| Medical Standards Brochure |
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Medical Standards Brochure
Medical Standards of Care is a presentation aimed at men who have sex with men (MSM) and women who have sex with women (WSW). Please consult with you health care professional to decide which of these standards apply most specifically to you.
Note: Provider throughout this document refers to physician (MD), physician assistant (PA) or nurse practitioner (NP).
Table of Contents
Coming out to your provider
Is your health care provider receptive to questions?
Does your provider take a complete medical history?
Do you trust your provider?
How does your provider handle issue of privacy and confidentiality?
Will your provider respect your particular wishes for privacy?
Does your provider explain their choices for treatment or non-treatment?
Does your provider have experience working with gay, bisexual, lesbian, and/or transgendered patients?
Do you feel your provider judges your sexual orientation or gender identity negatively?
There are benefits to being open about your sexuality with your provider. There may be benefits to locate an openly gay or lesbian provider as well, although it should be noted that just because a doctor is gay or lesbian, or that they may know about your sexuality, that this doesn't mean they may be competent health care providers! He or she can give you better advice and support you in your health choices.
You don't necessarily have to justify your sexual activities or gender issues, or spend a lot of time educating your provider about gender issues, or spend a lot of time educating your provider about "gay/lesbian issues" or sexual practices, such as our many subcultures--leather, bear, circuit boyz, transgender, drag, etc. Think about the pros and cons!
The assertive history and physical (H&P)
It's hard not to feel somewhat intimidated and fearful when talking with your health care provider, no matter how nice they are. Since the most important part of the clinical encounter between provider and patient is in the "talking" and history portion of the exam, it is essential that you not be afraid to speak up and ask questions.
It is essential to honestly inform you health care provider about your sexuality and sexual orientation/gender identity. If you end up in the hospital with a broken limb, or some other condition unrelated to sex, wouldn't it be nice if your provider would advocate on your behalf, making sure your lover or significant other had hospital visitation privileges?
Having one partner vs. multiple partners, or never have anal sex puts a different "spin" on what tests you may need for an adequate assessment (such as anal pap smears, e.g.). Inquiring about your vaccination status (such as Hepatitis A and B, e.g.) is also relevant.
The actual "laying on of hands" (and stethoscope, reflex hammer, etc.)--the physical exam--provides evidence to support or reject a particular diagnosis, but has lesser importance than the history. Ask questions during the exam!
How to pay for your health care
If you don't have insurance, consider acquiring it. If you do have health care insurance, find out about your benefits. Whether your insurance is public, private, or a HMO, you have the right to a careful explanation of the benefits due you. You should especially consider coverage of:
Routine exams and vaccinations
Emergency care
Hospitalizations
Mental health
Chiropractic/Acupuncture/Alternative medicine
Smoking cessation/Gym programs
Access to specialists (including HIV specialists)
Rehabilitation
Prescription meds (which can be very costly!)
Seeking a second opinion from another provider
If you can't afford insurance now but need medical care for an acute or chronic health care problem, many primary care providers will negotiate their fees, barter, or refer you to free health care in your community. Inquire!
The hassles of insurance and managed care
If you are having any problems with your health care provider or your insurance company, or if you believe that you are being treated unfairly or are being denied health care services, there are several things you can do. the proverbial squeaky wheel does get the grease!
You must first decide whether the problem is with the delivery of health care by the health care provider in the office or potential medical malpractice or liability, or whether your complaint involves your insurance coverage or claims denial.
Always start at the provider's office, speaking with the provider, clinic manager, or hospital customer service representative.
Consider the customer service representative at your managed care/insurance company.
Contact the Commissioner of Insurance for your state.
An attorney of choice to consider legal options should always remain your last choice for resolving a grievance.
An ounce of prevention--Hepatitis
Hepatitis is an infection & inflammation of the liver by one of several viruses, some bacteria, and exposure to alcohol and other drugs. Symptoms include a prolonged flu-like illness, loss of energy and appetite, severe fatigue, and sometime yellowing of the skin and eyes. Sometimes the urine will look really dark and tea-colored, and the stool may look very light and clay-colored
Some people never know they have hepatitis, since there may be no signs or symptoms.
Sometimes hepatitis will resolve without complications. Unfortunately, however, some people develop chronic and persistent infection that can cause severe disease, pain, and death. If you have other conditions, such as HIV, co-infection with hepatitis can also be life threatening.
