Yıl 2019, Cilt 18 , Sayı 56, Sayfalar 81 - 94 2019-12-30

Tıp Öğrencilerinin LGBTİ+ Hastalara Yaklaşımı
Medical Students’ Attitude Towards LGBTI+ Patients

Şirin Ertuğrul [1] , A. Hilal Batı [2]


Amaç

Sağlık hizmetlerinden sınırlı yararlanan ve toplumda azınlık oldukları düşünülen lezbiyen, gey, biseksüel, trans, interseks ve + bireylerin (LGBTİ+) belirli sağlık riskleri bulunmaktadır. Bu risklerin en önemlisi, özellikle trans bireylerin kimlikleri sebebiyle rutin sağlık hizmetinden kaçınmalarıdır. Sağlık çalışanlarının bu bireylere ilişkin algıları, sunulan sağlık hizmetinin niteliği ve hastalıkla ilgili karar süreçleri üzerinde belirleyici olmaktadır. Literatür LGBTİ+ bireylerin yetersiz sağlık hizmeti aldığını ve sağlık çalışanlarının ayrımcılığına maruz kaldıklarını göstermektedir. Bu araştırmanın amacı geleceğin sağlık çalışanlarının LGBTİ+ hastalara yaklaşımını belirlemek, tıp eğitimi programlarının bu anlamda kapsayıcılığını ve gizli müfredatı ortaya koymaktır.

Gereç ve Yöntem

Bu araştırma, Ege Üniversitesi Tıp Fakültesi (EÜTF) klinik dönem öğrencileriyle yürütülmüştür. Veriler, EÜTF Öğrenme Kaynakları Merkezi üzerinden çevrimiçi olarak gönüllülük temelinde uygulanan bir anketle toplanmış, SPSS istatistik programında analiz edilmiştir.

Bulgular

LGBTİ+ kavramını üniversitede duyan öğrenci oranı %33'tür. Öğrenme kaynakları film, sosyal medya, magazin, sosyal çevre olarak belirlenmiştir. Katılımcıların %52,4’ü bir hasta ile görüşmede inanç/duygu ya da düşüncelerinden etkilenebileceğini belirtmiştir. Hastanın dış görünüşüne göre tutum sergileyen öğrencilerin oranı %26,2’dır. Hastanın trans olabileceğini aklına getirip bütünsel değerlendiren öğrencilerin oranı %6,8’dir.

Sonuç

Sıklıkla bilimsel olmayan kaynaklardan öğrenilen LGBTİ+ kavramı eğitim programlarında yeterince yer almamaktadır. İnanç, duygu ve düşüncelerin hastaya yaklaşımı etkilemesi, dış görünüşe göre tutum belirlenebilmesi sağlık çalışanlarının ayrımcılığını açıklar niteliktedir. Heteroseksist yaklaşım, hastaların bütünsel değerlendirilmesi açısından risk oluşturmaktadır. Bu bağlamda LGBTİ+ bireyler ve sağlık risklerinin müfredatta yer alması önem taşımaktadır.

Background

There are certain health risks of lesbian, gay, bisexual, trans, intersex and + (LGBTI +) individuals having limited access to health services and considered to be minorities in the community. Most important is the fact that transgender individuals avoid routine health care because of their identities. The perceptions of health care workers about them are determinative on the quality of the health service offered and the decision-making processes related to the disease. The literature shows that LGBTI + individuals receive inadequate health care and are exposed to discrimination by health workers. The aim of this study is to determine the approach of future healthcare workers to LGBTI + patients and in this context the scope of the medical education programs and the hidden curriculum.

Methods

This study was carried out with the clinical students of Ege University Medical Faculty. Data were collected through an online questionnaire applied on a voluntary basis and analyzed in the SPSS statistical program.

