Master Lecture Exploring Ethical Challenges in Working with Diverse Couples in Primary Care Tina Schermer Sellers, PhD, LMFT Associate Professor, School Psychology, Family & Community Director, Medical Family Therapy Seattle Pacific University Please insert the assigned session number (track letter, period number), i.e., A2a Please insert the TITLE of your presentation. List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation. You may acknowledge other authors who are not attending the Conference in subsequent slides. CFHA 18th Annual Conference October 13-15, 2016  Charlotte, NC U.S.A. Collaborative Family Healthcare Association 12th Annual Conference

Faculty Disclosure I have not had any relevant financial relationships during the past 12 months. CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message. The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community. Collaborative Family Healthcare Association 12th Annual Conference

Learning Objectives At the conclusion of this session, the participant will be able to: Identify how your spiritual beliefs impact your work as a provider Identify two or more ethical dilemmas in primary care and how to manage those dilemmas Describe a two-fold strategy to increase support for ethical challenges in the workplace Include the behavioral learning objectives for this session Collaborative Family Healthcare Association 12th Annual Conference

He is the best physician who is the most ingenious inspirer of hope He is the best physician who is the most ingenious inspirer of hope. Samuel Taylor Coleridge Collaborative Family Healthcare Association 12th Annual Conference

Couple #1 Patient: 32 yr old African American female 34 yr old White Male – partner Routine physical and to discuss family planning Upon examination you notice severe bruising across her chest, upper arms, thighs and ankles. Collaborative Family Healthcare Association 12th Annual Conference

Couple #2 46 male, Carl, new patient, comes in to establish care. He brings his partner. He says it has been a long time since he has seen a doctor and he seems very anxious. Steve, his partner, chimes in saying Carl has been complaining of pelvic pain and he was becoming concerned. Steve says Carl has not had a pelvic exam since he began taking T 20 years ago. Most FtM patients do not undergo vaginectomy (colpectomy). For patients who take masculinizing hormones, despite considerable conversion of testosterone to estrogens, atrophic changes of the vaginal lining can be observed regularly and may lead to pruritus or burning. Examination can be both physically and emotionally painful, but lack of treatment can seriously aggravate the situation. Gynecologists treating the genital complaints of FtM patients should be aware of the sensitivity that patients with a male gender identity and masculine gender expression might have around having genitals typically associated with the female sex. WPATH Standards of Care – Version 7 Collaborative Family Healthcare Association 12th Annual Conference

Couple #3 Isaiah is a 29 year old second year Medical Student. They moved to your city 2 months ago, away from family, for Isaiah’s second year. Mary is his wife. They have come in for the 10 day check up following the birth of their second daughter. Their oldest child is a year. Doing a quick assessment of the system, you notice Mary seems very depressed. As you ask how things are going, Mary sarcastically says, “If it wasn’t bad enough, Isaiah has to drop on me that he’s gay.” Isaiah and Mary are LDS and plan to live in a mixed orientation marriage. Collaborative Family Healthcare Association 12th Annual Conference

Couple #4 Lucy, a 37 year old mom of 3, brings in her oldest daughter, Tara, 10 for her school physical. They have just moved into the area and plan to establish care with you for the whole family. Lucy says, Josh is 8 and Janie is 6. She seems hesitant to talk about her partner, but eventually says, “Pauline, will establish care with you too. I go by Mom and she goes by Mopa. She just transitioned 3 years ago. We are all still adjusting.” While Lucy is struggling, you notice Tara seems un-phased by the conversation. Collaborative Family Healthcare Association 12th Annual Conference

Couple #5 Constance is a 52 year old high powered professional and mother of 2 teenage daughters. Constance has a meningioma that has metastasized to her kidneys. This is a rare presentation, but after a failed trial of nuclear medicine, Constance is needing to be hospitalized for dialysis every few weeks or so. After a couple of months of this, it is clear Constance’s body is not doing well. Constance however is refusing to discuss the failure of her kidneys and is forbidding her husband to discuss her condition with her daughters or their support system. Collaborative Family Healthcare Association 12th Annual Conference

Strategies of Support

How Do our Beliefs Effect Our Care? Do They?

Questions to consider: List 3 major beliefs that you deem essential to the practice of your spirituality/faith/religion. 1. 2. 3. For each of the beliefs you listed, provide an example (real or imagined) for how the implications of that specific belief benefited (or could benefit) your work with patients and/or your work with colleagues.

Q & A Tina Schermer Sellers, PhD, LMFT Associate Professor, School Psychology, Family & Community Director, Medical Family Therapy Seattle Pacific University www.TinaSchermerSellers.com tsellers@spu.edu @TinaSSellers

Bibliography / Reference / Resources BDSM – The Ties that Bind by Guy Baldwin; www.bdsm-101.com Transgender – Where’s My Book – A Guide for Transgender and Gender Non-Conforming Youth, Their Parents & Everyone Else by Linda Gromko, MD, 2016 Mixed Orientation Marriage - http://www.joshweed.com/p/faq- new.html More Than Two – A Practical Guide to Ethical Polyamory by Franklin Veaux & Eve Rickert, 2016 Standards of Care for Transgender and Gender-Nonconforming People. WPATH – Version 7 NEW! Continuing education approval now requires that presenters include five references within the last 5 years. Please list at least FIVE (5) references for this presentation that are no older than 5 years. Without these references, your session may NOT be approved for CE credit. Collaborative Family Healthcare Association 12th Annual Conference

How do your spiritual beliefs impact your work as a provider? Learning Assessment How do your spiritual beliefs impact your work as a provider? What are two ethical dilemmas in primary care and how would you manage those dilemmas? Describe a two-fold strategy to increase support for ethical challenges in the workplace? Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation. This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements. Collaborative Family Healthcare Association 12th Annual Conference

Thank you! Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you! This should be the last slide of your presentation Collaborative Family Healthcare Association 12th Annual Conference