Major gaps continue to plague transgender medicine, including a lack of clinical and cultural training and education among health care professionals. Transgender health is missing from most medical school and residency curricula and the 2015 U.S. Transgender Survey found that 33 percent of transgender patients reported having at least one negative health care experience that year, including refusal of treatment and harassment.
This omission of transgender-related health education is harmful. It directly contributes to the health inequalities experienced by this group who are disproportionately affected by a number of health and social disparities. Transgender individuals have a higher prevalence of HIV/AIDS, mental health issues, victimization and suicide. While many have access to insurance, certain procedures can go uncovered or it can be difficult to meet all criteria when legal names change, and medical records do not match.
As health care professionals and institutions, we have a tremendous responsibility to fill the knowledge gap with our own training and education. To effectively do this, we must give transgender patients a voice at the table as an equal partner in co-designing their care and uphold an environment that is safe and supportive for patients as well as practitioners who are learning new care methods and techniques.
Here, we share learnings from our own journey to provide quality, affirmative transgender care.
The most important thing we can do as medical professionals is to take a step back and listen to patients’ needs. Patient-centered programs, such as our Patient-Family Partners Program (PFP), help facilitate this listening process. By listening to transgender individuals and families talk about their patient experiences, health systems can astutely uncover reasons why patients may be distrustful of health care, unique barriers to access, and other shortcomings. These insights can then be used to improve care, i.e. develop staff trainings, new programming, and other health care offerings that patients help co-design in real time.
For example, when a nurse mistakenly referred to a transgender woman using male pronouns, the patient was able to leverage our PFP program to advocate for better staff education around communication best practices with the transgender community.
A culturally incompetent health care team means even simple requests from a transgender patient might be disregarded and turned into a bigger problem: a negative and potentially harmful patient experience.
Educating care teams to provide an inclusive environment for the transgender community is an active, collaborative, and ongoing process. One effective way to manage this is through an internal working group to guide efforts and provide a pathway for solutions to be implemented throughout all departments. This also provides a safe space for team members to ask any questions they may have without being judged or scrutinized.
When our clinical and administrative staff have questions about transgender patient care, culture or approach, they are encouraged and empowered to seek guidance from our Transgender Guiding Team. With providers and staff helping other providers and staff, everyone is learning lessons to take back to exam rooms and clinic spaces. Members of our Transgender Guiding Team recently met with our call center team to discuss their approach during intake calls. The additional coaching helped make call center team members aware of the assumptions made about gender through the tone and pitch of voice and how to avoid that in the future.
As with any patient population, engaging with the community by participating in events and other gatherings is critical to gain visibility and develop trust. With the transgender community, it is foundational to make this effort, to counter historical distrust of health care. Showing up can also help to create unexpected partnerships that work collaboratively to improve social and health inequalities experienced by transgender individuals.
There are many ways to engage from community discussions and meetings that focus on resolving disparities among the LGBTQ community, to everyday interactions. It’s less important to show up with the “right answers” than it is to show up and be part of the conversation. Everyone’s experience is so different. Every story is an opportunity.
There is still much work to be done for all of us in health care to deliver positive, safe and high-quality care for our transgender patients. Every step we take to move the needle and keep improving the care we provide to this population helps break down barriers. This all starts with listening to patients, dedicating ourselves as providers to ongoing education and letting the transgender community know we want to do our best to respect and do right by all of our transgender patients, starting from the first intake call to recovery from a procedure to supportive care as transgender patients continue to live their lives in the way that affirms their identity.
Donna Smith, MD is Executive Medical Director of Clinics and Maria Rearick is Director of Ambulatory Services at Virginia Mason Medical Center in Seattle.