Results

The rate of students encountered the concept of LGBTI + at the university is 33%. Learning resources are determined as film, social media, magazine, social environment. 52.4% of the participants stated that they could be affected by beliefs/feelings or thoughts in the interview with the patient. 26.2% of the students were reported that they may exhibit attitude according to the appearance of the patient. The ratio of the students who think that the patient may be trans and that have holistic approach is 6.8%.

5

Conclusions

The concept of LGBTI +, which is frequently learned from non-scientific sources, is not sufficiently involved in education programs. That beliefs, feelings, and thoughts affect the approach to the patient, the attitudes of the health workers can be determined according to the outward appearance may explain the discrimination of health workers. The heterosexist approach poses a risk for the holistic assessment of patients. In this context, it is important that LGBTI + individuals and health risks are included in the curriculum.

  • Whitehead, M. (2001). Eşitlik ve Sağlık: Kavram ve İlkeler. Türk Tabipleri Birliği Yayınları.
  • Bertan, M., Güler, Ç. (1995). Halk Sağlığı Temel Bilgiler. Güneş Kitabevi, Ankara.
  • Kaos GL. (n.d.). LGBT’ler için sıradışı bir sağlık uygulaması: Hasta mısın aşkım? | Kaos GL Haber Portalı. Retrieved February 10, 2019, from http://www.kaosgl.org/sayfa.php?id=17497
  • Biçmen, Z., Bekiroğulları, Z. (2014). Social Problems of LGBT People in Turkey. Procedia - Social and Behavioral Sciences, 113, 224–233. https://doi.org/10.1016/J.SBSPRO.2014.01.029
  • White, W., Brenman, S., Paradis, E et al. (2015). Lesbian, Gay, Bisexual, and Transgender Patient Care: Medical Students’ Preparedness and Comfort. Teaching and Learning in Medicine, 27(3), 254–263. https://doi.org/10.1080/10401334.2015.1044656
  • Yilmaz, V., Gocmen, I. (2014). Türkiye’de Lezbiyen, Gey, Biseksüel ve Trans (LGBT) Bireylerin Sosyal ve Ekonomik Sorunları Araştırmasının Özet Sonuçları.
  • Bilgiç Çelik, D., Hotun Şahin, N. (2014). Sexual Orientations : Approach of Health Care Professional. Literatür Sempozyum, 1, 15–23.
  • Bonvicini, K. A. (2017). LGBT healthcare disparities: What progress have we made? Patient Education and Counseling. https://doi.org/10.1016/j.pec.2017.06.003
  • Akdas, M., Tevhide, A. (2008). Eşcinsellere yönelik olumsuz tutumlar: meslek grupları ve ilişkili özellikler. Adli Bilimler Dergisi, 7(4), 23–30. Retrieved from http://openaccess.dogus.edu.tr:8080/handle/11376/771#sthash.s6vbA8y0.dpbs
  • WHO | Addressing the causes of disparities in health service access and utilization For lesbian, gay, bisexual and trans (LGBT) persons. (2014). WHO. Retrieved from http://www.who.int/hiv/pub/populations/lgbt_paper/en/
  • Hanneman, T. (2014). Sağlık Hizmetleri Eşitlik Endeksi-HEI 2014 Lezbiyen, Gey, Biseksüel ve Trans Hastalar ile Aileleri için Adil ve Kapsayıcı Bakımı Teşvik Etmek, 6–18.
  • Cannon, S. M., Shukla, V., & Vanderbilt, A. A. (2017). Addressing the healthcare needs of older Lesbian, Gay, Bisexual, and Transgender patients in medical school curricula: a call to action. Medical Education Online, 22(1), 1320933. https://doi.org/10.1080/10872981.2017.1320933
  • Fallin-Bennett, K. (2015). Implicit Bias Against Sexual Minorities in Medicine. Academic Medicine, 90(5), 549–552. https://doi.org/10.1097/ACM.0000000000000662
