An affirming conversation about cervical and breast cancer screenings.
An affirming conversation about cervical and breast cancer screenings.
This provider is in the middle of a new patient visit with a non-binary patient and demonstrates how sexuality and gender identity can be assessed and integrated into conversations about preventive cancer screenings.
Well, Sandra, everything looks pretty good physically. But I’ve noticed you seem a little quieter today. How are you really doing?
Oh, you know how it is, Dr. Johnson. Life’s been busy—between the farm and helping out with the grandkids. Nothing I can’t handle.
I hear you, but you seem more tired than usual. Are you getting enough rest?
Not really. I’ve been having trouble sleeping, to be honest. I just lay there, thinking about everything I need to get done. Sometimes, I don’t even know what’s bothering me, but it feels like there’s always something.
I understand. Life on the farm, raising a family, supporting everyone—it’s a lot on your shoulders. Have you had any moments where you just feel... weighed down, like you can’t shake the feeling?
Yeah. Lately, it’s been like that. I’m usually the one holding things together, but some days it’s... hard. I feel like I’m failing somehow, even though I know I shouldn’t feel that way.
Sandra, it’s not a failure to feel overwhelmed. You’ve been managing so much for so long, but no one can carry that kind of weight alone forever. It’s important to take care of yourself too, mentally as well as physically.
I don’t know, Dr. Johnson. I don’t have time to run around talking to a therapist, and honestly... I wouldn’t even know what to say.
I get that. But I’d like to ask you a couple of questions that are important for understanding how you’re feeling. Sometimes, when people feel the way you do—tired, overwhelmed, and like they’re carrying the world on their shoulders—they might also have thoughts about whether life is worth it or feel like they’re at the end of their rope. Have you had any thoughts like that, Sandra?
I won’t lie, Dr. Johnson, there have been some nights where I think... maybe it would just be easier if I didn’t have to do this anymore. Not that I would do anything, but the thought crossed my mind. It’s been hard.
I hear you. And I want you to know that those feelings are more common than people talk about, especially when life feels as heavy as it does for you right now. But it’s important to know that you don’t have to face those feelings alone. You matter to a lot of people—your family, your community—and we can find ways to help you get through this. Have you ever thought about how you might hurt yourself, or had the urge to?
No, Dr. Johnson, I couldn’t do that. I wouldn’t put my family through it. But, sometimes it just feels like... it’d be easier if I wasn’t around, you know?
I understand. Thank you for being open with me about that. It sounds like you’re not actively planning to hurt yourself, and I’m really glad to hear that. But I do want us to keep an eye on those thoughts because they’re serious. When people feel overwhelmed, they can shift quickly, and I don’t want you to feel like you’re handling this alone.
Yeah, I get it. I wouldn’t do anything, but it’s been on my mind more than it should be.
Things to consider.
This provider identified relevant cancer risk and screenings by asking respectful, matter-of-fact questions about the patient’s sex assigned at birth and gender-affirming care received. This not only supported the identification of care goals, but also helped establish an identity-safe environment for the patient.
This provider knew some, but not everything about the patient’s risk and relevant screening guidelines based on their gender identity, anatomy, and care history. It is okay to not know everything. The key is establishing a trusting relationship with your patient and being willing to educate yourself when you identify a knowledge gap.
What language in this script could you adopt for use with your clients? What language doesn’t fit, and what language would you use instead?
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