, marijuana use, and HIV status could have negative effects on his health. His episodes of depression may also influence his ability to maintain a healthy lifestyle. His recent weakness could affect his physical activity and diet. Being a transgender individual, John might have encountered discrimination and faced challenges in accessing healthcare services (Westwood, 2022). He may also be concerned about finding a healthcare provider who is knowledgeable and respectful of his gender identity.

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

1. Can you describe your gender identity and share any experiences you’ve had while accessing healthcare as a transgender individual?
2. How has your recent unemployment affected your ability to maintain your health?
3. Can you discuss your smoking and marijuana use and any concerns you have about their impact on your health?
4. Have you experienced any symptoms related to your HIV status or medication regimen?
5. 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.

Your post is well done! Discrimination and stigma are challenges that transgender individuals often face in their daily lives, which can impact their access to healthcare. According to the (Centers for Disease Control and Prevention, 2022), it’s crucial to create a welcoming environment for transgender individuals by using their preferred names and pronouns. It’s also worth noting that recent studies suggest healthcare providers should avoid gendered terms like “women’s health.” As (Vermeir et al., 2018) emphasizes, healthcare providers should be aware that individuals with diverse gender identities may use traditionally gendered services, and they should not be isolated, singled out, or treated rudely for seeking care (para. 13).

Your chosen questions are indeed helpful in gathering the necessary information to build this patient’s health history. Here are a couple of additional questions to consider:

1. Can you describe any specific symptoms you’ve been experiencing that make you believe your health is declining?
2. Are you currently sexually active, and if so, are you using protection?
3. Would you be open to exploring the various treatment options available for managing 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/

  

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