When one of our heart transplant patients began rescheduling her appointments, an
atypical practice for her, it caused concern for the transplant coordinator who had
followed the patient before and after the heart transplantation. Fortunately, because
of the well-established relationship between the two, the experienced coordinator
was able to convince the patient to return for her routine follow-up appointment.
Upon entry into the examination room, the patient's anxiety was undeniable; she avoided
eye contact, her voice was tremulous, and her hands were restless. She began crying
when we inquired about any potential barriers precluding her from attending her follow-up
appointments. She then shared that she had been going through a “big change” in her
life. “After my heart transplant, I have been given a new chance to live the life
that I want and to be happy and live my true self,” she said. She also mentioned that
she had begun estrogen therapy as part of her transitioning process. She disclosed
that she had been avoiding her follow-up appointments in fear of judgment, or even
worse, exclusion from the clinic. It was a very emotional day for not only the patient,
but for all members of the care team in that room as well, who witnessed firsthand
the potential downstream effects of bias and health inequities on patients. To her
surprise, we shared both our support and joy of her decision to pursue her journey
to transition. Our patient's vulnerability and resilience was inspiring and elucidates
many of the challenges the lesbian, gay, bisexual, transgender, and queer (LGBTQ)
community faces in accessing health care.
Key Words
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References
- American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Hypertension; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council. Assessing and addressing cardiovascular health in LGBTQ adults: a scientific statement from the American Heart Association.Circulation. 2020; 142: e321-e332
- The health equity promotion model: reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities.Am J Orthopsychiatry. 2014; 84: 653-663
- A qualitative study examining young adults' experiences of disclosure and nondisclosure of LGBTQ identity to health care providers.J Homosex. 2017; 64: 1390-1410
- Research funded by the National Institutes of Health on the health of lesbian, gay, bisexual, and transgender populations.Am J Public Health. 2014; 104: e105-e112
- Still in the closet: the invisible minority in medical education.BMC Med Educ. 2014; 14: 171
- The availability of LGBT-specific mental health and substance abuse treatment in the United States.Health Serv Res. 2020; 55: 932-943
- Association between sexual orientation, mistreatment, and burnout among US medical students.JAMA Netw Open. 2021; 4e2036136
- Gay and lesbian physicians in training: a qualitative study.CMAJ. 2000; 162: 331-334
- Gender-affirming hormone therapy, vascular health and cardiovascular disease in transgender adults.Hypertension. 2019; 74: 1266-1274
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Article info
Publication history
Published online: February 01, 2022
Accepted:
December 13,
2021
Received in revised form:
December 1,
2021
Received:
November 20,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
