Getting Good Health Care and Preventive Care

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Knowing when and why to seek health care and getting adequate care from a sensitive provider can be a challenge for anyone. Lesbian, gay, bisexual and transgender (LGBT) people may experience added difficulty.

Recent studies show that many physicians, clinicians, and therapists view LGBT people and their lifestyles as strange or irrelevant. Many providers claim that they do not feel comfortable treating LGBT people, and others see them as problematic, confusing, and dismissible. Many LGBT people recognize these perspectives and are reluctant to seek medical care.

The following advice is beneficial to anyone seeking health care, especially lesbian, gay, bisexual, and transgender people who benefit from experienced health care providers, cultural sensitivity, and self-advocacy.

Choosing a Provider

Providers can be any of the following:

• Alternative health practitioners, including massage therapists, acupuncturists, and chiropractors
• Medical doctors (MD)
• Osteopathic doctors (DO)
• Nurse practitioners (NP)
• Physician assistants (PA)

Choosing a lesbian, gay, bisexual, or transgender provider may be beneficial, though there are many LGBT-sensitive heterosexual providers. Find an LGBT-friendly provider in our Locator section.

The four As of health care should frame the search for a provider:

• Ability
• Accessibility
• Affability
• Affordability

Self-Advocacy

Keeping good health records, including immunizations, dates of operations, allergies, medication history, etc. and finding whatever information is missing is important to anyone. Being honest with the provider about issues that are difficult or sensitive will help him or her to provide the best care. There are several issues that may be hard to discuss:

• Domestic violence
• History of sexually transmitted disease (STD)
• Sexual behavior

Preparing for a visit is perhaps the most beneficial thing a person can do. Being able to answer questions about the following issues will be helpful:

• Family health history
• Habits (e.g., smoking, drug use)
• Your health history
• Your sexual behavior and sexual history

It may be further helpful to prepare in the following ways:

• Take along a friend, relative, or partner.
• With an attorney's help, draft the "big 4" important documents related to health:
  • Durable power of attorney
  • Health care proxy
  • Last will and testament
  • Power of attorney
• Write down questions for the provider before the visit.

Preventive Care

Managed-care plans cover some or all of these routine visits.

• Flu shot
  • For anyone over age 50
  • For health care workers
  • For those with chronic health problems
• Pneumonia vaccine (every ten years)
  • For anyone over 65
  • For those with chronic health problems
• Routine dental care every 6 months
• Routine eye exam every 2 years
• Routine medical checkup:
  • Men under 45 — every 5 years, without chronic health problems
  • Men over 45 — every 1 to 2 years
  • Women age 18 and older, or younger if sexually active — annual Pap smear (to check for cancer cells)
  • Women, aged 50 — annual mammogram, earlier if family history of disease warrants or if recommended by physician

Preventive Care for Men Who Have Sex with Men (MSM)

• Anal health screening
  • Anal Pap (to check for cancer cells) advised every 2 years for men who are HIV-negative and who have receptive anal intercourse
  • Anal Pap every year for HIV-positive men who have receptive anal intercourse
• Counseling
  • Domestic violence
  • HIV testing, especially if at risk
  • Safer sex
  • Sexually transmitted disease (STD) screening
  • Use of tobacco, alcohol, recreational drugs
• Immunizations
  • Flu shot-see above for indications
  • Hepatitis A vaccine, if not immune (2 shots, 6 to 12 months apart)
  • Hepatitis B vaccine, if not immune (3 shots given over 6 months)
  • Pneumonia vaccine — see above for indications
  • Tetanus-diphtheria every 10 years
• Laboratory tests
  • Baseline cholesterol every 5 years and follow-up for elevated level
  • Tests based on family history of disease and other risk factors

Preventive Care for Women Who Have Sex with Women (WSW)

• Counseling
  • Domestic violence
  • HIV testing, especially if at risk
  • Safer sex
  • Sexually transmitted disease (STD) screening
  • Use of tobacco, alcohol, recreational drugs
• Immunizations
  • Flu shot — see above for indications
  • Hepatitis vaccine if at risk
  • Pneumonia vaccine-see above for indications
  • Tetanus-diphtheria every 10 years
• Laboratory tests
  • Baseline cholesterol
  • For anemia (low red blood cell count) associated with menstruation
  • Screening based on family history of disease and other risk factors
  • Thyroid disease screening in women over 50 years old
• Mammogram
  • Annual screening after age 50 is recommended
  • Screening before age 50 is controversial but becoming more common
  • Family history of breast cancer warrants early screening
• Pap smear
  • Annually for sexually active women and all women beginning at age 18
  • Three or more normal Pap smears may warrant testing every 2 years, up to age 65 when Pap smears may be discontinued
  • Annual ovarian examination regardless of Pap results
  • Periodically for women with history of human papillomavirus (HPV) of cervix

Preventive Care for Transgendered People
In people who have not had surgery, preventive care corresponds with guidelines for anatomical sex. The provider must know if patient is taking hormone supplements in order to provide optimal care.

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