Yesterday in our resident conference, we had an excellent diversity talk by Dr. Gabriel Schifman entitled: Diversity in the ED, Lesbian, Gay, Bisexual, and Transgender Youth. Dr. Schiffman is a pediatric emergency physician at Nationwide Children’s Hospital. I wanted to summarize some important points from this talk.
Dr. Schifman presented some surprising statistics:
1. Adolescent healthcare hasn’t shown signs of improvement since the 1950’s.
2. In 2007, 2.4-7.1% of males and 3.5-10.5% of females report same-sex sexual contact.
3. 30% of homosexuals under age 21 admit to excessive alcohol, 25% report illicit drug use.
4. 19-25% of adolescents experience physical abuse from family members based on sexual orientation
5. One-half of homeless youth are homosexual.
6. 90% of homosexual youth report being harassed or bullied at school, 60% felt unsafe at school.
7. While suicide is the 2nd leading cause of death in 15-24yo’s, homosexual youth are 8.4 times more likely to commit suicide. One-half of gay youth attempt suicide at least once.
The reason that the above statistics are so important became even more pronounced when he told us that adolescents have no real medical home. Most won’t go to their pediatrician and haven’t established at another primary care physician. This means that the emergency department is their location of choice for health care. Being mindful of the above stats will help when evaluating adolescents in the ED.
Dr. Schifman then reviewed the Developmental Phases of Gay Teen Identity:
1. Sensitization- prepubertal
2. Identity confusion- pubertal
3. Identity asssumption
5. Coming out
He pointed out that while not all will go through the stages in order, all will go through the stages at some point.
One interesting point that generated some discussion was the CDC recommendation that yearly HIV testing be done for persons in monogamous relationships and every 3-6 months for those with multiple partners. Currently Ohio law states that in order to perform HIV testing, you must have counseling services in place at the facility doing the testing. At Nationwide Children’s Hospital they have these services in place and actually perform HIV testing on a regular basis for those at risk.
We closed the discussion by reviewing The Riddle Scale which was devised for physicians so they can assess their attitude towards gay and lesbian people. The thought is that if you realize where you actually are on this scale, you’ll have a better self-understanding and hopefully work towards letting your innate prejudices affect your encounters with your patients. Here is the scale:
1. Repulsion 5. Support
2. Pity 6. Admiration
3. Tolerance 7. Appreciation
4. Acceptance 8. Nurturance
The scale is divided into negative attitudes (1-4) and positive attitudes (5-8.) As one can see, although tolerance and acceptance is traditionally viewed as positive attitudes, this scale labels them as negative attitudes. This is because, as Riddle points out, tolerance implies homosexuality is just a “phase,” homosexuals are less mature ,and should not be placed in positions of leadership. Acceptance implies that there actually is something to accept. Those with this attitude say things like “what you do is your business,” “as long as you don’t flaunt it,” and “you’re still just a person to me.”
Here’s a link to more information about The Riddle Scale