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Becoming a PA

Understanding the misunderstood

Lopez, Gemma

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Journal of the American Academy of Physician Assistants 32(12):p 1-2, December 2019. | DOI: 10.1097/01.JAA.0000604896.96475.02
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I have had the opportunity to spend some time with a group of extremely interesting people. For about 4 weeks, I attended a support group at a local community center in the Phoenix area with some members of the lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) community. As part of one of my rotations during physician assistant training, I was given the option of attending this support group weekly for a month. The support group was run by a member of the LGBTQ community and a psychologist who specializes in the concerns of the LGBTQ population.

The members of the support group were very welcoming and excited that I was there to ask them about their continuing journey. They were insistent that I ask as many questions as I wanted. As a future healthcare provider and heterosexual woman, I was worried about how I would interact with people who live differently than most. I was terrified to offend someone by asking a question the wrong way or just asking personal questions in general. In these meetings, I was encouraged to freely ask any questions that came to mind, so I did. In doing so, I gained an enormous amount of respect for those members who chose to change their outward appearance in a drastic and controversial way.

Many of the members in this group are trans-female, meaning they were assigned male sex at birth but have made or were making the transition to female. Each of the members were in a different part of their transition: one had just come out to her family the week before; most were in the middle of hormone therapy and contemplating sex reassignment surgery; one had just completed sex reassignment surgery. Sexual preference did not seem to matter as much as finding a life partner who would love and treat each person with the respect he or she deserved.

Hearing their stories about feeling lost and unhappy and then being so bold as to change their appearance to mirror how they were feeling on the inside inspired me. The group members admitted that their transitions had not been easy. Many have dealt and continue to deal with worsening mental health issues. Depression and anxiety are almost three times more common among this community, according to the National Alliance on Mental Illness (NAMI).1 Some of the members revealed that there were times when they questioned their decisions: Are these hormones safe? Will I like the results? Will this really change the way I feel? How will people treat me now? But despite their doubts, they pushed forward to what they hoped would make them happy.

The LGBTQ community has support groups in almost every city, blogs with information on which healthcare providers are welcoming and open to the idea of transition and alternative lifestyles, success stories, hormone treatment information, and much more. I was moved by the amount of commitment, passion, and continuing support to every new and current member.

Talking with this group was easy and comfortable. We shared common life struggles such as dealing with family drama, passing that tough class in school, or when to restart that annoying diet. I quickly realized that being different one way does not make you different in every way. I had much more in common with this group of people than I imagined I would in the beginning.

Being able to spend time with this group has made me even more excited to practice medicine. To be able to assist in an event that will change someone's life for the better fills me with the greatest joy. As healthcare providers, we need to advocate for our patients' well-being, to assist them in their life choices, and to not let preconceived ideas of what is socially acceptable affect the care we provide. In addition, monitoring this community of people for suicide risk is just as important if not more than monitoring heterosexual and cisgender patients. A population-based survey found that 40% of transgender adults have attempted suicide in their lifetime.2 NAMI reports that suicide is a leading cause of death among LGBTQ people ages 10 to 24 years and that “LGBTQ youth are 4 times more likely and questioning youth are 3 times more likely to attempt suicide, experience suicidal thoughts or engage in self-harm than straight people.”1 We need to be vigilant in the care of our patients both physically and mentally.

Many helpful resources are available for healthcare providers serving the LGBTQ community, including the LGBTQ community website and creating an LGBTQ-friendly practice (www.ama-assn.org/delivering-care/creating-lgbtq-friendly-practice).3-5

This experience has given me a new perspective on the people of the LGBTQ community, and I am thankful for the raw and personal feelings that were shared.

Box 1


1. National Alliance on Mental Illness. LGBTQ. www.nami.org/Find-Support/LGBTQ. Accessed October 22, 2019.
2. The Trevor Project. Preventing suicide: facts about suicide. www.thetrevorproject.org/resources/preventing-suicide/facts-about-suicide. Accessed October 22, 2019.
3. Harper A, Finnerty P, Martinez M, et al. ALGBTIC LGBQQIA Competencies Taskforce. Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling Competencies for Counseling with Lesbian, Gay, Bisexual, Queer, Questioning, Intersex, and Ally Individuals. J LGBT Issues Couns. 2013;7:12–43.
4. American Psychological Association. Guidelines for psychological practice with lesbian, gay, and bisexual clients. Am Psychol. 2012;67(1):10–42.
    5. Shain B. American Academy of Pediatrics Committee on Adolescence. Suicide and suicide attempts in adolescents. Pediatrics. 2016;138(1):e20161420.
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