Hepatitis A (HAV)--spread by anal-oral contact (rimming) or from contaminated food or water, and can be easily prevented with a series of 1-2 vaccinations.
Hepatitis B (HBV)--spread by sexual or blood contact. It can make you very sick or even kill you. You can protect yourself with a series of 3 vaccinations!
Hepatitis C (HCV)--spread by sexual or blood contact. It is an especially serious disease if you also have HIV.
It is recommended that all adults get the flu vaccine every autumn, especially for HIV infected and older folks, or if you work in health care, child care, or teaching!
Alternates to flu vaccination by injection (with a needle) are available (e.g., nasal spray). Ask your provider!
STD Testing--regular exams for gonorrhea, chlamydia, herpes, warts, syphilis, and HIV are essential for your protection, since many of these infections are totally without signs or symptoms, Of course if you never have persistent itching, irritation, rashes, pain, bleeding sores, bumps, discharge, discomfort of any kind, especially involving the genitals or anus, get checked out by a health care provider immediately. Vaginitis caused by herpes, yeast, trichomonis, as well as bacterial vaginosis can be spread by woman-to-women contact.
An ounce of prevention--Cervical Pap Smears
Pap smears (cervical cytology) are one of the best screening tools for cancers and precancers of the cervix. The test involves a simple scraping of cells from the cervix, inside the vagina. It is usually conducted routinely during a woman's annual pelvic exam, and for most women is usually not uncomfortable. Even if you have never had sex with a man, you should discuss with your provider the recommended frequency of having pelvic exams and this effective and inexpensive test.
An ounce of prevention--Anal Pap Smears
Anal paps (cytology) involve a simple scraping of cells from the anal canal with a dacron swab--not uncomfortable at all and much like a woman's cervical pap smear--and is a new diagnostic tool for anyone who ever had anal sex (even one long, long ago), or anyone who ever had anal warts. Abnormal cytology may signify early pre-cancerous changes that can be monitored and/or easily treated. the virus that causes genital warts can cause cervical cancer in women, and is thought to be strongly associated with anal cancers, especially in those who are HIV positive or others who are immune suppressed.
An ounce of prevention--Safer Sex
Safer sex seeks to avoid possible exposure to potential infections by minimizing exposure to invisible germs carried in cum (semen), pre-cum, vaginal and cervical secretions, blood (tiny invisible amounts as well as visible bleeding), secretions of the anorectum. Latex rubber condoms and the new polyurethane plastic condoms (the reality "female condom"), plastic wraps, and latex rubber dams (squares of rubber) help prevent unwanted infections, but nothing is 100% effective in preventing transmission of some infections.
Good fitness includes cardiovascular training which may benefit your overall physical and mental health. This means jogging, swimming, bike riding, jump rope, cross country skiing, and similar activities that sustain heavy breathing and heart rate. weight training (anaerobic) is better for your health if paired with the cardiovascular (aerobic) training.
Eating well balanced nutritionally wholesome food paired with adequate exercise helps to keep you fit. Additional vitamins, including vitamins C, E B6, folate, selenium, betacarotene, and possibly others, may be very beneficial to your well being.
After you turn 40, you may also ask your health care provider about taking aspirin daily for your cardiovascular heath, and calcium to help prevent osteoporosis.
Visit your regular health care provider every two years if you feel well and have no chronic health problems. If you're over 40, you may need more frequent visits. If you are HIV +, you should see your clinician and appropriate specialists on a regular schedule. If you have a family history of certain medical conditions (e.g. hypertension, diabetes, breast or ovarian cancer), you my need to see your provider more frequently. You need to request a physical examination and ask your provider about the following routine tests:
Blood pressure
Complete blood count (CBC)
Cholesterol (serum lipid profile)
Blood glucose for diabetes
vaccinations
HIV and STDs
Chest x-ray and TB skin test for TB exposure
stool guiaic for blood
digital rectal and prostate exam and PSA test
Breast exams and mammography for breast cancer
Colonoscopy or flexible sigmoidoscopy
None of the following techniques should replace your provider's exam. A mirror may help you see certain difficult to view areas!
Breast cancer--men get it too! Feeling for breast lumps over slippery skin in the shower is quick and easy!
Skin cancer--especially if you like sun tanning and if you have a ruddy (reddish) or fair complexion! Check your skin in the shower.
