Lee Tetreault:

Hello and welcome to Frequently Asked Questions from the session 'LGBTQ Mental Health: From Closets to Communities'. We are joined today with Dr. Petros Levounis. Doctor, what I wanna go over with this talk today... Or what are some of the major topics that a primary care clinician should be aware of when it comes to the mental health of LGBTQ patients? How can we go above and beyond just raising awareness? 

Dr. Levounis:  

Yes, well, thank you so much for having me here. One of the very unique processes in any LGBTQ person's life is coming out, coming out of the closet. And as much as this is a very healthy process and a very common one, it is often very stressful for the person coming out. During that time, the patient may be experiencing intense anxiety or depression and we need to address that, sometimes even pharmacologically with an antidepressant, to help a patient through that period.

This being said, we do need to do an evaluation and see if the patient does have other psychiatric disorders, perhaps along the lines of depression, anxiety, but also PTSD, ADHD, and make sure that we address those and not just saying, "Ha, they are all the consequence of the stressful times that the patient has coming out." Yes, we appreciate coming out. We'll help the patient in the process, but also, we'll look for independent psychiatric disorders that may be happening that they may need significant attention and treatment.

The second topic that is quite common and is very often discussed is the fluidity of a person's sexuality. Most of us, we're brought up thinking about being either a man or a woman or being straight or gay. In 2019, we do appreciate and celebrate much more of the fluidity of sexuality and of gender identity. There are a lot of people who identify as bisexual, as queer, they may have a more complex sexual orientation, they may be almost straight but not entirely or almost gay but not entirely. And similarly, for gender, there are several, especially younger people who identify as gender fluid. And at some point, they may feel more like a man, other times, more as a woman. That does not mean that a person may be transgender, although, of course, we do see and treat a number of transgender patients, as well.

In terms of practical considerations and advice here, I very often recommend empathy and curiosity. The world out there is becoming more complex in terms of sexuality and gender identity, and that's wonderful and we love that, but it can become a little overwhelming for a primary care clinician to keep all these new terms in mind and make sure that they use the correct pronouns and so on. If you come from a point of view of curiosity and warmth, everything else will follow and if you happen to make a mistake on a pronoun, so be it, it is far more important to engage with your patient, ask questions, have a curious attitude about their lives than being always exactly correct on these matters.

This being said, another area that we can certainly improve on is to use gender-neutral language when interviewing patients, not assume that they're all heterosexual. Don't ask about a young woman, do you have a boyfriend, ask about their partners, in general, both romantic and sexual. Change the intake forms in clinics, not just say male, female, but have male, female, and other, because people way often do not identify as just male or female.

And finally, one thing that certainly, keep in mind, is how much we as clinicians, physicians, nurse practitioners, physician assistants, act as role models for our patients. If you happen to be LGBTQ yourself and you're open about it, the patient, a young person who may be struggling with their sexuality will certainly look up to you and will have you as a role model, not certainly, but there's a very, very good likelihood that they will look up to you and treat you as a role model. Keep that in mind. Even if you're heterosexual yourself, and you're an ally of LGBTQ people, you can still act very much like a role model and show your patients how open you are and how accepting you are, and how much you celebrate differences in both sexual orientation and gender identity.

Lee Tetreault:

This is great information, Doctor. Thank you so much for your time today.

Dr. Levounis:  

Thank you, thank you for having me here.


Associated Content