Book Review
Gender Issues
Caring for Lesbian and Gay People: A Clinical Guide Allan D Peterkin, Cathy Risdon.
Toronto (ON): University of Toronto Press; 2003. 378 p. CAN$40.00.
Reviewer
rating*: Excellent
Review by: Peter Moore, MD, FRCPC
Toronto, Ontario
Here is a long overdue and very necessary book. Dr Peterkin and Dr Risdin present, with admirable care, a practical and evidence-based text covering topics as various as the doctor–patient relationship; lesbians’ and gay men’s physical and sexual health; the management of disease, mental health, and substance abuse; and the pressing needs of gay and lesbian adolescents.
Engaging vignettes introduce each chapter, and from the first, when we read of a gynecologist who hasn’t learned his patient is lesbian and reproaches her for not using some form of birth control or the ophthalmologist, consulted for glaucoma, who turns his inquiry to AIDS and sexually transmitted diseases (STDs) when he learns his male patient lives with a man, we catch a glimpse of why a clinical guide for lesbian and gay health is needed. Whether they know it or not, all health care providers deal with plenty of lesbians, bisexuals, and gay men.
However, homophobia is one of the main barriers to their care, and all of us are tarnished by it. Since heterosexuality is seen as the social norm, many health care workers assume that their patients fit this norm. Further, reluctance to raise sexual topics often keeps health care providers unaware of salient realities of their patients’ lives. In Chapter 2, the authors challenge readers to examine their attitudes and offer suggestions for learning appropriate details of their patients’ sex lives—starting, for example, with the question, “Is your partner a man or a woman?”
Lesbians have a lower profile than gay men and are frequently shortchanged by the medical system. Compared with heterosexual women, they have higher rates of smoking and drinking and a higher body mass index, but despite these risk factors, they are failed by providers who neglect to investigate for STDs, cancers, and coronary disease, as well as for reproductive health concerns. As in the following chapter, which deals with gay men’s physical and sexual health, we find extensive tables detailing sexual practices, risks, and risk reduction. Risks, indeed, are blithely taken by many gay men; in these pages, doctors will find critical information about appropriate screening and treatment for, among others, STDs, HIV, cardiovascular disease, and cancers, together with suggestions about preventive counselling, especially for sexual health.
For gays and lesbians, adolescence is filled with challenges. Family rejection, social hostility, and antigay violence are only a few of the hurts and insults they face, and consequent low self-esteem, even self-hate, can lead them not only to lasting self-fakery but also to drug abuse and suicide. The chapter on adolescent physical and mental health will prepare readers to offer compassionate help, ranging from sexual identity counselling to physical, sexual, and mental health interventions, always emphasizing the message that these young persons have the right to respect and that “you [the provider] are there to give facts and not to judge.”
Two chapters deal, respectively, with STDs and HIV. The first stresses the importance of careful screening, starting with inquiry into the number and sex(es) of partners, types of sexual activity, drug use, prostitution, and sex abuse (that boys and men also get raped is still not widely known). Syphilis, gonorrhea, human papilloma virus, herpes, chlamydia, genital warts, and the hepatitides are all relevant to this population, and the authors discuss meticulous screening and treatment for both women and men. Turning to HIV, we find a chapter replete with aids to competence for various providers—psychiatrists, family doctors, medical and surgical specialists, and all other workers in health care.
Workers in health care will also be confronted with the emotional problems of many lesbians and gay men. Expressed as substance abuse, low self-esteem, body image concerns, eating disorders, and depression and suicidality, these problems are more common among gays and lesbians, compared with heterosexuals, owing to the ordeal of lifelong stigmatization. Approaching mental health services, gays and lesbians are still dogged by stigma that is often shown as insensitivity, such as when a patient’s sexual orientation is the chief focus of the provider’s interest instead of the problem the patient presents with. Three chapters addressing, respectively, mental health, substance abuse, and body image offer suggestions for thoughtful counselling, including the crucial suggestion to use the heft of one’s professional status to endorse the normalcy of same-sex feelings and actions.
One of the most normal of these actions is to find a partner. Just as heterosexual couples face conflicts about family, money, sex, and power, so do gays and lesbians. However, no helpful role models guide them, no celebration strengthens their union, and no support is offered to help with their relationship problems. Providers are enjoined to examine their own notions of couplehood, and to be open to, and helpful with, the ways same-sex couples arrange to work together most harmoniously.
Among the last 3 chapters, “Special Populations” reminds providers that there is not a common gay identity, and that experiences will vary greatly for ethnoracial minorities, the aged, the disabled, the transgendered, and the transsexual. Another chapter, “Professional and Training Issues,” looks at ways that professional training might dispel myths (for example, about whether homosexuality is a sickness, a sin, or a choice). Finally, in “Legal Issues,” consideration is variously given to the legal rights of gay and lesbian youth, the legal agreements between same-sex couples, the legal needs of the incapacitated, the drawing of wills, and the problems of workplace discrimination.
This book is attractively laid out, accompanied by many comprehensive tables, and written with clarity and vigour. I cannot recommend it too warmly. For a vast population that has been burdened with second-class status, here is a gallant, and potentially lifesaving, advocacy.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
|
