“This isn’t something I do.”
Patients do not want to hear this from doctors. Yet, sadly, many of my transgender patients have heard this from at least one medical provider.
Confused and exasperated, my patients come to me saying their requests for medical care, primary care or HIV-prevention medication are met with shrugs. It leaves them with a sense that it is the patient’s job to educate their physician, and that their health and well-being aren’t a priority.
Physicians’ offices, hospitals and community health clinics aren’t allowed to deny medical care to transgender patients, but patients may not know that—and doctors may not realize that their lack of knowledge is tantamount to a denial. Either way, it’s a cycle that can lead patients to delay or stop seeking care.
The discouragement may be unintentional but can come in the form of patients being “deadnamed” in medical offices—referred to by the names they were given at birth instead of their chosen names. Or patients may be unable to indicate their gender identity on medical intake forms because their gender identity isn’t an option. Many medical providers simply didn’t learn in medical school how to gather stigma-free medical histories for transgender patients that would reveal helpful information about their physical, sexual and emotional health.
These are more than administrative details. It can cause patients to feel undermined even before we get to see and treat them.
The Centers for Disease Control and Prevention (CDC) has taken note.
“Transgender patients’ concerns often arise at the front desk and in waiting areas because those are the first points of contact for most patients,” the CDC states. “For instance, front desk staff may not know how to handle a situation in which patients’ legal names and genders differ from their preferred names and gender identities and/or expressions. This puts patients in the uncomfortable position of having to explain their transgender status to the front desk within hearing distance of other patients.”
The Center for American Progress goes on to cite that 1 in 3 transgender people reported feeling the need to teach their doctors about transgender care. It puts an already at-risk population at greater risk.
The Trevor Project has found that 19 percent of lesbian, gay, bisexual, transgender and queer (LGBTQ) youth ages 13 to 18, and 8.3 percent of LGBTQ youth ages 19 to 24, reported attempting suicide in the last year. So transgender patients’ feelings of invisibility are real.
The Trevor Project also offers a hopeful view: LGBTQ youth with access to spaces that affirm their sexual orientation and gender identity report lower rates of attempting suicide than those who did not. My office is one of those affirming spaces, and my colleagues and I are trying to make medical practitioners better at creating them, from the bottom up.
We’ve created a medical school curriculum that has grown to include content on social determinants of health, what it’s like to live with HIV and how to take full, telling medical histories. These future doctors are becoming more comfortable with transgender patients and are learning the power of asking the right questions, listening carefully to the answers and using them as a starting point for honest discussion about all aspects of a patient’s well-being.
My colleagues at Northwell also are writing the textbooks on understanding the effect of hormones on musculosketal tissue and how to approach medical care for transgender patients. We’re bringing multiple medical specialties under one roof to provide patients with accessible and comprehensive care, including mental health care; employing a “health navigator” to direct patients to the right specialists and insurance; and expanding our LGBTQ services to more locations.
It can take transgender patients a long time to find medical providers willing to offer the medical care and expertise they need and, along the way, many of them are forced to educate their providers. That dynamic results in many transgender patients fighting for appropriate medical care and feeling they need to earn the right to be heard and treated. We need to ensure that there are more safe spaces for the LGBTQ community to obtain health care that meets their needs.
We have an opportunity to positively rewrite medical care for transgender patients, starting in medical school. We can, and should, create standards for properly trained providers who understand the unique needs of transgender patients who can deliver affirming, compassionate care.
This is an opinion and analysis article; the views expressed by the author or authors are not necessarily those of Scientific American.