  • Fredriksen-Goldsen, K. I., Cook-Daniels, L., Kim, H et al.(2014). Physical and mental health of transgender older adults: an at-risk and underserved population. The Gerontologist, 54(3), 488–500. https://doi.org/10.1093/geront/gnt021
  • Bonvicini, K. A., & Perlin, M. J. (2003). The same but different: Clinician-patient communication with gay and lesbian patients. Patient Education and Counseling, 51(2), 115–122. https://doi.org/10.1016/S0738-3991(02)00189-1
  • Tabaac, A. R., Sutter, M. E., Wall, C. S. J., & Baker, K. E. (2018). Gender Identity Disparities in Cancer Screening Behaviors. American Journal of Preventive Medicine, 54(3), 385–393. https://doi.org/10.1016/J.AMEPRE.2017.11.009
  • Lambda Legal. (2010). When Health Care Isn’t Caring: Lamda Legal’s Survey on Discrimination Against LGBT People and People Living with HIV, 1–26. Retrieved from http://www.lambdalegal.org/health-care-report
  • T-DER (Trans Danışma Merkezi). (2014). YENİDEN DOĞDUM VERİ TOPLAMA RAPORU - I WAS REBORN DATA COLLECTİON REPORT. Retrieved March 2, 2018, from https://www.nadirkitap.com/yeniden-dogdum-veri-toplama-raporu-i-was-reborn-trans-birey-kitap9490668.html
  • Nama, N., MacPherson, P., Sampson, M., & McMillan, H. J. (2017). Medical students’ perception of lesbian, gay, bisexual, and transgender (LGBT) discrimination in their learning environment and their self-reported comfort level for caring for LGBT patients: A survey study. Medical Education Online, 22(1), 1–8. https://doi.org/10.1080/10872981.2017.1368850
  • Parameshwaran, V., Cockbain, B. C., Hillyard, M., & Price, J. R. (2017). Is the Lack of Specific Lesbian, Gay, Bisexual, Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students. Journal of Homosexuality, 64(3), 367–381. https://doi.org/10.1080/00918369.2016.1190218
  • Sekoni, A. O., Gale, N. K., Manga-Atangana, B., Bhadhuri, A., & Jolly, K. (2017). The effects of educational curricula and training on LGBT-specific health issues for healthcare students and professionals: a mixed-method systematic review. Journal of the International AIDS Society, 20(1), 21624. https://doi.org/10.7448/IAS.20.1.21624
  • Sequeira, G. M., Chakraborti, C., & Panunti, B. A. (2012). Integrating Lesbian, Gay, Bisexual, and Transgender (LGBT) Content Into Undergraduate Medical School Curricula: A Qualitative Study. The Ochsner Journal, 12(4), 379–82. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23267268
  • Braun, H. M., Ramirez, D., Zahner, G. J., Gillis-Buck, E. M., Sheriff, H., & Ferrone, M. (2017). The LGBTQI health forum: An innovative interprofessional initiative to support curriculum reform. Medical Education Online, 22(1), 1306419. https://doi.org/10.1080/10872981.2017.1306419
  • Burke, S. E., Dovidio, J. F., Przedworski, J. M et al. (2015). Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual First-Year Medical Students? A Report From the Medical Student CHANGE Study. Academic Medicine : Journal of the Association of American Medical Colleges, 90(5), 645–51. https://doi.org/10.1097/ACM.0000000000000661
  • People, G. N., Psychological, A., & Psychological, A. (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. American Psychologist, 67(1), 10–42. https://doi.org/10.1037/a0024659
  • Weber, A. (2009). Nefret söylemi el kitabı. Avrupa Konseyi Yayınları.
  • National Center for Transgender Equality. (2014). Transgender terminology, 20005(January), 2. Retrieved from http://transequality.org/Resources/TransTerminology_2014.pdf