Digital self-rectal exam--gently inserting a well lubricated finger into your anus while in the shower can help you feel for lumps, prostate enlargements and/or detect soreness.
Testicular exam--other signs of testicular cancer include any enlargement or loss of size of the testicle; a feeling of heaviness in the scrotum; a dull ache in the lower abdomen or groin; blood in the urine; enlargement or tenderness of the breasts. If not cancer, these symptoms can be related to other medical conditions.
Annoying prostate enlargements and inflammations can affect men in their 20-40s and is usually first noticed by a change in he urinary stream, pain, heaviness, or discomfort in he scrotum, testicles, or perineal area (between the scrotum and anus).
Of special concern for guys older than 40 and African American men is prostate cancer. Prostate cancer is one of the most common cancers in the US. After reaching 40, ask about a prostate exam and prostate specific antigen (PSA) test.
Using tobacco of any kind (cigarettes, cigars, pipe, or chew) is responsible for the early deaths and much of the illnesses of many men and women. If you don't use tobacco, don't be tempted to start. If you do smoke or chew, get help to stop. New treatments are now available to make stopping easier.
Have you ever left a bar or party and notice a persistent ringing or humming in your ears? This is a sign of damage to the cells of the inner ear! Persistent exposure to loud sounds, music, and other vibrations that result in that persistent ringing may lead to permanent hearing loss.
Don't want to wear a hearing aid? Wear ear plugs when you go out to protect your ears from the loud volumes! Protect your hearing.
Alcohol and other drugs can have bad effects on your liver, brain, immune system and other organs.
Their use can affect your judgment and diminish you sense of pain, which can result in activities that you later regret (e.g. unprotected sex resulting in STDs or injury).
Please consider talking to your provider if:
your normal daily work, school, or usual routine is disturbed by drinking or drugs
the regular routine becomes disturbing or unmanageable
you think you use too much
your friend or family think you are using too much
You may also wish to consider a 12-step program. Designate a non-drinking friend, and never drink and drive!
Cocaine, crack, heroin, methamphetamines (crystal meth), ecstasy (X, MDMA), ketamine (K), gammabutyrolactone (GHB/GBH/GBL, G, liquid E, blue nitro), LSD, mushrooms, and other hallucinogens may all have unpredictable and potentially permanent or life threatening effects either when used alone or when inadvertently or purposefully mixed with small doses of alcohol, prescription anti-anxiety, anti-depressants, cardiac, and/or Viagra medications.
Poppers (volatile nitrites) and Viagra can also have terrible consequences, especially if you have other health conditions or use medications or illicit drugs.
Marijuana can be "cut" with more dangerous drugs.
Steroids also can affect your hear and liver. Many drugs can have unpredictable effects when you are dehydrated from hours of dancing and sweating. They can dull you perception of pain and cloud your judgment and thinking.
Please consult other resources to find out the detailed effects of these drugs on the body and mind. These drugs are illegal! Just imagine the embarrassment and consequences of being arrested...
If you are HIV -, monitor you HIV status with regular blood or oral tests and ALWAYS practice safer sex. If you are HIV +, monitor your viral load and t-cell counts and protect yourself from other infections including STDs by practicing safer sex.
Please also consider viewing the ACT UP Philadelphia web site for very specific guidelines depending on your viral load and CD4 cell count. www.critpath.org/docs/soc13.htm
Counseling and mental/emotional health professionals include therapists, social workers, psychologists and psychiatrists. They can give you a different perspective and sometimes greater clarity on some of the many emotional challenges and developmental issues among MSM and WSW.
coming out
anxiety
anger & resentment
stress managment
relationship issues
homophobia and other fears
depression
grief and guilt
spirituality
violence
sexuality, love, intimacy, promiscuity, and "bare-backing"
family dysfunctions, abuse and sexual coercion
having and raising children
addictive behaviors--alcohol, drugs, sex, the gym, eating, tobacco, gambling...
risk seeking
self esteem
aging and midlife crisis
interracial, intergenerational, inter religious relationships
Although these standards address mostly preventive health issues, please remember that it is easier to treat problems early in their course, than after waiting. Fear and denial are two of the many defense mechanisms that may be harmful if you ignore symptoms of disease! Many conditions, including cancer can be cured if detected early. If you have any unusual pain, bleeding , fevers, weight loss or other persistent signs or symptoms that do not respond to over-the-counter medications, you should see your provider immediately. and if necessary see a second opinion.
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