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These clinical vignettes are a part of a series highlighting various aspects of the health of LGBT and gender nonconforming populations and are designed to give learners the opportunity to analyze clinician-patient communication strategies. The series can be used in a variety of ways from independent learning to small group learning to large group learning. Each clip is generally three-five minutes long with discussion questions and additional resources listed at the end of each scenario. In an ideal setting, the learner would be able to practice the communication strategies identified after viewing the vignettes.

Learning Objectives

By the completion of this vignette/vignette series, the learner will be able to:

  • Identify three strategies to engage LGBT patients in the clinical environment.
  • Discuss methods to sensitively approach history taking and physical examination with LGBT patients.
  • Describe three verbal or non-verbal strategies to identify sexual orientation and gender identity in the clinical environment.
  • Describe three unique risk factors for health conditions related to sexual orientation and gender identity.
  • Outline three techniques for tailoring health promotion strategies to the needs of LGBT patients.

Clinical Vignettes

Assessing Bullying in Developmental History
In this vignette, a clinician assesses the impact childhood bullying has had on the emotional development of his adult patient.

Assessing Family and Developmental History
In this vignette a clinician and patient discuss the patient’s father coming out when she was a youth and the impact this had on her family.

Assessing Minority Stress and Risk Behaviors
In this vignette, a clinician assesses the impact instances of discrimination and stigma have had on a patient.

Assessing Sexually Transmitted Infection Symptoms
In this vignette, a patient comes to a clinic with the concern that she may have contracted a sexually transmitted infection. Prior to engaging in the physical exam, the clinician asks questions to gather information on the patient’s symptoms, sexual behaviors and counsels the patient on methods to safely engage in sexual practices.

Breast Cancer Screening and Prevention
In this vignette, a patient expresses her concern that her estrogen treatments, combined with her family history of breast cancer, may increase her chances of developing breast cancer.

Cervical Cancer Screenings

  • In the first vignette, a patient meets with a clinician to discuss her concerns prior to undergoing her first cervical cancer screening. The clinician explains the process and attempts to address the patient’s concerns.
  • In the second vignette, a transgender patient and his new clinician discuss the patient’s cervical cancer screening history. The clinician addresses the patient’s concerns regarding prior insensitive health care experiences before initiating the physical exam.

Family Counseling and Coming Out
In this vignette, a clinician engages in a conversation with his teenage patient, who has come out as bisexual, and her mother. The clinician responds to the mother’s concerns and connects her to resources for parents of LGBT children.

Gender and Sexual History

  • In the first vignette, a clinician takes the gender and sexual history of a new patient.
  • In the second vignette, a clinician takes a patient’s sexual history, inclusive of sexual trauma. While the history has a less than ideal start, the provider is successful in connecting the patient to counseling and trauma resources.

Ineffective History Taking
In this vignette, viewers are given an example of ineffective medical history. The clinician makes assumptions about his patient’s anatomy, leading him to ask questions that are not relevant to his patient’s medical history or health. The vignette concludes with the clinician apologizing to the patient and modeling behavior that would be useful for clinicians who find themselves in similar circumstances.

La historia social, género, y sexual
In this vignette, a clinician takes a social and sexual history of his patient.

Queer Family Building

  • In the first vignette, a clinician has a conversation with two couples who are planning to have and co-parent a biological child. The clinician answers questions posed by the couples and poses thought-provoking questions in order to gather essential information the family needs to begin their family-building process.
  • In the second vignette, a clinician counsels a female couple and their close male friend on their decision to start a family together and co-parent. In this initial conversation, the clinician responds to the patients’ preliminary medical and legal concerns.

Sexual Orientation and Practices History
In this vignette, a clinician takes a sexual history of a patient inclusive of the patient’s sexual orientation, sexual attraction, and sexual behaviors.

Sexual Practices History and Counseling Series
In this vignette series, a clinician takes a patient’s sexual history and counsels the patient on methods to safely enjoy sexual practices.

Substance Use History
In this vignette, a clinician takes a patient’s substance use history and counsels the patient on support services.

Welcoming Patients at the Front Desk
In this vignette a receptionist checks in a transgender patient whose name differs from what appears in the patient’s medical record. The receptionist locates the patient’s record and offers accommodations to maximize the patient’s comfort level.

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