  • Hayes, V., Blondeau, W., & Bing-You, R. G. (2015). Assessment of Medical Student and Resident/Fellow Knowledge, Comfort, and Training With Sexual History Taking in LGBTQ Patients. Family Medicine, 47(5), 383–7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25905882
  • Noonan, E. J., Sawning, S., Combs, R., Weingartner, L. A., Martin, L. J., Jones, V. F., & Holthouser, A. (2018). Engaging the Transgender Community to Improve Medical Education and Prioritize Healthcare Initiatives. Teaching and Learning in Medicine, 30(2), 119–132. https://doi.org/10.1080/10401334.2017.1365718
  • Kitts, R. L. (2010). Barriers to optimal care between physicians and lesbian, gay, bisexual, transgender, and questioning adolescent patients. Journal of Homosexuality, 57(6), 730–47. https://doi.org/10.1080/00918369.2010.485872
  • Bolderston, A., & Ralph, S. (2016). Improving the health care experiences of lesbian, gay, bisexual and transgender patients. Radiography, 22(3), e207–e211. https://doi.org/10.1016/J.RADI.2016.04.011
  • Sanchez, A. A., Southgate, E., Rogers, G., & Duvivier, R. J. (2017). Inclusion of Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Health in Australian and New Zealand Medical Education. LGBT Health, 4(4), 295–303. https://doi.org/10.1089/lgbt.2016.0209
  • Boehmer, U. (2018). LGBT Populations’ Barriers to Cancer Care. Seminars in Oncology Nursing, 34(1), 21–29. https://doi.org/10.1016/J.SONCN.2017.11.002
  • Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., … Lunn, M. R. (2011). Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. The Journal of the American Medical Association, 306(9), 971–7. https://doi.org/10.1001/jama.2011.1255
  • Chuang, A. W., Nuthalapaty, F. S., Casey, P. M., Kaczmarczyk, J. M., Cullimore, A. J., Dalrymple, J. L., … Peskin, E. G. (2010). To the point: reviews in medical education—taking control of the hidden curriculum. American Journal of Obstetrics and Gynecology, 203(4), 316.e1-316.e6. https://doi.org/10.1016/J.AJOG.2010.04.035
  • Gofton, W., & Regehr, G. (2006). What We Don???t Know We Are Teaching. Clinical Orthopaedics and Related Research, PAP(449), 20–27. https://doi.org/10.1097/01.blo.0000224024.96034.b2
  • Kidd, J. D., Bockting, W., Cabaniss, D. L., & Blumenshine, P. (2016). Special-“T” Training: Extended Follow-up Results from a Residency-Wide Professionalism Workshop on Transgender Health. Academic Psychiatry, 40(5), 802–806. https://doi.org/10.1007/s40596-016-0570-7
  • Cruz, T. M. (2014). Assessing access to care for transgender and gender nonconforming people: A consideration of diversity in combating discrimination. Social Science & Medicine, 110, 65–73. https://doi.org/10.1016/J.SOCSCIMED.2014.03.032
  • Cheng, L. F., & Yang, H. C. (2015). Learning about gender on campus: An analysis of the hidden curriculum for medical students. Medical Education, 49(3), 321–331. https://doi.org/10.1111/medu.12628
  • O’Brien, J. (2015). Heterosexism and Homophobia. In International Encyclopedia of the Social & Behavioral Sciences (pp. 790–795). Elsevier. https://doi.org/10.1016/B978-0-08-097086-8.10204-1
Birincil Dil tr
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Orjinal Araştırma
Yazarlar

Orcid: 0000-0001-5973-1973
Yazar: Şirin Ertuğrul (Sorumlu Yazar)
Kurum: MUĞLA SITKI KOÇMAN ÜNİVERSİTESİ EĞİTİM VE ARAŞTIRMA HASTANESİ
Ülke: Turkey


Yazar: A. Hilal Batı (Sorumlu Yazar)
Kurum: EGE TIP FAKÜLTESİ
Ülke: Turkey


Tarihler

Yayımlanma Tarihi : 30 Aralık 2019

Vancouver Ertuğrul Ş , Batı A . Tıp Öğrencilerinin LGBTİ+ Hastalara Yaklaşımı. Tıp Eğitimi Dünyası. 2019; 94-81.